Loading
Get Flex Cash Authorization - Csulb Foundation - California State ...
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Flex Cash Authorization - CSULB Foundation - California State University online
Filling out the Flex Cash Authorization form is an essential step for individuals at California State University, Long Beach, who wish to enroll in the FlexCash Plan. This guide provides clear and concise instructions to ensure that the form is completed accurately and efficiently online.
Follow the steps to successfully complete the Flex Cash Authorization form online.
- Press the ‘Get Form’ button to obtain the Flex Cash Authorization form and open it in your selected form editor.
- Begin by checking the appropriate box that corresponds to your enrollment type: Annual/Newly Eligible Enrollment, Change Due to Permitting Event, or Cancellation.
- Enter your Campus ID Number in the designated field.
- Indicate your Marital Status by selecting either 'Married' or 'Single'.
- In the Plan Elections section, review the FlexCash Plan Description before checking the Flex Cash options you wish to enroll in or cancel. This includes options for cash in lieu of medical and/or dental insurance.
- Complete the Statement of Other Medical and/or Dental Coverage section if you choose cash instead of your own CSULB Foundation medical or dental insurance plans. Include the name of your alternative medical insurance carrier, policy number, and the name of the policyholder, as well as similar information for dental insurance.
- Certify that you are covered by another non-Foundation medical and/or dental insurance plan and agree to maintain this coverage. Also, understand your obligations regarding notifying HR of any changes.
- Sign and date the form to indicate your agreement with the terms and conditions of the FlexCash Program.
- If required, the entry for benefits coordinator and effective date should also be provided, along with any permitting event details.
- Once all fields are completed, save your changes, and you may choose to download, print, or share the form as needed.
Complete your Flex Cash Authorization form online today to ensure your benefits are in order.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.