S125 Forms

Exciting News! If you’ve previously enrolled with eflex for 2016, login and enter your annual flexible spending account (FSA) and dependent care account (DCA) elections online—see online enrollment instructions directly below.

For employees previously enrolled

eflex Online Enrollment Instructions  (Only if previously enrolled)

  • The only plans available for the 2016 enrollment include Health FSA and Dependent Care FSA
  • The eflex website will require you to acknowledge you have read and understand each option listed in order to proceed

For employees who have never enrolled

If you’ve never enrolled, and would prefer to submit a paper enrollment, or are waiving participation, please print and return forms to Xenium Benefits Department at benefits@xeniumhr.com or fax to (503) 352-1764

(note: if you are not currently enrolled, completing the paper form is the only method currently available to enroll).

All eligible employees must return the S125 Enrollment Form.

  1. To participate: Select your Annual election amount
  2. To waive participation: Select “No, I don’t want to Enroll”

Here is your new Summary Plan Description.

All eligible employees must return the Acknowledgement of Receipt of SPD.

 

Additional Materials:

Your eflex debit card will automatically be loaded with your election beginning January 1, 2016.