Flexible Benefits Forms

Enrollment Form for CSI Flexible Benefits Plan

  • Enrollment Form for the Flexible Benefits Plan   Any staff member who is eligible to participate in the employer's medical plan is eligible to participate in the Christian Schools International Flexible Benefit Plan Health FSA. They must be must be 50 percent of full-time employment to participate in the Dependent Care FSA and must complete an enrollment form to participate each plan year. Those employees that are new mid-year have 31 days from their date of hire to complete the form.



Claim Form for Health Care and Dependent Care Expense Accounts

Complete the claim form and attach supporting documentation for reimbursement of health care and/or dependent care expenses. Please note that you can speed your reimbursement by faxing your claim to the number at the bottom of the form.



Change in Benefit Election Form

Complete the change in benefit election form for mid-year election changes due to an IRS change in status.



Direct Deposit Authorization Form

Complete the direct deposit authorization form to have your flexible spending account (FSA) reimbursements deposited directly into your checking or savings account or to change your checking or savings account numbers.



Dependent Care Certification Statement 



Employee Status Change Form

The school must complete the employee status change form when an employee has a name change, address change, termination of employment, or leave of absence.



Cash Compensation in Lieu of Benefits Form

Cash compensation in lieu of benefits form is a form that schools use that offer a cash incentive to employees eligible to opt out of the schools’s insurance plan.