2014 DCAP Participants Re-Enroll in benefits for 2015 on FSA website during the Fall October 14 - December 5, 2014 Open Enrollment period.

Abbreviated Re-Enrollment Instructions (Not currently available)

Comprehensive Re-Enrollment Instruction (Not currently available)

2015 DCAP Enrollment and Change form for new participants doc format of 2015FSA_enroll_changeform.doc
- Enroll in DCAP benefits for 2015 during the October 14 - December5, 2014 open enrollment.

2014 DCAP Enrollment form doc format of 2014FSAenrollmentform.doc
Enroll in DCAP benefits as a new hire for during the 2014 year with a qualifying event. Return the completed form to your payroll coordinator.

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?

Open Enrollment for 2015 Participants - Contact ASIFlex; 1-800-659-3035

Current 2014 Participants - 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 .