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Flexible Spending Account Account Change or Termination Form

Flexible Spending Account Account Change or Termination Form 2025

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The document is a Flexible Spending Account (FSA) Account Change or Termination Form from Sterling HSA, providing a structured format for employees to report changes in personal information, qualified status events, and salary redirections related to health care and dependent care FSAs. It includes sections for employee details, changes in marital or employment status, and options for continuing coverage under COBRA.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Are FSA funds available after termination?

For employees, the main downside to an FSA is the use-it-or-lose-it rule. If the employee fails to incur enough qualified expenses to drain his or her FSA each year, any leftover balance generally reverts back to the employer.

Can you cancel a flexible spending account?

Once an employee enrolls in FSA they cannot cancel until the following year unless there is a qualifying event such as a marriage, birth of child, loss of health insurance coverage.

Can you change a flexible spending account?

To change your FSA contributions, complete and submit a Request for Change in Status form. In most plan years, certain qualified changes in status may provide an opportunity in which you may start or stop participating, or change the amount of your FSA contribution during the plan year.

What happens to FSA money if you dont use it?

Any remaining funds in the account must be forfeited back to your employer. Any expenses you incur after your period of employment will not be eligible for reimbursement.

Do you get your FSA money back if you quit?

Any unused money in your FSA goes back to your employer once you leave your job. If you have a healthcare FSA, you could have the option to continue access to your funds through COBRA.

What happens to FSA when you terminate?

You typically cant take your FSA with you if you switch jobs or leave the workforce. Generally, if you leave your job, the remaining funds in your FSA go back to your employer. This is also the case if you dont spend all your FSA dollars within the plan year.

Can I Disenroll from FSA?

Once you elect to enroll in a Dependent Care FSA, you cannot change your election (disenroll from the FSA) or increase or decrease contribution amounts, unless you have a qualifying life event.

Flexible Spending Account Account Change or Termination Form 2025

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