FLEXIBLE BENEFITS FORMS

GB-02 2023 Flexible Spending Arrangement Enrollment Form

The plan member must complete this form each year during annual enrollment to enroll into a Flexible Spending Arrangement (FSA). New hires have 30-days in which to decide to enroll in a FSA and complete this form.

Optum Financial FSA Claim Form (Effective June1, 2022)

Optum Financial Dependant Care Claim Form (Effective June1, 2022)