The Pension Boards - PBUCC - Flexible Spending

Flexible Spending Account Forms

We recently updated our forms and applications. Please select the link for the applicable benefits in which you want to enroll and complete the application. If you are enrolling in Life Insurance and Disability Income benefits you must also complete the Life Insurance and Disability Income (LIDI) Metlife Enrollment Change form.

Flexible Spending Account Forms

Election Forms

Health FSA

Dependent Care FSA