New employees can elect a Medical, Dependent Care, or Limited Purpose Flexible Spending Account (FSA) by completing an FSA Enrollment form within 30 days of their date of hire or by completing their elections on line using Self Service.
1. Employee submits a paper enrollment application or applies using Self Service within 30 days of hire.
2. If paper application, Benefits Office reviews enrollment form and enters into HRS (Reference: 58169 ). See below for enrollment application tips.
3. If paper application is received, file it in employee's benefits file.
4. Shared Services sends a weekly enrollment file to ConnectYourCare on Wednesdays.
5. ConnectYourCare creates an account for employee.
You may click on the links below to navigate directly to a section:
Instructions for Completing and Verifying the Application
1. Enter the following information:
- Employer Name = Univ of WI - System
- Employee ID = Employee's HRS Employee ID
- Enrollment Status = New Enrollment or Re-Enrollment
- Change Effective Date = Coverage is effective the first of the month following date of hire. When you enter this in HRS, use this date for the FSA or ADM Event date. Adding Events to the BAS Activity Table in HRS
- Date of First Payroll: Pay date of when first deduction is taken. Normally, this will be the payroll that includes the coverage effective date.
- Example: For a bi-weekly employee with coverage effective 6/1/20, the date of first payroll would be 5/10/20 (5B Pay Date).
2. Verify the information in the Enrollee Personal Information section:
- Employee Name
- Date of Birth
- Social Security Number
- Home Phone Number
- Home Address
- Mobile Phone Number
- Marital Status
Regardless of what the employee writes on the form for their contact information, it is their current contact information in HRS that will be transmitted to ConnectYourCare. The address will be what is listed as the "Home" address in HRS, and for phone and email it will be the ones selected as "preferred." Emails from ConnectYourCare will go to the preferred HRS email, not what the employee writes on the form.
- If the employee would like to update their ConnectYourCare profile, they may do so when their information has been transmitted to ConnectYourCare and an account has been created.
3. Verify the employee election amounts for Health Care and/or Dependent Care:
- Annual Employee Contribution:
- Annual Employee Contribution: Amount entered is for the remainder of the calendar year
- Number of regular pay periods: Count the number remaining in the calendar year (Note: FSA, LPFSA, and HSA are not taken on C Payrolls or during summer months for C-Basis employees)
- Contribution per pay period: Divide the number of remaining pay periods in the calendar year to determine a pay period deduction. (For 9-month employees, be sure to put in an override in HRS and divide the annual election over the remaining pay periods in the calendar year. This assumes they are returning in the fall.)
4. Verify that the employee has signed and dated the application.
- Click HERE to contact UW Shared Services or HERE for the Office of Technology Services (OTS) Helpdesk if you have any issues with these instructions.