Christian Schools International

Claim Form for Health Care and Dependent Care Expense Accounts

Complete the Arcadia FSA Claim form and attach supporting documentation for reimbursement of health care and/or dependent care expenses. Please note that you can speed your reimbursement by faxing your claim to the number at the bottom of the form.

Arcadia FSA Claim form - Used to submit claims.

Change in Benefit Election Form

Complete the Change in Benefit Election Form for mid-year election changes due to an IRS “change in status”.

Change in Benefit Election Form - Used for mid-term election changes due to IRS change in status.

Direct Deposit Authorization Form

Complete the Direct Deposit Authorization Form to have your Flexible Spending Account (FSA) reimbursements deposited directly into your checking or savings account or to change your checking or savings account numbers.

Direct Deposit Authorization Form - Used to authorize direct deposit into a bank account.

Employee Status Change Form

The school must complete the Employee Status Change Form when an employee has a name change, address change, termination of employment or leave of absence.

Employee Status Change Form - Used to submit name, address, and employment change.

Cash Compensation in Lieu of Benefits Form

Cash Compensation in Lieu of Benefits Form - Is a form that schools use that offer a cash incentive to employees eligible to opt out of the schools’s insurance plan.

Cash in Lieu of Benefits - Used for employees eligible to opt out of the school's insurance plan.