WebThe employer downloads the HSA contribution template spreadsheet from the Employer Administrator Portal. This template may be saved locally and reused for subsequent contributions. The Employer enters contribution data for each plan Participant Consumer on the contribution template spreadsheet. The employer then uploads it to the Employer ... Web• HSA benefits cannot be elected in addition to health care flexible spending account reimbursements unless a Limited Purpose FSA option is available. For more information about HSA eligibility requirements, see IRS Publication 969. Employee Signature Date WageWorks is the administrator of your Plan. Please return this form to your Employer.

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