Get Flexelect

This guide provides users with a step-by-step approach to filling out the Flexelect Reimbursement Account Enrollment Authorization form. By following these instructions, you can ensure a smooth enrollment process and maximize your benefits.

Follow the steps to complete your Flexelect enrollment form.

1. Press the ‘Get Form’ button to access the Flexelect Reimbursement Account Enrollment Authorization form and open it in your editor.
2. In the enrollment section, check the appropriate box to indicate whether you are participating in open enrollment, newly eligible enrollment, a change due to a permitting event, cancellation, or COBRA continuation.
3. Enter your social security number in the designated field to ensure proper identification.
4. Provide your name in the format of first name, middle initial, and last name in the specified fields.
5. In section 5, indicate the total monthly amount you wish to have deducted for each account by entering the relevant amounts for the Medical Reimbursement Account and Dependent Care Reimbursement Account.
6. Review the terms of enrollment by reading the information in section 7. This ensures you understand the consequences of your enrollment choices.
7. Sign and date the form in the designated areas to confirm your agreement to the Flexelect program terms.
8. If applicable, ensure any additional documents, such as health or dental forms, are attached as indicated in the appropriate sections.
9. Finally, save your changes, download a copy of your completed form, and print it if necessary. Share it with your department's personnel/payroll office as instructed.

Start filling out the Flexelect form online today to ensure your benefits are processed efficiently.