NAVIA BENEFIT SOLUTIONS This form continued on next pageEmployees may enroll or revoke their Medical Flexible Spending Arrangement (FSA) or Dependent Care Assistance Program(DCAP) election(s) and make a new election when a special open enrollment (SOE) event occurs.
Instructions
1.
Section I—Employee Information.
Includes: marriage or registering a
domestic partnership, birth, adoption, assuming a legal obligation for total or partial support in anticipation of adoption, a childbecoming eligible as an extended dependent, or a change in the number of family members qualifying for DCAP.
? A change in the number...
Allowed
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