Change FSA Enrollment Mid-Year

If you have had a qualifying change in family status, you can change your FSA enrollment details midyear . However, because changing midyear requires review we cannot process this change online.

Changes you can make include, but are not limited to: increasing or decreasing your salary reduction amounts for medical/dental and/or dependent care or withdrawing from participation. Changes must be consistent with your change in family status. If you are reducing your salary reduction amount, you cannot reduce the amount to less than the amount that is already in your FSA. Any increases to your annual salary reduction amount should be the total you want for the year, including any amounts already deducted from your salary.

You must request a change within 60 days of the change in family status.

To make a change, you need to complete a new "FSA Enrollment Form" and the "FSA Change in Family Status Form."

Because changing your FSA midyear requires review, you will need to mail or bring your completed forms to either your employer or DMBA. Forms are available from your employer, DMBA, or this Web site.

Click on the form name below and print a copy. After printing the forms, complete them and gather your documentation. When everything is ready, either give your material to your employer or mail it to DMBA at: PO BOX 45530, Salt Lake City, UT 84145.

The forms require Adobe's Acrobat Reader. If you do not have Acrobat Reader, you may download it for free from Adobe's Web site with the link below.

Download Acrobat Reader.

FSA Enrollment Form (F-03)
FSA Change in Family Status Form (F-04)

If for any reason your request for a change is denied, you will have 60 days to appeal the decision.