HBA4 - Medical Opt-Out/Cash-Back Attestation for 2025

Only if you have selected Medical Opt-Out/Cash-Back option for 2025 calendar year. For more information about Medical Opt-Out, click here.
HBA4 - Medical Opt-Out Cash-Back Attestation Form - 2025.pdf, 332.64 KB; (Last Modified on January 14, 2025)