Application to modify your the amount SASMI pays for your premiums to your Health Plan from your HCRA Account.
SASMI will modify the amount it pays for your health care premium payments based on the information you provide below.
This payment(s) will continue until you formally submit a request to cease payments.
Funds will be deducted from your HCRA account as directed (monthly/quarterly) and sent directly to your health care provider.
For any questions, please email us at:
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