DCAP Enrollment form for 2014 doc format of 2014FSAenrollmentform.doc
Enroll in DCAP benefits as a new hire of\r during the 2014 year with a qualifying event.

Return the completed form to your payroll coordinator.

 2014 DCAP Participants Re-Enroll in benefits for 2015 on FSA website during the Fall 2014 Open Enrollment period.

Abbreviated Re-Enrollment Instructions (Not currently available)

Comprehensive Re-Enrollment Instruction (Not currently available)

DCAP Claim Form doc format of FSAclaim_form.doc
: Use this form to submit dependent care-related claims for reimbursement.

Flexible Spending Account Status Change form doc format of FSAstatuschangeform.doc
– 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.


HCSA Questions?

Benefit Strategies 1-877-FLEXGIC (1-877-353-9442); flexgic@benstrat.com


2014 Calendar Year Flexible Spending Account Handbook doc format of 2014FSAHandbook.doc

This information provided by the Group Insurance Commission .