UDM Logo

Flexible Spending Accounts (EBC)

Healthcare & Dependent Care FSA (PDF forms)

EBC_FLEX_Enrollment_Form.pdfFSA Enrollment FormFSA Enrollment Form/www.udmercy.edu/hr/benefits/flex/pdf/EBC_FLEX_Enrollment_Form.pdf213673FSA_Brochure.pdfFSA BrochureFSA Brochure/www.udmercy.edu/hr/benefits/flex/pdf/FSA_Brochure.pdf837046UDM_FSA_Debit_Card_FAQ.pdfFSA FAQFSA FAQ/www.udmercy.edu/hr/benefits/flex/pdf/UDM_FSA_Debit_Card_FAQ.pdf84532FSA_Understanding_of_Agreements.pdfUnderstanding of AgreementUnderstanding of Agreement/www.udmercy.edu/hr/benefits/flex/pdf/FSA_Understanding_of_Agreements.pdf22280EBC_Summary_Plan_Description.pdfFSA Summary Plan DescriptionFSA Summary Plan Description/www.udmercy.edu/hr/benefits/flex/pdf/EBC_Summary_Plan_Description.pdf72527EBC_FLEX_Online_Instructions.pdfOnline InstructionsOnline Instructions/www.udmercy.edu/hr/benefits/flex/pdf/EBC_FLEX_Online_Instructions.pdf25468FSA_Qualified_Expenses.pdfQualified Medical ExpensesQualified Medical Expenses/www.udmercy.edu/hr/benefits/flex/pdf/FSA_Qualified_Expenses.pdf51116EBC_Qualified_Daycare_Expenses_2011.pdfQualified Daycare ExpensesQualified Daycare Expenses/www.udmercy.edu/hr/benefits/flex/pdf/EBC_Qualified_Daycare_Expenses_2011.pdf30850EBC_Qualified_Elder_Care_Expenses_2011.pdfQualified Elder Care ExpensesQualified Elder Care Expenses/www.udmercy.edu/hr/benefits/flex/pdf/EBC_Qualified_Elder_Care_Expenses_2011.pdf107667EBC_FLEX_Medical_Claim_Form.pdfMedical Claim FormMedical Claim Form/www.udmercy.edu/hr/benefits/flex/pdf/EBC_FLEX_Medical_Claim_Form.pdf38701EBC_Dependent_Care_Claim_Form.pdfDependent Care Claim FormDependent Care Claim Form/www.udmercy.edu/hr/benefits/flex/pdf/EBC_Dependent_Care_Claim_Form.pdf303251EBC_Direct_Deposit_Form.pdfDirect Deposit FormDirect Deposit FormDirect Deposit FormDirect Deposit Form/www.udmercy.edu/hr/benefits/flex/pdf/EBC_Direct_Deposit_Form.pdf0/www.udmercy.edu/hr/benefits/flex/pdf/formsforms