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spa follow
<br /> a.
<br /> Formatted:Justified
<br /> A. 2023 and 2024 D,-om;,,m r''o,-,t,-•;1-utio,-,s Formatted:Justified,Indent:Left: 0.5",Hanging: 0.5"
<br /> ' Formatted:Justified
<br /> 2023 and • > >
<br /> Formatted:Justified,Indent:Left: 1"
<br /> the u u n R 7 R A o, H.S.A n ry
<br /> listed bolow.
<br /> Monthly City Cantfibtitions to Pfemiums
<br /> . Lormatted:Justified,Indent:Left: 1.25"
<br /> Iv�rom,,,m, ,-�� C��„� � � rl $ntin Q „-, n,-,and Y,�. Co exe 7n7� � � ov�vo.�
<br /> TLTiirr �avnaa �. iCCC
<br /> • �iZLri TTChi Ibuti o s will by,pn,d at
<br /> he dollat:
<br /> valtieto 60oi of the$2 c nn Dvd,,,,t;b1 v Do4,.,.m Notwo• ,-y
<br /> iktion will b/%eal paid at the della
<br /> J Employee And Spouse City L
<br /> valuet,-.ono/ of the$25nn noel,,,-.t;1-,lo Dorf,�,-,-.,l�To w.-.,-lT
<br /> v
<br /> rh
<br /> $1 3 2 20
<br /> , LCT
<br /> 0
<br /> but not to exeeed $1 4 99 tin i 2023 and not to e eee $1 64 7 n�
<br /> Formatted:Justified,Indent:Left: 1"
<br /> 7 c; lY10 plans with
<br /> n $40
<br /> 0
<br /> 0
<br /> deduetible ,-ono,vv Y1 $1 04 nn ,-,o,- p,prflk. - -FFormatted:Justified,Indent:Left: 1.25"
<br /> tewafd the 14.D R.A./t T.D.R.A.o,Tl
<br /> uv n l�T>�R n � uc n
<br /> ��. . r H.S.A.
<br /> All famil:v nkins will Ti C $192 Gr L�TCrC GT1Ti 1�T7prr.1.Al.E.R.A. of uT c�nr
<br /> -• � Formatted:Normal,Justified, No bullets or numbering
<br /> Formatted:Indent:Left: 1"
<br /> 52 f,..
<br /> Formatted:Right,Right: 0"
<br />
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