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Flexible Spending Accounts Status Change

Flexible Spending Accounts Status Change

 

INSTRUCTIONS: FLEXIBLE SPENDING ACCOUNT STATUS CHANGE
 
Alabama public employees who have enrolled in the flexible spending account program of the state's PEEHIP health insurance fund can use the form discussed in this article to document a change in their account status. This document can be obtained from the website maintained by the Retirement Systems of Alabama.
 
Flexible Spending Account Status Change Step 1: The first section concerns subscriber information. Enter your PID or Social Security number in the first box.
 
Flexible Spending Account Status Change Step 2: Enter your first name in the second box.
 
Flexible Spending Account Status Change Step 3: Enter your middle name or initial in the third box.
 
Flexible Spending Account Status Change Step 4: Enter your last name in the fourth box.
 
Flexible Spending Account Status Change Step 5: Enter your mailing address in the fifth box.
 
Flexible Spending Account Status Change Step 6: Enter your city in the sixth box. 
 
Flexible Spending Account Status Change Step 7: Enter your state in the seventh box.
 
Flexible Spending Account Status Change Step 8: Enter your zip code in the eighth box.
 
Flexible Spending Account Status Change Step 9: Enter your date of birth in the ninth box.
 
Flexible Spending Account Status Change Step 10: Enter your home phone number in the tenth box.
 
Flexible Spending Account Status Change Step 11: Enter your work phone number in the eleventh box.
 
Flexible Spending Account Status Change Step 12: Enter your email address in the twelfth box.
 
Flexible Spending Account Status Change Step 13: Indicate your marital status with a check mark in the thirteenth box.
 
Flexible Spending Account Status Change Step 14: In the next question, place a check mark next to all statements describing the change in your status being documented. Enter the date on which the event in question occurred.
 
Flexible Spending Account Status Change Step 15: The next section concerns changes to your health care flexible spending account. Enter your new annual election amount or indicate that you wish to stop payroll deductions.
 
Flexible Spending Account Status Change Step 16: The next section concerns changes to your dependent care flexible spending account information. Enter your new annual election amount or indicate that you wish to stop payroll deductions.
 
Flexible Spending Account Status Change Step 17: Sign and date the bottom of the page.
 

 

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