Waive. Divide your Annual Pledge by the number of months in this current year that you will have coverage = Monthly Pledge $ . Flex Made Easy (Annual Maximum FSA Dependent Care Contribution = $5,000.00 per household) FSA – Dependent Care Annual Pledge $ . Waive Divide your Annual Pledge by the number of months in this current year that you will have coverage = Monthly Pledge $ . To complete your Flexible Spending Account enrollment – you must complete the attached form for FLEX Made Easy. You will NOT be enrolled in this program if you have not completed the enrollment form and returned to the Benefits Office To figure your cost per month $ . Annual Salary X .70 = X .040 Divide your total from the last line by 52 = ❑ Accept ❑ Refuse
Appears in 2 contracts
Sources: Benefits Election and Salary Reduction Agreement, Benefits Election and Salary Reduction Agreement
Waive. Divide your Annual Pledge by the number of months in this current year that you will have coverage = Monthly Pledge $ . Flex Made Easy (Annual Maximum FSA Dependent Care Contribution = $5,000.00 per household) FSA – Dependent Care Annual Pledge $ . Waive Divide your Annual Pledge by the number of months in this current year that you will have coverage = Monthly Pledge $ . ._ To complete your Flexible Spending Account enrollment – you must complete the attached form for FLEX Made Easy. You will NOT be enrolled in this program if you have not completed the enrollment form and returned to the Benefits Office To figure your cost per month $ . Annual Salary X .70 = X .040 ❑ ❑ Divide your total from the last line by 52 = ❑ Accept ❑ Refuse=
Appears in 1 contract