How to Enroll in the Flexible Benefits Program

SUFFOLK County

ENROLLMENT INSTRUCTIONS

Read the material about the Plan: Summary Plan Description || Enrollment Letter.

Pay special attention to the Questions and Answers form. Refer to the FAQ

Fill out the Confidential Survey Form. Remember to estimate expenses you expect during the NEXT plan year, NOT last plan year!

From the Survey Form, categorize your expenses.

Category	Expenses
I	Employer sponsored Health, Dental, Long Term Disability and non-statutory Short-Term insurance premium (if you do not have a payroll deduction for Survey Form items lA-C you do not have expenses in this category.)
II & III	All Child Care and other dependent care costs for care of an eligible dependent while both spouses work. (This may include a dependent elder.) You will need the Social Security number or the Tax Identification number of the person or entity which provides the dependent care, even though we do not report that number to the IRS. When claiming a dependent care deduction, you must file Form 2441 with your annual 1040. This category can also be used for eligible adoption assistance expenses. Please contact your HR Director or us to determine if your employer offers an Adoption Assistance account.
IV& V	All out of pocket medical, dental and vision care expenses. These are expenses not covered or only partially covered by your insurance. Specific exclusions to these types of expenses are cosmetic procedures, incidental supplies, vitamins, etc, which do not require a prescription. UPDATE - Jan 2011 Over The Counter Medications Change From your Survey Form, items for inclusion in this Category include IV, A-J; and V, A-G.

Take the total of your anticipated expenses in each category and divide each total by the number of pay periods in the Plan Year. Transfer these amounts to the Flexible Compensation Enrollment Form.

Complete the top information of the Flexible Compensation Enrollment Form (or this PDF version).

Contact the Flex Hotline toll-free at 1-800-836-8100 or (585) 385-6010 between 9:00am and 4:30pm (EST) to request help with your enrollment or to verify the ability to deduct an expense.

Fill out the on-line form or mail the completed Enrollment Form (PDF version) and Survey Form to us.