Get Enroll In A Flexible Spending Account! - East Tennessee State ... - Etsu

This guide provides a step-by-step approach to filling out the 'Enroll in a Flexible Spending Account' form provided by East Tennessee State University. Designed to be user-friendly, this resource will help you understand each section of the form and what information is required.

Follow the steps to successfully complete your enrollment form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Fill in your personal information at the top of the form, including your last name, first name, social security number, and contact details.
3. Indicate your enrollment status by checking either 'New Enrollment' or 'Re-enrollment'.
4. Specify the effective date based on your reference guide or provided list, ensuring it aligns with the plan year.
5. Complete the FSA contribution details. For the Medical Expense FSA, enter your total desired contribution for the year, the number of paychecks, and calculate the reduction amount per paycheck.
6. If applicable, complete the Dependent Care FSA sections similarly, ensuring you adhere to the contribution limits delineated in the guide.
7. Review the important terms and conditions provided at the bottom of the form, ensuring that you understand your responsibilities and the implications of your enrollment.
8. Sign and date the form to confirm your agreement with the terms outlined.
9. Return your completed enrollment form to the Office of Human Resources by the specified deadline.
10. You can save changes, download, print, or share the form as needed for your records.

Take the next step in managing your financial health by enrolling online today!