Page 5 - 2016 Enrollment
P. 5
2016 Medical Rates by Pay Period Tobacco Surcharge
Non Tobacco Tobacco To promote healthy lifestyle choices,
If You are Paid Weekly Ronnoco has a tobacco surcharge of
Employee (EO) $31.93 $38.85 $30 per month. If you enroll in Medical
Employee + spouse (ES) $90.46 $97.38 coverage, you must complete and
Employee + child(ren) (EC) $78.04 $84.97 return a Tobacco Attestation Form. If a
Family (FA) $131.55 $138.48 Tobacco Attestation Form is not received
If You are Paid Semi-Monthly it will be assumed you are a tobacco
Employee (EO) $69.18 $84.18 user and the tobacco surcharge will
Employee + spouse (ES) $196.00 $211.00 apply.
Employee + child(ren) (EC) $169.10 $184.10
Family (FA) $285.03 $300.03 Tobacco users may complete a tobacco
Note: Medical premium payroll deductions are taken on a pre-tax basis. cessation program to be exempt from
the tobacco surcharge. If you would like
Midland States Bank—Health Savings Account to enroll in the free tobacco cessation
(HSA) program, contact Human Resources for
more information.
Ronnoco has a banking relationship with Midland States Bank for you
to open a personal healthcare bank account (HSA) with no fees. You It is your responsibility to notify Human
Resources if you are no longer a
own and administer your account and you can use it to pay for out- tobacco user.
of-pocket medical expenses with pre-tax dollars. Ronnoco will deposit
funds to your HSA on a quarterly basis which you can use to pay for
qualiied medical expenses.
Want to pay for your eligible
Ronnoco’s Contribution to your HSA Quarterly Total Annual
Employee (EO) $62.50 $250.00 medical expenses tax-free?
Employee + spouse (ES) $78.12 $312.50 Refer to IRS Publication 502 for a
Employee + child(ren) (EC) $78.12 $312.50 complete list of eligible HSA expenses at
Family (FA) $93.75 $375.00
www.irs.gov/pub/irs-pdf/p502.pdf.
Note: Ronnoco cannot make contributions until your HSA has been opened with Midland
States Bank.
You can also set aside your own dollars by making contributions on a There is no “use it or lose it” rule. All
pre-tax basis through payroll deduction. For 2016 you can contribute unused money will remain in your HSA
up to the IRS maximum contribution amounts of $3,350 for single for future use. If you leave Ronnoco,
coverage and up to $6,750 for family coverage for 2016. If age 55 or you take your HSA funds with you.
older you can make an additional $1,000 catch up contribution. You
will need to indicate if you want to make contributions to your HSA in
2016 when you complete your annual enrollment.
Contact Human Resources to open your Midland States Bank HSA.
5
Non Tobacco Tobacco To promote healthy lifestyle choices,
If You are Paid Weekly Ronnoco has a tobacco surcharge of
Employee (EO) $31.93 $38.85 $30 per month. If you enroll in Medical
Employee + spouse (ES) $90.46 $97.38 coverage, you must complete and
Employee + child(ren) (EC) $78.04 $84.97 return a Tobacco Attestation Form. If a
Family (FA) $131.55 $138.48 Tobacco Attestation Form is not received
If You are Paid Semi-Monthly it will be assumed you are a tobacco
Employee (EO) $69.18 $84.18 user and the tobacco surcharge will
Employee + spouse (ES) $196.00 $211.00 apply.
Employee + child(ren) (EC) $169.10 $184.10
Family (FA) $285.03 $300.03 Tobacco users may complete a tobacco
Note: Medical premium payroll deductions are taken on a pre-tax basis. cessation program to be exempt from
the tobacco surcharge. If you would like
Midland States Bank—Health Savings Account to enroll in the free tobacco cessation
(HSA) program, contact Human Resources for
more information.
Ronnoco has a banking relationship with Midland States Bank for you
to open a personal healthcare bank account (HSA) with no fees. You It is your responsibility to notify Human
Resources if you are no longer a
own and administer your account and you can use it to pay for out- tobacco user.
of-pocket medical expenses with pre-tax dollars. Ronnoco will deposit
funds to your HSA on a quarterly basis which you can use to pay for
qualiied medical expenses.
Want to pay for your eligible
Ronnoco’s Contribution to your HSA Quarterly Total Annual
Employee (EO) $62.50 $250.00 medical expenses tax-free?
Employee + spouse (ES) $78.12 $312.50 Refer to IRS Publication 502 for a
Employee + child(ren) (EC) $78.12 $312.50 complete list of eligible HSA expenses at
Family (FA) $93.75 $375.00
www.irs.gov/pub/irs-pdf/p502.pdf.
Note: Ronnoco cannot make contributions until your HSA has been opened with Midland
States Bank.
You can also set aside your own dollars by making contributions on a There is no “use it or lose it” rule. All
pre-tax basis through payroll deduction. For 2016 you can contribute unused money will remain in your HSA
up to the IRS maximum contribution amounts of $3,350 for single for future use. If you leave Ronnoco,
coverage and up to $6,750 for family coverage for 2016. If age 55 or you take your HSA funds with you.
older you can make an additional $1,000 catch up contribution. You
will need to indicate if you want to make contributions to your HSA in
2016 when you complete your annual enrollment.
Contact Human Resources to open your Midland States Bank HSA.
5
