2014 HCSA Participants Re-Enroll online during the Fall October 14 - December 5, 2014 open enrollment for 2015 benefits.

Abbreviated Re-Enrollment Instructions (Not currently available)

Comprehensive Re-Enrollment Instructions (Not currently available)

2015 HCSA Enrollment and change form for new participants doc format of 2015FSA_enroll_changeform.doc
- Enroll in HCSA benefits for 2015 during the October 14 - December 5, 2014 Open Enrollment.

2014 HCSA Enrollment form doc format of 2014FSAenrollmentform.doc
- Enroll in HCSA benefits as a new hire or during this 2014 year with a qualifying event.

Not for municipalities

2014 HCSA Claim Form doc format of FSAclaim_form.doc
- use this form to submit HCSA and DCAP claims for reimbursement.

2014 HSCA Notice and Election Form doc format of COBRA_HCSA_Notice_App.doc
- HCSA Enrollees may elect to contribute to the HCSA account under COBRA by making direct payments on an after-tax basis.

HCSA COBRA Acknowledgement Form doc format of COBRA_HCSA_Ackn_COBRA_Notice.doc
- State employees enrolled in HCSA who are leaving state service use this form to acknowledge that they have been advised of their right to HCSA COBRA benefits.

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

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 .