Declaration of Tax Status You must complete and submit this form with your enrollment form when enrolling an individual on your PEBB coverage who does not qualify as your dependent for tax purposes (for example, a state-

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Date: 2014-10-02 14:01:08 United States National Health Care Act Government Health insurance United States Income tax in the United States Flexible spending account Taxation in the United States Social Security Medicare		Declaration of Tax Status You must complete and submit this form with your enrollment form when enrolling an individual on your PEBB coverage who does not qualify as your dependent for tax purposes (for example, a state- Add to Reading List Source URL: www.hca.wa.gov Download Document from Source Website File Size: 221,80 KB Share Document on Facebook

	Dependent Care/Day Care Flexible Spending Account (FSA) Discovery Benefits is the Flexible Spending Account (FSA) vendor. • New this year: You must select the amount to contribute to your Dependent Care/Day Care FSA du DocID: 1vqRZ - View Document
	Request for Reimbursement Dependent Care Flexible Spending Account What to Do 1. Complete all details on the next page. Or if you prefer, submit an electronic claim through your online account at mybenefits.wageworks.co DocID: 1v6X8 - View Document
	Flexible Spending Account Claim Form Health Care & Dependent Care Mail or Fax completed form and documentation to: PayFlex Systems USA, Inc. DocID: 1u3xt - View Document
	State and Higher Education Employees Save more money on health costs PayFlex® Limited Purpose Flexible Spending Account (LPFSA) DocID: 1tqyh - View Document
	Save money on your payroll taxes! BPC is offering Chamber members special pricing on flexible spending accounts. A Flexible Spending Account (FSA) could save you over $350 per employee per year in payroll taxes. Employee DocID: 1tmGF - View Document