The Office of Human Resources, in collaboration with various stakeholders, is excited to host a day dedicated to the
Pelican HSA 775 Health Savings Account Enrollment and Payroll Deduction/Change Form
Mon, 12/05/2016 - 7:37pmAs a reminder, employees selecting the Pelican HSA 775 are to complete the Health Savings Account Enrollment and Payroll Deduction/Change Form each calendar year. The form is attached. An employee who elects to change his/her monthly deduction must also complete a new form. This form must be turned into Human Resources.
Health Savings Account Enrollment and Payroll Deduction/Change Form