Placer West Insurance Services

Call us toll-free at 877.645.7816

Get your FREE, custom insurance quote now!

Free Insurance Quotes

Workers' Compensation Insurance

To receive your free insurance quote, please fill out the request form below. To see how we use your personal information, please see our Privacy Policy.

Contact Information
*Your Name:
Your Spouse's Name:
*Home Address:
*City (California Only):
Contact and Personal Information
Name of Business: Name of Owner/s:
Address: SS# & Birthdays:
Business Information
Type of Entity: Total Number of Employees:
Tax ID# Number of Part-Time Employees:
General Explanation
of Duties:
Number of Full-Time Employees:
Projected Payroll:
(over next 12 months)

Federal Poverty Level (FPL) Chart

View Chart

HSA Contribution Limits

Please be aware of the 2016 annual HSA contribution limits listed below.

  • $3,350* - Maximum HSA Annual Contribution Limit (Self-only)
  • $6,650* - Maximum HSA Annual Contribution Limit (Family)
  • $1,000 - HSA Catch-up Contribution Limit
  • $1,300 - Minimum HDHP Annual Deductible (Self-only)
  • $2,600 - Minimum HDHP Annual Deductible (Family)
  • $6,450 - Maximum HDHP Annual Out-of-pocket (Self-only)
  • $12,900 - Maximum HDHP Annual Out-of-pocket (Family)
  • *For purposes of the full contribution rule an employee is treated as being eligible for the entire calendar year as long as he or she is eligible as of December 1 of that calendar year and continues eligibility throughout the following year. However, failure to maintain eligibility during the "testing period" will result in adverse tax consequences (including an additional excise tax). The testing period begins in December of the year in which the employee becomes eligible and ends the last day of December of the following year.

Copyright 2011 Placer West Insurance Services | Lic. # OD58581 | Privacy Policy | Site by Sibling Systems.