Get 2015 Moneyplus Enrollment Form - South Carolina Public ... - Eip Sc

The 2015 MoneyPlus Enrollment Form is essential for users looking to initiate a tax-free Medical Spending Account, Dependent Care Spending Account, or for Health Savings Account enrollment in South Carolina. This guide will provide you with clear instructions to successfully complete the form online.

Follow the steps to accurately complete your enrollment form.

1. Click the ‘Get Form’ button to download the MoneyPlus Enrollment Form and open it in your preferred editor.
2. Begin by filling in your personal information in the ‘Name’ and ‘Mailing Address’ sections. Ensure that all names are clearly printed and accurate, as this identifies your enrollment.
3. In the 'Social Security #' field, provide your Social Security Number to verify your identity.
4. Next, complete the 'Date of Birth', 'Physical Address', 'Daytime Phone', and 'Home Phone' sections. This information is crucial for your enrollment.
5. Select the appropriate section for your enrollment: Section A for Health Savings Accounts, Section B for Limited-Use Medical Spending Accounts, Section C for Medical Spending Accounts, or Section D for Dependent Care Spending Accounts.
6. For the selected section, indicate the dollar amount you wish to contribute for the upcoming plan year in Box #1. For Section A, be aware that additional forms are required to establish your HSA.
7. In Box #2, indicate the total number of regular payroll checks you expect to receive in the upcoming year. Use this to calculate your contribution for Box #3, the reduction amount per paycheck.
8. Review the section instructions carefully—if discrepancies arise in calculations, adjustments may be made by the payroll administrator.
9. If applicable, indicate if you wish to participate in the myFBMC Card® PROGRAM, being mindful of associated fees.
10. After completing all necessary fields, sign and date the form at the bottom to affirm your consent and understanding. Ensure you have read all important information on the back.
11. Finally, save your changes, and prepare to submit the completed form to your Benefits Administrator as indicated.

Complete your 2015 MoneyPlus Enrollment Form online today to ensure your participation in beneficial spending accounts!