Get Employer Cafeteria Plan Salary Redirectionreduction Agreement

This guide provides clear and supportive instructions on filling out the Employer Cafeteria Plan Salary Redirection/Reduction Agreement online. Whether you are new to this process or looking for a refresher, this step-by-step approach will help you complete the form with confidence.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the document and open it in your selected digital format.
2. Begin by filling in the employer's name and tax ID number in the designated fields at the top of the form.
3. Next, provide the affiliate's name and location along with their corresponding tax ID number.
4. Indicate whether you are an Aflac Benefit Services FSA participant by checking 'Yes' or 'No'.
5. Specify the cafeteria plan year by entering the start and end dates in the appropriate fields.
6. Select whether you are enrolling during open enrollment or if you are a newly eligible employee, and indicate your eligibility date if applicable.
7. Enter your social security number, date of birth, and contact phone number.
8. Fill in your name, street address, city, state, and ZIP code.
9. Provide your email address for communication purposes.
10. Enter the number of payroll cycles in the plan year and the date of the first deduction.
11. Select your payroll mode (weekly, biweekly, semimonthly, or monthly).
12. Confirm your enrollment in any benefit or insurance coverage and understand that deductions will occur continuously throughout the plan year.
13. Select your desired coverage options from the provided lists and indicate whether these contributions will be pre-tax or after-tax.
14. Complete the medical and dependent care FSA plan sections by inputting amounts per pay period and the total annual election.
15. Initial to acknowledge understanding the features of the Flexible Benefits Plan, and sign and date the agreement.
16. Review the completed form for accuracy before saving, downloading, printing, or sharing as necessary.

Complete the Employer Cafeteria Plan Salary Redirection/Reduction Agreement online today for seamless participation in your benefits.