Get Enrollment Form - Ameriflex

Completing the Enrollment Form - AmeriFlex online is a straightforward process that allows users to take advantage of flexible spending accounts. This guide will provide a clear, step-by-step approach to ensure that you can fill out the form accurately and efficiently.

Follow the steps to successfully complete the Enrollment Form - AmeriFlex

1. Click the ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by providing your personal information in the designated fields. Fill in your company name, location, employee name, social security number, email address, home address, city, state, telephone number, and zip code.
3. Indicate the plan year for which you are enrolling by filling in the relevant year in the provided field.
4. Provide your date of birth and date of hire in the specified sections to complete your personal details.
5. In the Employee's Flexible Benefit Per Pay Deduction / Allocation section, specify your contributions for each account type, including the medical flexible spending account, dependent care spending account, and commuter reimbursement account. Enter your per pay contribution, the date of first payroll, and the annual contribution amount as required.
6. Review the understanding section carefully. This section outlines critical points regarding automatic renewal, changes in agreement, and compliance with the company's flexible benefits plan.
7. Sign and date the form at the bottom to confirm your agreement to the terms stated.
8. If applicable, provide information for additional cards for dependents, ensuring to fill in names, addresses, and other relevant details.
9. Complete the authorization agreement for ACH debits/credits by filling out the bank account information accurately, including the depository name, account name, routing number, and account number.
10. Finally, review the entire form for completeness and accuracy. You may then save changes, download, print, or share the form as needed.

Take the next step in your benefits enrollment by filling out the Enrollment Form - AmeriFlex online today.