
3350 East Paris Ave. SE
Grand Rapids, MI 49512
p. 877.274.8796
f. 616.301.2149

Enrolling for the Plan Year Beginning Sepember 1, 2010
Employees working half-time or more are eligible to participate in the CSI Flexible Benefits Plan. To enroll:
1. Carefully read the brochure to learn about the features of the Plan and use the worksheet to assist with estimating predictable expenses.
2. Complete the enrollment form. Beginning September 1, you will be automatically enrolled in the premium account if you have a payroll deduction for premium. For the Health Flexible Spending Account, use Line B for the amount to be used for expense reimbursement. Use Line C, the “Limited Purpose” line, ONLY if you are covered for health by a Health Savings Account (HSA). Line D is for dependent care expenses.
3. Complete the Direct Deposit section of the enrollment form. All reimbursements will be made by direct deposit.
4. Submit the completed enrollment form to your school office. Each eligible employee must complete an enrollment form to either participate in the Plan or to decline participation