| Director
Janet A. Tofani |
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| Health Benefits Home | ||||||
| Flexible Benefit Plan Information(Cafeteria Plan) | ||||||
| * | Flexible Benefit Plan Report 3
Effective January 1, 2008 the Kempton Group Administrators, Inc. will become the Third Party Administrator for The United Methodist Church Employees Flexible Benefit Plan (Cafeteria Plan). You can view a wealth of information on your medical plan and/or cafeteria plan by visiting our web-site at www.kemptongroup.com. |
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| * | Flexible Spending Account Summary (posted 7/09) | |||||
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An election form must be submitted online or mailed to the Conference Treasurers office by November 23 every year even if you are not participating. Effective August 15, 2011, we are using online forms for our Medical, Dental, Vision, FSA and Section 125 enrollments. Login at: www.kemptongroup.com Call the Health Benefits office for the "Group Number." 2012 Flexible Spending Account Section Enrollment Form (printable formats) 2011 Flexible Spending Account Section Enrollment Form |
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Send the signed original form to: |
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| * | Employees Flexible 125 Benefit Plan Summary Plan
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| * | Flexible 125 Claim Form: PDF Word
This form should be used when filling a manual claim for unreimbursed medical or dependent care. In the case of unreimbursed medical any claim which does not automatically rollover from your medical plan administered by the Kempton Group Administrators, Inc will require that a manual claim be filed for reimbursement. |
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| * | Flexible 125 Rollover Statement: PDF Word
We ask that anyone who has chosen to have co-pays and deductibles automatically rollover or anyone choosing to opt out of automatic rollover fill out this form and return it us. |
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| * | Flexible 125 Direct Deposit Authorization:
One of your new benefits is the ability to have your Section 125 reimbursements deposited directly to your checking or savings account. If you would like to take advantage of this wonderful benefit please complete this authorization and return the form to us. |
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| * | Flexible 125 Change of Status Form | |||||
| * | Flexible 125 Revoke Status Form | |||||