Get the free Dentistry FSA Enrollment Form - shb umn

Flexible Spending Accounts 2013 School of Dentistry Residents and Fellows Enrollment, Change, and Payroll Deduction Form Optional enrollment for new/incoming residents and fellows in job codes 9552

How to fill out dentistry fsa enrollment form

How to fill out dentistry FSA enrollment form:

1. Gather necessary information: Before starting, gather all the required information such as your personal details, social security number, and any relevant dental insurance information.
2. Begin with personal information: Start by providing your full name, address, date of birth, and contact information.
3. Social security number: Enter your social security number accurately to ensure proper identification and processing of your form.
4. Choose coverage details: Indicate the coverage period for your FSA plan, which is usually for one calendar year. Select the dental coverage option that suits your needs, such as individual or family coverage.
5. Indicate contribution amount: Determine the amount you want to contribute to your FSA for dental expenses. Be mindful of the contribution limits set by the IRS, as exceeding these limits can result in tax penalties.
6. Coordinate with dental insurance: If you have dental insurance coverage, specify the name of the insurance provider and any relevant policy or group numbers. This information helps in coordinating your FSA benefits with your insurance coverage.
7. Sign and date the form: Once you have completed all the necessary sections accurately, sign and date the dentistry FSA enrollment form to certify its authenticity.

Who needs dentistry FSA enrollment form:

1. Employees with dental expenses: Individuals who anticipate incurring dental expenses throughout the year and have access to an FSA through their employer would need to fill out a dentistry FSA enrollment form.
2. Individuals with dental insurance: Those who have dental insurance coverage and wish to maximize their dental benefits by utilizing an FSA alongside their insurance plan would also need to complete the enrollment form.
3. Individuals seeking tax savings: Filling out the dentistry FSA enrollment form can help individuals save money on eligible dental expenses by using pre-tax dollars. This can be especially beneficial for those incurring significant dental costs.

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What is dentistry fsa enrollment form?

The dentistry FSA enrollment form is a document used to enroll in a Flexible Spending Account (FSA) specifically for dental expenses.

Who is required to file dentistry fsa enrollment form?

Employees who wish to set aside pre-tax dollars for dental expenses are required to file the dentistry FSA enrollment form.

How to fill out dentistry fsa enrollment form?

To fill out the dentistry FSA enrollment form, employees must provide their personal information, select the amount to contribute, and sign the form.

What is the purpose of dentistry fsa enrollment form?

The purpose of the dentistry FSA enrollment form is to allow employees to allocate funds for dental expenses on a pre-tax basis.

What information must be reported on dentistry fsa enrollment form?

The dentistry FSA enrollment form typically requires information such as employee name, address, Social Security number, desired contribution amount, and signature.