Flexible Choices Program (FSA)

FLEXIBLE CHOICES PROGRAM (FSA)
Process Works, Inc.

• Expense Worksheet
• ProcessWorks Inc. website (click here)
• QUESTIONS? Click here to send an E-Mail message.

Miscellaneous Forms:

• Flexible Spending Enrollment Form: MS Word / Adobe PDF
  • This form is also to be used if you have an eligible change in status (i.e., birth, adoption, marriage, divorce, etc.).
• Debit Card Request Form 
• Direct Deposit Authorization Form
• Parking Enrollment Form: MS Word / Adobe PDF
• This form is also used if you need to change your election amount, or to discontinue your participation.
   

Claim Forms:

• Dependent Day Care Claim Form
• Medical Expense/HRA Claim Form
• Parking Claim Form (2007)
• Parking Claim Form (2008)

SPECIAL NOTE REGARDING 2008 GRACE PERIOD: You may incur expenses for the year 2008 through March 15, 2009. However, you must claim reimbursement for any 2008 expenses prior to using your Debit Card in 2009 or claiming reimbursement for 2009 expenses. The DEADLINE for claiming reimbursement for 2008 expenses is April 30, 2009.

SPECIAL NOTE REGARDING 2007 GRACE PERIOD: You may incur expenses for the year 2007 through March 15, 2008. However, you must claim reimbursement for any 2007 expenses prior to using your Debit Card in 2008 or claiming reimbursement for 2008 expenses. The DEADLINE for claiming reimbursement for 2007 expenses is April 30, 2008.

If you have any questions regarding this grace period or other Flexible Choices issues, please click on the link above to send an email.

If you are nearing retirement PLEASE read the following:

• Flexible Spending Account - Medical:
  • If you leave City employment and you are enrolled in a Medical-FSA, your period of coverage ends on your separation date unless you arrange to maintain your account. You must claim reimbursement of eligible expenses within 30 days of your date of separation from the City. Expenses incurred after your coverage ends are not eligible for reimbursement unless you continue making "after-tax" contributions to your account. Please contact the Employee Benefits Division at 286-3184 for further information.
• Flexible Spending Account - Dependent Care:
  • Coverage for the Dependent Day Care-FSA ends on your separation date. You must claim reimbursement of eligible expenses within 30 days of your date of separation from the City. Contact the Employee Benefits Division at 286-3184 for further information.

Any questions regarding these accounts should be directed to ProcessWorks, Inc. at 1-262-827-7030 or 1-888-868-2492 (click here to visit their website). Their address is PO Box 2490, Brookfield, WI 53008-2490.

-- back to TOC --