Flexible Spending Account Forms
FSA Enrollment Form
The FSA Enrollment form is also included in the FSA Guide, which provides useful information about FSAs. Submit the form to Benefits and Retirement Operations within 30 days after your county health benefits begin or a qualifying status change occurs (explained in the guide), or during open enrollment.
FSA Change Form
Submit the Flexible Spending Account Change form to Benefits and Retirement Operations to request changes to your flexible spending account. Benefits and Retirement Operations will verify the changes and forward them to FBMC if they qualify.
FSA Reimbursement Claim Form
FSA reimbursement claim forms are available on the Web site of or by request from Fringe Benefits Management Company, which administers FSAs for King County. You may also submit the forms to FBMC as you incur eligible expenses during the calendar year. You may submit forms until March 31 for previous year expenses.
FSA Authorization for Automatic Reimbursement Deposits Form
Submit the Authorization for Automatic Reimbursement Deposits form to FBMC to have reimbursements directly deposited to your checking or savings account. The form is available on the FBMC Web site or by request from FBMC. You may set up direct deposit at any time.
Current for 2008.
