Flexbene.com - County of Suffolk

SUFFOLK County

START HERE (Enrollment Instructions)

Use documents and forms below to learn about and participate in a Flexible Benefits program.

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FORMS

printable

interactive

FLEX FORMS
• Flexible Benefits Reimbursement Voucher 2012	(PDF)	(on-line)
• How To Fill Out A Reimbursement Voucher	(PDF)
• Direct Deposit Authorization	(PDF)
• Flex Plan Change Form	(PDF)
• FSA Letter of Medical Necessity	(PDF)
• Lost Check and Replacement Form.pdf	(PDF)
• Flex Reimbursement Procedures	(PDF)
DEPENDENT CARE FORMS
• Dependent Care Registration Statement	(PDF)
• Dependent Care Reimbursement Calendar - 2012	(PDF)
ENROLLMENT FORMS
• 2012 Flexible Benefits Enrollment Form	(PDF)	(on-line)
• Suffolk County Community College Adjunct Enrollment Form - Semester	(PDF)
• Suffolk County Community College Adjunct Enrollment Form - Session	(PDF)
• Confidential Flex Spending Worksheet	(PDF)
• Examples Of Expenses Eligible For Reimbursement	(PDF)
• Calculate Your Flexible Benefits Savings Potential		(on-line)
PLAN INFORMATION
• Summary Plan Description	(PDF)
• Questions And Answers	(PDF)
• Claims Reimbursement FAQ	(PDF)
• HIPAA NOTICE REGARDING CLIENT PRIVACY	(PDF)
• IMPORTANT NOTICE REGARDING CLIENT PRIVACY	(PDF)