Get Flexible Spending Plan Election Form

Filling out the FLEXIBLE SPENDING PLAN ELECTION FORM is an important step in managing your healthcare and dependent care expenses. This guide will provide you with clear, step-by-step instructions on how to complete the form online effectively.

Follow the steps to successfully complete your election form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your name in the format: Last, First, Middle Initial. This is crucial for proper identification in the system.
3. Input your date of birth to verify eligibility.
4. Indicate your department or division for administrative purposes.
5. Provide your Social Security Number, ensuring accuracy for tax purposes.
6. Select your gender, which is used for demographic reporting.
7. Fill in your current home address, including street address, city, state, and zip code.
8. Select your marital status from the available options to determine eligibility and benefits.
9. Enter today’s date to mark when you completed the form.
10. Provide a contact number where you can be reached.
11. Acknowledge the receipt of two MyBenny cards upon enrollment if applicable.
12. Choose whether you waive enrollment in the flexible spending account plan or elect to participate in it.
13. If participating, specify the annual contribution amount you wish to allocate for health care and dependent care.
14. Select your pay period preference: bi-weekly or monthly.
15. Review all entered information for accuracy and completeness.
16. Once satisfied, save changes to your form, and consider downloading, printing, or sharing it for your records.

Complete your FLEXIBLE SPENDING PLAN ELECTION FORM online today!