Get Health Pre-tax Waiver.pdf - Dchr Dc

The Health Pre-tax Waiver is an essential document for individuals wishing to elect or waive pre-tax treatment of their health insurance premium contributions. This guide will provide you with clear instructions on how to accurately complete this form online.

Follow the steps to successfully complete the Health Pre-tax Waiver.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter your participant information in Section I. Fill in your last name, first name, middle initial, agency, office phone, home phone, and Social Security number (SSN). Ensure that all information is accurate and complete.
3. In Section II, indicate your election to waive participation in the pre-tax health insurance program. Select the appropriate statement that applies to your situation, and provide your signature and date.
4. In Section III, if you choose to restore participation in the pre-tax health insurance program, complete the corresponding section. Similarly, provide your signature and date after indicating your choice.
5. Leave Section IV blank, as this will be completed by the DC Office of Personnel Staff once your form is processed.
6. After ensuring all sections are filled out correctly, save your changes. You may download, print, or share the completed form as required.

Complete your health pre-tax waiver form online today to ensure your health insurance preferences are accurately reflected.