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During the annual Open Enrollment employees are automatically re-enrolled in the Premium Only Plan, unless the employee completes a waiver form at that time.
Forms
FSA's are administered by Benefit Administration Company (BAC). Forms may be printed or filled-in online.
- BAC Healthcare Reimbursement Form
- BAC Dependent Care Reimbursement Form
- BAC Benefits Card Enrollment Form
- BAC Reimbursement Direct Deposit Authorization
- IRS-Allowed Reimbursable Expenses (may be used for both Healthcare FSA and HSA)