Common Contracts
1 similar School District contracts
HSA) Health Savings Account Authorization PLAN YEAR – July 1, 2019 – June 30, 2020School District • July 8th, 2019
By my signature below, I certify that I am not covered under any other plan that would disqualify me from opening or contributing to a HSA (such as a traditional FSA, HRA, Medicare or VA benefits), nor am I claimed as a dependent on another person’s tax return. The District will make a contribution based on the schedule below.
