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Medical Plan
Oct 1, 2020 If you enroll in one of the plans approved by Medicare which offer prescription drug coverage, you may need to provide a copy of this notice.
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HIPAA Authorization Revocation Form
AFTER YOU HAVE SIGNED THE AUTHORIZATION, KEEP A COPY FOR YOUR RECORDS. Submit to: WageWorks, Inc. Fax: (866) 672-3703. Claims Administrator. PO Box 14766.
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Health Care and Dependent Care Spending Account Plan
However, a Participant may revoke a Benefit election or a Salary Redirection Agreement after the Plan Year has commenced and make a new election with respect to
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