Open Enrollment Re-enrollment Instructions doc format of 2016FSA_Online_Enrollmentinstructions.doc
-  If you are a 2015 FSA participant, re-enroll for half-year 2016 benefits online during the Open Enrollment period. 

Fall 2015 Open Enrollment Form doc format of 2016_GIC_FSA_Half-Year_Enrollment_Form.doc
– 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.

2016 Half-Year Enrollment Form doc format of 2016_GIC_FSA_Half-Year_Enrollment_Form.doc
– use this form to enroll in FSA benefits if you are hired on December 5, 2015 or later.

DCAP Claim Form doc format of GIC_FSA_claimform2015.doc
: Use this form to submit dependent care-related claims for reimbursement.

Flexible Spending Account Status Change form doc format of 2015FSA_enroll_changeform.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.

2015 DCAP Participants Re-Enroll in benefits for 2016 on FSA website during the Fall 2015 Open Enrollment period. 

Flexible Spending Account Appeal Form docx format of FSA_Appeal_Form.docx
- 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.

HCSA Questions?

2016 Flexible Spending Account Handbook  doc format of 2016FSA_Participant_Handbook.doc
Contact ASIFlex; 1-800-659-3035

This information provided by the Group Insurance Commission .