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Health Reimbursement Arrangement (HRA) Enrollment and Change Form Please print responses. * required fieldEnrollmentChange1. Employment Employer×City ofSpringfieldDivision/Class Hire Date (required

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What is hra enrollment and change?

HRA enrollment and change is the process of signing up for or updating your HRA (Health Reimbursement Arrangement) plan.

Who is required to file hra enrollment and change?

Employees who are eligible for an HRA plan through their employer are required to file HRA enrollment and change.

How to fill out hra enrollment and change?

You can fill out HRA enrollment and change forms provided by your employer or through an online portal.

What is the purpose of hra enrollment and change?

The purpose of HRA enrollment and change is to ensure that employees are enrolled in the correct HRA plan and that any changes to their plan are accurately documented.

What information must be reported on hra enrollment and change?

Information such as employee details, dependent information, plan selection, and any changes to coverage must be reported on HRA enrollment and change forms.

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