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Home » Health Plan » Topics » Flexible Spending Account Plan Enrollment Form
We've made FSA enrollment simple for you. Scroll down to use the form below to enroll in, or modify, your UnitedHealthcare Flexible Spending Account for both Healthcare and Dependent Care benefits. While these benefits are available to you, please note that Commuter benefits are not part of your package.
You have access to both FSA and Commuter benefits, but they require separate enrollment processes. Healthcare and Dependent Care FSA require enrollment thru the ADP system. Commuter Benefits FSA enrollment is to be performed using this site by scrolling down and using the form below.
Access these benefits through your ADP portal. Here's how:
ADP Enrollment Link Here
For Parking and/or Transit benefits, scroll down to use the separate enrollment form.
Remember to:
After enrolling, always review your confirmation statement. If you spot any errors, you can return to the page to make corrections.
Remember: While taking advantage of these pre-tax benefits can reduce your annual expenses and ensure you're prepared for healthcare and commuting costs, be mindful of how much you wish to set aside. It is recommended that employees be conservative in selecting set-aside amounts to avoid forfeiting unspent funds at the end of the year.
Fields marked with * are required.
View Terms and Conditions
This agreement will remain in effect for the Plan Year unless changed for reasons stated in the terms and conditions of the Plan. By typing my name, I certify that I have examined this agreement and understand and agree to comply with the terms and conditions of the Plan. If this is a change in status, I certify that this change is consistent with the qualifying event. I agree to hold UnitedHealthcare Benefit Services and my employer harmless from any liability to my participation in this plan. *:
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Last updated: 11/25/2024 9:33:59 AM
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