Case File
efta-efta01220515DOJ Data Set 9OtherSelf-Only Coverage Plan Smart Worksheet
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01220515
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1
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0
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Self-Only Coverage Plan Smart Worksheet
A
If questions 1 and 2 in the Employer Contributions Smart Worksheet are not checked "yes",
answer the following question:
1 Did the
make an MSA contribution related to
a high deductible health plan with self-only coverage
which was in effect at the same time as this plan?
Yes
No
EFTA01220515
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