Salary Reduction/allocation Agreement Form (Page 2 of 2) in pdf

Salary Reduction/allocation Agreement Form Page 2

Salary Reduction/Allocation Agreement Form

General Rules and Procedures

Eligible employees who want to commence voluntary pre-tax employee contributions or change their

current contributions are required to complete the Salary Reduction/Allocation Agreement form. This

amount is in addition to the mandatory employee contribution to your retirement plan. These

contributions are not subject to federal income taxes but are subject to federal income taxes.

You are permitted by the Hospital to make four salary reduction changes during the calendar year by

providing at least 30 days written notice of the change.

If you are currently directing your contributions to a single provider, you are permitted to change to

another provider on a quarterly basis only. The salary Reduction / Allocation Agreement form must be

received in the Human Resources Office at least 30 days prior to the commencement of the quarter.

The change will go into effect with the first pay period of the affected quarter.

If you are currently directing your contributions to more than one provider, you are permitted to

change the allocation of contributions between carriers as often as you wish by using the Salary

Reduction/Allocation Agreement form.

You will be required to contact the investment carrier representative to enroll in any of their

investment choices. The enrollment application should accompany the Salary Reduction/Allocation

Agreement form. The completed form and the applicable carrier enrollment application must be

returned to the Human Resources Office and will be applied as follows:

Change in investment provider(s) will be in the first paycheck in the next

calendar quarter based on meeting the notification criteria for receipt of the form.

Change in contribution amounts will be in the next available paycheck.

Salary Reduction/allocation Agreement Form Page 2