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Payroll Account Acknowledgment - .web

Cafeteria Plan Benefits: (To add, account must be qualified under Section 106 of the Internal Revenue Code.) Check plans to add: Medical Short-Term Disability Dental Personal Sickness Indemnity Long-Term Disability Accident Group Term Life HSA (Section 223) Vision Care Cancer Specified Health Event Intensive Care Hospital Indemnity

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  Terms, Plan, Short, Disability, Term disability

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