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2018 ENROLLMENT AND CHANGE FORM: FLEXIBLE SPENDING ACCOUNT (FSA)City of Springfield1/1/2018EmployerEffective DateOnfile
Employee: Last NameEmployee: Mailing AddressFirst NameMiddle Initial(Street)(City)(State)Work
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How to fill out 2018 enrollment and change
How to fill out 2018 enrollment and change
01
To fill out the 2018 enrollment and change form, follow these steps:
02
Obtain the enrollment and change form for 2018 from your employer or insurance provider.
03
Carefully read through the instructions provided with the form.
04
Fill in your personal information, including your full name, date of birth, and contact details.
05
Provide information about your current coverage, such as the name of your insurance provider and the type of plan you have.
06
Determine if you need to make any changes to your coverage for the following year. If yes, specify the changes accordingly.
07
Review the completed form for accuracy and completeness.
08
Sign the form and submit it to your employer or insurance provider before the designated deadline.
Who needs 2018 enrollment and change?
01
Anyone who currently has health insurance coverage and wants to make changes to their plan for the year 2018 needs to fill out the enrollment and change form.
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What is enrollment and change form?
The enrollment and change form is a document used to enroll individuals in a program or to update their information in a system.
Who is required to file enrollment and change form?
Individuals who wish to enroll in a specific program or those who need to update their existing information are required to file the enrollment and change form.
How to fill out enrollment and change form?
To fill out the enrollment and change form, individuals should follow the provided instructions, typically entering personal information, program details, and any changes needed in the designated fields.
What is the purpose of enrollment and change form?
The purpose of the enrollment and change form is to ensure accurate record-keeping and to facilitate the enrollment process for programs or services.
What information must be reported on enrollment and change form?
The information that must be reported on the enrollment and change form typically includes personal identification details, program selections, and any changes to previously submitted information.
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