Get the free Change of Election Form - hrs wsu

Washington Flexible Spending Account (FSA) & Dependent Care Assistance Program (CAP) Change of Election Form You must complete this form within 60 days of your triggering event to change your FSA

How to fill out change of election form

How to fill out a change of election form:

1. Start by obtaining the change of election form from your employer or the appropriate authority. This form is typically provided during open enrollment periods or when you experience a qualifying life event.
2. Carefully read the instructions on the form to understand the information that needs to be provided and any supporting documents that may be required.
3. Begin by filling out your personal information, such as your name, address, and contact details. Ensure that you provide accurate and up-to-date information.
4. Next, indicate the reason for your change of election. This could be due to a change in marital status, birth or adoption of a child, change in employment status, or other qualifying life events.
5. If required, provide any necessary documentation to support your request for a change of election. This may include marriage certificates, birth certificates, or other relevant documents.
6. Review the section related to your existing coverage and the changes you are requesting. This could involve selecting a different health insurance plan, changing your contribution levels, or adding or removing dependents from your coverage.
7. Ensure that you review your elections carefully to avoid any mistakes or omissions. Double-check all the information you have provided before signing and dating the form.
8. If necessary, make a copy of the completed form for your records before submitting it to the appropriate authority. Consider sending it via certified mail or obtaining proof of submission to ensure that your request is received.
9. If you have any questions or need assistance completing the form, reach out to your employer's human resources department or the entity responsible for managing your benefits.

Who needs a change of election form:

1. Employees who experience a qualifying life event such as marriage, divorce, birth, adoption, or death that affects their insurance or benefit coverage may need to fill out a change of election form.
2. Those who wish to make changes to their existing coverage during open enrollment periods, such as selecting a different health plan or adjusting contribution levels, will also need to complete this form.
3. Individuals who have recently started or terminated employment, resulting in a change in their benefits eligibility or enrollment status, may be required to fill out a change of election form.

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