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Flexible spending account Enrollment/change form With employer contributionAttention: AS Flex MS 2260 1231 East Belt line NE Grand Rapids, MI 495254501 Fax to 616.942.5242 | PHenrollment@priorityhealth.comI

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How to fill out flexible spending account enrollmentchange

01

Log in to your employee benefits portal or contact your HR department for the necessary forms.

02

Review the enrollment/change form and fill out all required fields accurately.

03

Specify the changes you want to make to your flexible spending account, such as increasing or decreasing contribution amounts.

04

Submit the completed form before the deadline to ensure your changes take effect for the upcoming benefit year.

Who needs flexible spending account enrollmentchange?

01

Employees who want to make changes to their flexible spending account contributions.

02

Anyone who has experienced a qualifying life event, such as marriage, birth/adoption of a child, or change in employment status, that impacts their healthcare or dependent care needs.

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What is flexible spending account enrollment change?

Flexible spending account enrollment change allows individuals to make changes to their contribution amounts or eligible expenses during the plan year.

Who is required to file flexible spending account enrollment change?

Employees who want to make changes to their flexible spending account contributions or eligible expenses are required to file a flexible spending account enrollment change.

How to fill out flexible spending account enrollment change?

To fill out flexible spending account enrollment change, individuals need to submit the necessary form provided by their employer and follow the instructions on the form.

What is the purpose of flexible spending account enrollment change?

The purpose of flexible spending account enrollment change is to allow individuals to adjust their contributions or expenses based on changes in their financial situation or healthcare needs.

What information must be reported on flexible spending account enrollment change?

On flexible spending account enrollment change, individuals must report changes to their contribution amounts, eligible expenses, and any other relevant information requested by the employer.

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