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I receive my health and/or dental benefits through the Utica City School District and elect to have the portion of the premium that I pay come out of my paycheck on a pre-tax basis for this and all subsequent years.  \n B. I receive my health and/or dental insurance through the Utica City School District but DO NOT want my portion of the premium to come out of my paycheck on a pre-tax basis for this and all subsequent years.  \n\n| Section 3 Signature |  |\n| --- | --- |\n| Employee Signature | Date |","cbCaia4lwq9L1JPk","https://ap.wps.com/l/cbCaia4lwq9L1JPk","pdf",621896,"English","# Employee Information\n## Tax Deduction Elections\n## Signature","[{\"question\":\"What does Section 2 require from the employee?\",\"answer\":\"Section 2 requires selecting whether the portion of the premium paid by the employee should be deducted from paychecks on a pre-tax basis or not, for this and all subsequent years.\"},{\"question\":\"What are the plan year dates shown on the form?\",\"answer\":\"The plan year is listed as 7/1/2026 to 6/30/2027.\"},{\"question\":\"What information must be provided in Section 3?\",\"answer\":\"Section 3 requires the employee signature and the date.\"}]","Utica City School District Health & Dental Insurance Tax Deduction Form - Plan Year 7/1/2026 - 6/30/2027 | PDF",1789794729]