2021 Flexible Spending Account Forms

FLEXIBLE SPENDING ACCOUNT – Please complete the attached form if you would like to contribute to a FLEX account for Medical or Dependent Care in 2021.

Please review the attached form and submit to Denise Nichols by November 13, 2020.

Flexible Spending Account Enrollment Form – The form must be completed if you would like to contribute to a flex account for Medical or Dependent care expenses.

Keep the following in mind:

  • Your entire election amount is available to you at the start of the plan year, even if you haven’t contributed funds from your paycheck yet. This means that if you have medical expenses early on, you can use your funds in advance to pay for them.
  • Any unused funds over $550 in your account at the end of the plan year will be forfeited.
  • You cannot change your election amount throughout the year, unless there has been a qualifying life event.