This program has an open enrollment period, meaning participants must re-enroll each year.
- During open enrollment, current enrollees should re-enroll online on the FSA carrier’s website (see the forms section of the GIC’s website). The employee must print, sign and date the online confirmation page and give it to the payroll office.
- Enter the HCSA/DCAP and pre-tax fee amounts into your payroll system.
- File a copy of the online confirmation page in the employee’s personnel file. Do not send re-enrollment forms to the GIC or the FSA carrier.
- Instruct the employee to complete, sign and date the HCSA/DCAP GIC Flexible Benefit Plan Enrollment Form. See the Direct Deposit Instructions on form.
- Complete the Payroll Coordinator section of the form. Indicate your Agency/Division number (999/XXXX).
- Fax a copy of the completed and signed form to the FSA carrier.. Note: Failure to send a form to the FSA carrier will result in an employee not receiving reimbursement for an eligible HCSA and/or DCAP expense.
- File a copy of the form in the employee’s personnel file. Do not send forms to the GIC.
This information provided by the Group Insurance Commission .