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CLAW BENEFIT PLAN RevisedAPPLICATION FOR Enrollment AND BENEFICIARY DESIGNATION Please complete in ink and print clearly. This is a two sided form please see reverse. Please fill in all information

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How to fill out health care savings program

01

Enroll in a health care savings program through your employer or other qualified provider.

02

Determine the amount you want to contribute to the account each pay period.

03

Fill out the necessary paperwork provided by the program administrator.

04

Set up automatic contributions if desired.

05

Keep track of your contributions and use the funds for eligible health care expenses.

Who needs health care savings program?

01

Individuals who want to save money on taxes by contributing pre-tax dollars to cover health care expenses.

02

People who anticipate needing funds for medical expenses not covered by insurance.

03

Those looking for a way to budget for health care costs and save for future medical needs.

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What is health care savings program?

A health care savings program is a type of savings account that allows individuals to set aside money for medical expenses, often with tax advantages.

Who is required to file health care savings program?

Individuals who participate in a health care savings program and meet certain eligibility criteria, often related to income and employment, are required to file.

How to fill out health care savings program?

To fill out a health care savings program, individuals typically need to provide personal information, income details, and contributions made to the account on the appropriate forms.

What is the purpose of health care savings program?

The purpose of a health care savings program is to help individuals save for medical expenses while potentially benefiting from tax incentives.

What information must be reported on health care savings program?

Reporting on a health care savings program usually includes account balances, contributions, withdrawals, and any tax deductions claimed.

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