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EMPLOYEE ENROLLMENT FORM Flexible Spending Account (FSA) City of MadisonInstructions: Please sign, date, and complete each line on the enrollment form. Enter zero (0) where no amount is being elected.
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How to fill out flex spending accounthuman resources

01
Speak with your HR department to determine if your company offers a flex spending account.
02
If your company does offer a flex spending account, complete the necessary enrollment forms provided by HR.
03
Decide how much money you want to contribute to your flex spending account for the year.
04
Use your flex spending account to pay for eligible medical expenses such as copays, prescriptions, and certain medical supplies.
05
Keep track of your expenses and submit appropriate documentation to receive reimbursement from your flex spending account.

Who needs flex spending accounthuman resources?

01
Employees who want to save money on out-of-pocket medical expenses.
02
Employers who want to offer a valuable benefit to their employees.
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A flex spending account (FSA) is a special account that allows employees to set aside pre-tax dollars for certain out-of-pocket health expenses or dependent care costs.
Employees who participate in a flexible spending account plan may need to file for reimbursement of eligible expenses, but typically there is no requirement to file unless they are seeking reimbursement.
To fill out a flex spending account claim form, you generally need to provide your personal information, details of the expenses incurred, and attach receipts or documentation supporting the claim.
The purpose of a flex spending account is to allow employees to pay for eligible expenses with pre-tax dollars, thereby reducing their taxable income and allowing for savings on taxes.
You must report your personal information, the type of expenses incurred, the amount spent, and attach appropriate documentation or receipts that verify the expenses.
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