Get Csi Flexible Benefits Plan Employee Status Change Form

The CSI Flexible Benefits Plan Employee Status Change Form allows users to update their employment information or make necessary changes regarding their benefits. This guide provides a clear, step-by-step approach to filling out the form online, ensuring a smooth and efficient process.

Follow the steps to complete the form effectively

1. Press the ‘Get Form’ button to access the CSI Flexible Benefits Plan Employee Status Change Form and open it in your preferred editor.
2. Begin by entering the school name in the designated field. This should be the name of the institution where you are currently employed.
3. Fill in your full name in the ‘Employee Name’ section as it is listed on your official documents.
4. Enter your Social Security number in the appropriate field, ensuring that it is accurate to avoid any issues with processing.
5. If there has been a change in your employee information, specify the new name or address in the ‘Change in Employee Information’ section. Indicate your new address details, including street, city, state, and zip code.
6. In the 'Termination of Employment' section, provide the date of termination and the date of your last payroll deduction if applicable.
7. If you are reinstating coverage due to COBRA for Health FSA, calculate the monthly premium amount by dividing your annual election by 12 and enter that figure.
8. For a leave of absence, fill in the date of leave and indicate if it qualifies under FMLA by selecting 'Yes' or 'No.' Enter the anticipated return date and last payroll deduction date.
9. If continuing coverage during your leave, select your chosen payment option from either pre-pay, pay-as-you-go, or catch-up options.
10. Lastly, ensure the school representative signature is included along with the date before you submit the form.
11. Once you have completed all sections of the form, save your changes. You can then download, print, or share the form as needed.

Complete your form online to ensure your employee status changes are processed smoothly!