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EDUCATIONAL SERVICE UNIT #8 FLEX PLAN REVOCATION/CHANGE OF BENEFIT ELECTION AND COMPENSATION REDUCTION AGREEMENT Pay Periods (circle one): 12 10 Social Security No.: ___ DOB: ___ Employee No. ___

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How to fill out revocationchange of benefit election

01

Obtain the revocationchange of benefit election form from your benefits administrator.

02

Fill out your personal information including name, employee ID, and contact information.

03

Indicate the benefits you wish to revoke/change and provide reasons for the change.

04

Sign and date the form.

05

Submit the form to your benefits administrator within the specified deadline.

Who needs revocationchange of benefit election?

01

Employees who wish to make changes to their existing benefits plan.

02

Employees who no longer require certain benefits and wish to revoke them.

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What is revocation/change of benefit election?

Revocation/change of benefit election refers to the process by which an individual cancels their current benefit election and selects a different option or returns to a previous election.

Who is required to file revocation/change of benefit election?

Any individual who wishes to modify their previously elected benefits, whether it be healthcare, retirement, or other types of benefits, is required to file a revocation/change of benefit election.

How to fill out revocation/change of benefit election?

To fill out the revocation/change of benefit election, individuals must complete the designated form provided by their employer or benefits provider, ensuring that all required fields are filled in accurately and that they specify the elections they are revoking and the new elections they are making.

What is the purpose of revocation/change of benefit election?

The purpose of revocation/change of benefit election is to allow individuals the flexibility to adjust their benefit selections based on their changing needs, circumstances, or preferences.

What information must be reported on revocation/change of benefit election?

The information that must be reported includes personal identification details, the benefits being revoked, the new elections being made, and any relevant dates pertaining to the changes.

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