Flexible Spending Election Form (SPPS)
This form is a fillable PDF.
1 - Download the form to your computer
2 - Fill it out on your computer, save
3 - Email completed form to email@example.com
Use this form when:
New Hire - Do not use this form, election is made when completing your benefits enrollment online.
Qualifying Status Change - Change in daycare
This form is not used during Open Enrollment. Online enrollment required annually.