Health Care (H-Care) Pre-Tax Medical Premium Program Enrollment Form

*Please Note*

1. If I am enrolled in County medical coverage and choose to opt out of County medical coverage, my participation in H-Care ends.
2. If I am enrolled in County medical coverage and go on an unpaid leave of absence, my participation in H-Care ends.
3. If I meet the criteria to participate in H-Care, I can re-enroll by submitting an enrollment form during the Open Enrollment period.