Employee Change Notification for Healthcare Reimbursement Account

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Employee Change Notification for Healthcare Reimbursement Account

Use this form to change employee status. Complete this form and enclose it with your payroll for any new employees not listed or terminated since the last contribution list.

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By Mail

Security Benefit
Retirement Plan Services
P.O. Box 750600
Topeka, KS 66675-0600
United States

Overnight Delivery

Security Benefit
Mail Zone 560
One Security Benefit Place
Topeka, KS 66636-0001
United States

By Fax
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