Health Benefits Flexible Spending Account Plan

 
    Director

Janet A. Tofani 
Phone: 530.2069;
FAX: 530.2097
jtofani@okumc.org

    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.

  * Flexible Spending Account Summary (posted 7/09)
  *

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)
PDF   WORD

2011 Flexible Spending Account Section Enrollment Form 
PDF  Word

  *

Send the signed original form to:
Oklahoma Conference
Health Benefits
1501 N.W. 24th St.,
Oklahoma City, OK 73106

  * Employees Flexible  125 Benefit Plan Summary Plan

Contents

 
  • Eligibility
  • Operation
  • Contributions
  • Benefits
  • Benefit Payments
  • Highly Compensated And Key Employees
  • Plan Accounting
  • General Information About Our Plan
  • Claims Process
  *
  * 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.

  * 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.

  * 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.

  * Flexible 125 Change of Status Form
  * Flexible 125 Revoke Status Form