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5.i) City of Scandia HSA Agreement 20140101[I,,:,
ervice C�aperacives
ADOPTION AGREEMENT
For the
HEALTH SAVINGS ACCOUNT MASTER SERVICE AGREEMENT
City of Scandia ("Employer") hereby adopts the Health Savings Account Master Services
Agreement attached hereto effective on January 1, 2014 and end on December 31, 2014. Each
service year thereafter will begin January 1 and end on December 31. The Plan restates and
amends the Health Savings Account maintained by the Employer and in effect prior to the
Effective Date.
Employer also agrees to the terms of the HSA Master Services Agreement ("the Agreement")
attached hereto for the provision of administrative services by MII Life, Incorporated dba
SelectAccount.
SIGNATURES
Date:
Date:
City of Scandia
Signed:
Name:
Title:
SelectAccount
Accepted:
Reed Erickson
Title: Vice President, Compliance and Risk Manaizement