2019 Parking and Transportation Election Forms for plans that allow the benefit card and the IRS maximum contribution for the year

Transportation & Parking
Transit & Parking FSA Only

2019 FSA Election Forms for plans that allow the benefit card and the IRS maximum contribution for the year

One FSA Plan Offered
Medical FSA Only
Limited Purpose FSA Only
Dependent Care FSA Only

Two FSA Plans Offered
Medical FSA & Limited Purpose FSA
Medical FSA & Dependent Care FSA
Limited Purpose FSA & Dependent Care FSA

Three FSA Plans Offered
Medical FSA, Limited Purpose FSA & Dependent Care FSA

2019 FSA Election Forms for plans that DO NOT allow the benefit card, but do allow the IRS maximum contribution for the year

One FSA Plan Offered
Medical FSA Only
Limited Purpose FSA Only
Dependent Care FSA Only

Two FSA Plans Offered
Medical FSA & Limited Purpose FSA
Medical FSA & Dependent Care FSA
Limited Purpose FSA & Dependent Care FSA

Three FSA Plans Offered
Medical FSA, Limited Purpose FSA & Dependent Care FSA