Flexible Spending Account Forms

• 2018 Health Care FSA and or Dependent Care FSA Enrollment Form 
• 2019 Health Care FSA and or Dependent Care FSA Enrollment Form - Please note: This form is for new employees. Faculty and staff who are eligible for Open Enrollment (with a job online prior to 5:00 p.m. October 12, 2018) wishing to enroll in a 2019 FSA should enroll trough Wolverine Access self-service during Open Enrollment, from October 22 to 5:00 p.m. on November 2, 2018). A paper 2019 FSA enrollment form will be available after Open Enrollment with a November 30, 2018 due date.
• Health Care FSA Request for Change in Status
• Dependent Care FSA Request for Change in Status
• Dependent Care Provider's Identification and Certification
• PayFlex Health Care and Dependent Care FSA Claim Form

Flexible Spending Account Book

• 2018 Flexible Spending Account Book
• 2019 Flexible Spending Account Book - For accounts effective January 1, 2019. The Health Care FSA annual contribution limit will increase to $2,650. As a reminder, IRS regulations do not permit FSA enrollments to cross calendar years. If you want to particpate in an FSA for 2019, you will need to re-enroll during Open Enrollment.

More Information on Flexible Spending Accounts

• PayFlex Flexible Spending Account - A quick summary of health care and dependent care flexible spending accounts, administered by PayFlex.
• PayFlex FSA Card - A guide to using the PayFlex Card, your FSA debit card
• Stay Connected to Your PayFlex Account - Information on managing your account online, signing up for account notifications, and using the PayFlex Mobile® app.
• Learn how to use an FSA to pay for dental expenses
• PayFlex Claim Filing Guidelines