Page 7 - The Polyclinic New Hire Guide

Pro-Rated Contribution Schedule (Based on Month Hired)
Full-Time
Employee Only Employee + Dependent(s)
2015 contribution max $1,500 2015 contribution max $3,000
Polyclinic contribution Polyclinic contribution
to your HSA $125 per month to your HSA $250 per month
Month of Hire Polyclinic Contributes Month of Hire Polyclinic Contributes
August $625 August $1,250
September $500 September $1,000
October $375 October $750
November $250 November $500
December $125 December $250

Part-Time
Employee Only Employee + Dependent(s)
2015 contribution max $1,020 2015 contribution max $2,040
Polyclinic contribution Polyclinic contribution
to your HSA $85 per month to your HSA $170 per month
Month of Hire Polyclinic Contributes Month of Hire Polyclinic Contributes
August $425 August $850
September $340 September $680
October $255 October $510
November $170 November $340
December $85 December $170

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