Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling out the employer name and plan year (2014). Then, enter your personal information, including your full name, social security number (SSN), address, phone number, birth date, city, state, and zip code.
3. Indicate your pay cycle by choosing from the options available: Weekly (52), Bi-Weekly (26), Semi-Monthly (24), or Monthly (12). If you are a new employee, provide your benefit eligibility date.
4. Complete the pre-tax election sections, including checking the boxes for group medical insurance categories and providing the corresponding amounts for each category (Group Health/Medical, Dental, Vision). Sum these amounts in the 'Combined Total' section.
5. Fill out the flexible spending account categories by entering amounts for dependent care expenses, medical out-of-pocket expenses, commuter parking expenses, and mass transit expenses. Ensure you adhere to the specified maximum contributions.
6. Review and enter your total pre-tax contribution amount for the plan year. Fill in the initial amounts for your chosen benefits.
7. Read the Flex-Advantage Plan Election Agreement carefully. Understand that by signing, you are committing to the elections made and acknowledging the rules regarding contributions and potential forfeiture.
8. Finally, sign and date the form to validate your elections. Once completed, you can save the changes, download, print, or share the form as needed.

Complete your document online to ensure your benefits are set up properly.