Get the free Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form

This document serves as an election form for employees of Ball State University to enroll in the Flexible Benefits Plan, allowing pre-tax salary reductions for Healthcare and Dependent Care Flexible

How to fill out flexible benefit plan healthcare

How to fill out Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form

1. Obtain the Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form from your HR department or the company's benefits portal.
2. Read through the instructions and eligibility requirements carefully to ensure you qualify for participation.
3. Fill in your personal information, including your name, employee ID, and contact information at the top of the form.
4. Select the desired election amounts for Healthcare FSA and Dependent Care FSA, keeping in mind the annual contribution limits.
5. Indicate your preferred payment method, if applicable, and understand the reimbursement process for expenses.
6. Review your selections for accuracy before submitting the form.
7. Sign and date the form to acknowledge your elections, and submit it to your HR department by the specified deadline.

Who needs Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form?

1. Employees who wish to set aside pre-tax dollars for eligible healthcare expenses and dependent care costs.
2. Individuals seeking to reduce their taxable income and lower their out-of-pocket costs for medical and care expenses.
3. Employees with dependents who incur daycare or child care costs while they are at work.

For pdfFiller’s FAQs

What is Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form?

The Flexible Benefit Plan Election Form is a document that allows employees to elect to participate in a flexible spending account (FSA) for healthcare and dependent care expenses, allowing them to set aside pre-tax income to pay for eligible costs.

Who is required to file Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form?

Employees who wish to participate in the Flexible Benefit Plan and use the healthcare or dependent care flexible spending accounts are required to file the election form.

How to fill out Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form?

To fill out the election form, employees need to provide personal information, specify the amount they wish to contribute to their FSAs, and select the type of accounts they want to enroll in, ensuring they follow the instructions provided on the form.

What is the purpose of Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form?

The purpose of the election form is to formalize an employee's decision to participate in the flexible spending accounts, allowing them to manage healthcare and dependent care expenses with pre-tax dollars.

What information must be reported on Flexible Benefit Plan (Healthcare & Dependent Care FSA) Election Form?

The information that must be reported includes employee details (name, address, employee ID), the desired contribution amounts for healthcare and dependent care FSAs, and any applicable signature or date to validate the election.