Re-enroll Online – If you are a 2015 FSA participant, re-enroll online.
Open Enrollment Re-enrollment Instructions for HR/CMS and Offline Agency Employees – If you are a 2015 FSA HR/CMS or Offline Agency (housing and redevelopment authority) participant, re-enroll for half-year 2016 benefits online during the Open Enrollment period.
* Re-enrollment Screen Shots for HR/CMS and Offline Agency Employees – HR/CMS and Offline agency employees, these screen shots show you what you’ll see as you re-enroll in FSA benefits online.
* Fall 2015 Open Enrollment Form – during the October 13–December 4 open enrollment, enroll for half year benefits. If you are not a current participant, use this form to enroll for coverage effective January 1 – June 30, 2016. Return the completed form to your Payroll Coordinator no later than Friday, December 4, 2015.
* Open Enrollment Instructions for UMass employees – If you are a 2015 FSA UMass participant or are a UMass employee and wish to enroll, enroll for half-year benefits during the Open Enrollment period. These instructions walk you through the steps.
* Screen Shots of UMass Enrollment Screens file size 1MB – UMass employees, these screen shots show you what you’ll see as you enroll in FSA benefits online.
2016 Enrollment Form – during the October 13 – December 4 open enrollment, enroll for half year benefits. If you are not a current participant, use this form to enroll for coverage effective January 1 – June 30, 2016. Return the completed form to your Payroll Coordinator no later than Friday, December 4, 2015. Also use this form if you are hired on December 5, 2015, or later.
DCAP Claim Form : Use this form to submit dependent care-related claims for reimbursement.
Flexible Spending Account Status Change form – use this form to increase or decrease your contribution to, or terminate your election in Flexible Spending Account within 30 days of a qualifying event during the plan year. You must submit this form with supporting documentation within 30 days of the qualifying event: change in legal marital status; change in number of dependents; change in employment status; change in work schedule that affects your eligibility for the program; change in dependent’s FSA eligibility, or a judgment decree pertaining to your spouse or child.
2015 DCAP Participants Re-Enroll in benefits for 2016 on FSA website during the Fall 2015 Open Enrollment period.
Flexible Spending Account Appeal Form - If you disagree with a denied claim or adverse decision regarding your HCSA or DCAP benefit (e.g. claim for reimbursement denial, eligibility for pre-tax benefits or election change), and you feel this denial was made in error you may file a formal appeal by using this form.
This information provided by the Group Insurance Commission .