Skip to content
Secondary Menu »

HSA Election Form

If you participate in a High Deductible STAR Plan you have the option to contribute to an Health Spending (HSA) account and a Limited Flexible Spending (FSA) Account. This form allows you to designate the amount you would like withheld from your paycheck on a biweekly basis.

HSA Enrollment Instructions and Form

HSA EnrollmentĀ Form

Site SettingsSettings