How do I complete the FSA Enrollment Form?

Participant Plan Effective Date: 1/1/2022

First Payroll date: 1/13/2022

 

Employee Annual Salary – This is the Employee Out of Pocket contribution (Section 6 on Benefit Election Worksheet).

Employer Annual Contribution – This is where an employee will place any allocated Cafeteria dollars.

Maximum Employee Annual Election – Add the two Columns for a total Contribution to FSA.

 

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1. What does “Passive Enrollment” mean?
2. If, I am currently enrolled in a Flexible Spending Account and want to continue enrollment for the same dollar amount into the next calendar year; do I need to take action.
3. I have less than $550 in my Flexible Spending Account; do I need to take any action to roll over the funds to the new calendar year.
4. I want to change my Deferred Compensation contributions for the new calendar year; do I need to complete a Benefit Election Worksheet.
5. I have waived medical coverage through the City for the current calendar year and am waiving coverage for the new calendar year. Do I need to take any action?
6. How do I compare Medical Plans and where do I find this information?
7. How do I complete the Benefit Election Worksheet?
8. Who Qualifies for Cash in Lieu?
9. How are Cafeteria Dollars Distributed?
10. What can Cafeteria dollars be used to fund?
11. How do I compare Medical Plans and where do I find this information?
12. How do I complete the Benefit Election Worksheet?
13. How do I complete the FSA Enrollment Form?
14. I want to change my Deferred Compensation contributions for the new calendar year; do I need to complete a Benefit Election Worksheet.