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CSI Flexible Benefits Forms

Claim Form for Health Care and Dependent Care Expense Accounts

Complete the Arcadia FSA 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.

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Change in Benefit Election Form

Complete the Change in Benefit Election Form for mid-year election changes due to an IRS “change in status”.

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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.

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Cash Compensation in Lieu of Benefits Form

Click here to obtain the enrollment and authorization form for Cash Compensation in Lieu of Benefits.