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Flexible Spending Account Salary Reduction AgreementNovember 1st, 2018
Please use this form to enroll in a health care and/or dependent care Flexible Spending Account (FSA) or update your current election(s). Return your completed and signed form to University Benefits within 30 days of you hire date, or within 30 days of a qualifying event (60 days for birth or adoption). These elections remain in effect from the effective date through December 31 of the year the account is designated for unless you experience a qualifying event. A new FSA election is required each year and you must re-enroll annually is you wish to participate.
