Get Bestflex Plan Enrollment Form - Beloit

This guide provides step-by-step instructions for completing the BESTflex Plan Enrollment Form - Beloit online. It aims to support users in accurately filling out the form, ensuring a smooth enrollment experience.

Follow the steps to complete your enrollment form successfully.

1. Click ‘Get Form’ button to access the form and open it in your editor.
2. Begin with the general information section. Enter the organization name and division accurately to ensure proper processing.
3. In the participant information section, provide your full name, including your last name, first name, middle initial, and suffix as applicable.
4. Fill in your Social Security or identification number, gender, date of birth (formatted as mm-dd-yyyy), and date of hire (formatted as mm-dd-yyyy).
5. Complete your mailing address, including apartment number, home phone, city, state, and zip code. Ensure this information is clear for efficient communication.
6. Enter your email address in the specified field. Rest assured that this information will not be shared.
7. Specify the effective start date and the number of pay periods for your enrollment, referring to the eligibility section of the plan.
8. Review the plan benefits section. Indicate your elections for both the standard health care flexible spending account (FSA) and the dependent care FSA, along with any employee paid administrative fees.
9. Input the total election amounts on a per pay period basis and also for the plan year total.
10. If applicable, fill out the direct deposit section by providing your banking information, including the account type, number, and routing number.
11. Carefully read through the authorization section. Indicate your enrollment choice in the BESTflex Plan and acknowledge your understanding of the terms by signing and dating the form.
12. Finally, review all provided information for accuracy. Save your changes, and download or print the form for submission as needed.

To begin the enrollment process, ensure you complete the BESTflex Plan Enrollment Form - Beloit online today.