Page 13 - 2018 Roquette Benefit Guide
P. 13
Roquette America Inc.
How Much to Contribute
How Much Do You Spend Out-of-Pocket During an Average Year
on… Amount
Routine Doctor Visits?
Hospital Services?
X-Rays, Lab Exams, Tests?
Eye Doctor Visits?
Glasses/Contacts and Cleaning Supplies?
Prescriptions?
Dental Expenses?
Total: Regular Expenses*
Divided by Number of Paychecks You Receive Each Year ÷ 52
÷ 24
Equals Amount to Deposit Into Your Eligible Account Each Pay =
Period
Don’t Forget—Which Medical Option You Choose Will
Affect How Much You Pay Out-of-Pocket
How Much Do You Spend Out-of-Pocket During an Average Year
On… Amount
Last Year’s Tax Credit-Eligible Daycare Expenses?
Day Care/Preschool Programs?
After-School Programs?
Babysitters?
Adult Day Care?
Plus Any Fee Increases?
Total: Regular Expenses*
Divided By Number of Paychecks You Receive Each Year ÷ 52
÷ 24
Equals Amount to Deposit Into Your Dependent Care Account =
Each Pay Period
* Each account has speciic maximum limits you are eligible to contribute each year pre-tax.
Refer to more information about each account in this guide to be sure you limit your election
to those maximums if applicable.
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How Much to Contribute
How Much Do You Spend Out-of-Pocket During an Average Year
on… Amount
Routine Doctor Visits?
Hospital Services?
X-Rays, Lab Exams, Tests?
Eye Doctor Visits?
Glasses/Contacts and Cleaning Supplies?
Prescriptions?
Dental Expenses?
Total: Regular Expenses*
Divided by Number of Paychecks You Receive Each Year ÷ 52
÷ 24
Equals Amount to Deposit Into Your Eligible Account Each Pay =
Period
Don’t Forget—Which Medical Option You Choose Will
Affect How Much You Pay Out-of-Pocket
How Much Do You Spend Out-of-Pocket During an Average Year
On… Amount
Last Year’s Tax Credit-Eligible Daycare Expenses?
Day Care/Preschool Programs?
After-School Programs?
Babysitters?
Adult Day Care?
Plus Any Fee Increases?
Total: Regular Expenses*
Divided By Number of Paychecks You Receive Each Year ÷ 52
÷ 24
Equals Amount to Deposit Into Your Dependent Care Account =
Each Pay Period
* Each account has speciic maximum limits you are eligible to contribute each year pre-tax.
Refer to more information about each account in this guide to be sure you limit your election
to those maximums if applicable.
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