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3350 East Paris Ave. SE
Grand Rapids, MI 49512
p. 877.274.8796
f. 616.301.2149
Enrolling for the Plan Year Beginning September 1, 2011
Employees working 40% 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. 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.