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Enrollment Form for the take care Flex Benefits

Enrollment Form for the take care Flex Benefits 2025

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The document is an enrollment form for the take care® Flex Benefits Plan, requiring personal and employment information from the employee. It outlines options for contributing to Health Care and Dependent Care Accounts, as well as an agreement to save taxes on insurance premiums. Employees must indicate their election choices and understand the implications of declining options. The form emphasizes the importance of using the take care® Card for qualified expenses and includes a section for employee acknowledgment and signature.

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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.

What is Flex enrollment?

The FlexElect Program is a voluntary tax savings program available to eligible state employees each Plan Year (January 1 through December 31).

What is FSA enrollment?

In a flexible benefits plan, employers provide workers with benefits credits. These credits may equal a fixed dollar amount for each worker, or an amount that varies ing to the employees earnings, length of service, size of family, or other characteristics.

Is it worth enrolling in FSA?

FSA Enrollment Employees eligible for FEHB are eligible to participate in an FSA and can enroll during their first 60 days of employment or a qualifying life event (QLE) prior to October 1 of the calendar year. Thereafter employees can enroll during the Federal Benefits Open Season.

Who is eligible for FSA enrollment?

Generally, individuals who are not covered by an HDHP should enroll in the general purpose health care FSA. Individuals who are covered by an HDHP, or individuals whose spouse is covered by an HDHP, should enroll in the limited purpose health care FSA (LFSA in Workterra).

What is FSA and how does it work?

FSAs work alongside your health insurance plan to help you manage out-of-pocket costs like co-pays and deductibles. Whether its covering a medical expense, budgeting for dental and vision care, or planning during open enrollment, FSAs can be a smart choice.

What is a benefits enrollment form?

Benefit enrollment forms capture employee data during the different types of enrollment periods (e.g., open enrollment, special enrollment, and new hire enrollment). The form can be an actual physical form or part of your employee self-service software portal, such as Eddy or UKG.