PDF-REV 3162021 ORIGINAL TO PEBA COPY TO ENROLLEE Page 1 of 2You

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3 SuffixIf you enroll in a health savings account Section C you cannot enroll in a medical spending account Section A but may enroll in a limiteduse medical spending

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REV 3162021 ORIGINAL TO PEBA COPY TO ENROLLEE Page 1 of 2You: Transcript

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