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Get Health Savings Account Plan An Endowed ... - Cornell University
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How to fill out the Health Savings Account Plan An Endowed ... - Cornell University online
This guide provides a comprehensive overview of how to complete the Health Savings Account Plan enrollment form for Cornell University. Follow these steps to ensure a smooth process in submitting your online application.
Follow the steps to successfully complete the enrollment form.
- Click ‘Get Form’ button to obtain the enrollment form and open it in your preferred editor.
- Indicate whether you are enrolling as a new participant or changing your enrollment by selecting the appropriate checkbox.
- Provide your personal information including your name, date of birth, social security number, employment date, home address, job title, department name, and campus address.
- Review eligibility criteria for HSA enrollment to confirm that you meet the conditions outlined in the document.
- Select your desired coverage level by checking one of the options: Individual, Individual + Child(ren), Individual + Spouse/Domestic Partner, or Individual + Spouse/Domestic Partner + Child(ren).
- If covering a spouse or domestic partner, complete the additional fields including their name, social security number, date of marriage/partnership, sex, date of birth, and employer information.
- If applicable, list your eligible dependent children along with their names, dates of birth, gender, relationship to you, and social security numbers.
- If you qualify for dual eligibility, check the corresponding box and have your spouse or domestic partner sign the form.
- In Section A, specify your contribution amount under age 55, remembering to enter a value, even if it is zero.
- For Section B, if you are age 55 or will turn 55 during the year, elect to contribute under the catch-up provision and indicate the contribution amount.
- Review the final declaration section to ensure all information is accurate, sign the form, and date it.
- Complete both sides of the form, then save your changes, download or print it, and share it as instructed.
Begin your enrollment process online now to secure your Health Savings Account.
To access Cornell Health services, you must be a current student or staff member at Cornell University. Eligibility also extends to dependents of eligible students and staff. Enrolling in the Health Savings Account Plan An Endowed ... - Cornell University benefits those eligible by providing funds for various health-related expenses.
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