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Cagney Healthcare of Illinois, Inc. INDIVIDUAL AND FAMILY EVIDENCE OF COVERAGE Cagney Connect HSA 5500 and Native American / Alaskan Native Over 300% Plan THIS EVIDENCE OF COVERAGE MAY NOT APPLY WHEN
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It is a form for filing HSA (Health Savings Account) information with the IRS.
Employers offering HSA plans are required to file this form.
The form must be filled out with detailed information about the HSA plan and contributions.
The purpose is to report HSA plan information to the IRS.
Information such as plan details, contributions, and distributions must be reported.
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