[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-301942-105":53,"doc-detail-301942-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","sisc-flex-change-form-2024-plan-year","SISC Flex Change Form - 2024 Plan Year","","SISC Flex Change Form for the 2024 plan year collects employee details and records requested changes to benefit elections under the SISC Flex Plan. Employees specify the type of change, identify the qualifying event and its date, and authorize pre-tax salary reduction to fund the selected benefits. The form also provides employer-use fields for effective date and payroll deduction, plus instructions for submitting the completed document to SISC Flex.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/sisc-flex-change-form-2024-plan-year/301942/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/sisc-flex-change-form-2024-plan-year/301942.png","ImageObject",442,249,{"name":88,"@type":89},"\tWilliam","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-25","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What information must be completed to request a change in the SISC Flex benefits for 2024?","Question",{"text":108,"@type":109},"The form requires employee name details, the type of requested change, the qualifying event and its date, and a signed salary reduction authorization for the plan year.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What is a qualifying event and why is its date required?",{"text":113,"@type":109},"A qualifying event is a permitted life or employment change under IRS rules that makes the requested benefit change allowable. The form states processing cannot occur without the qualifying event date.",{"name":115,"@type":106,"acceptedAnswer":116},"How should the completed change form be submitted to SISC Flex?",{"text":117,"@type":109},"Submit via the secure e-mail system, mail to the provided P.O. 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Box | City | State | Zip | PHONE: |  |\n\nIndicate employee name, social security number, item(s) to be changed, sign the form and submit to your employer.  \n\n| Type of change requested: |\n| --- |\n| 􀂅 Change of address\u003Cbr>􀂅 Decrease in monthly deduction amount (indicate new amount below)\u003Cbr>􀂅 Enroll in a plan (indicate election amount below) * Only use change form to enroll if previously completed enrollment form for this year.\u003Cbr>􀂅 Increase in monthly deduction amount (indicate new amount below)\u003Cbr>􀂅 Name change (Would you like a new Navia Benefit Card issued? If yes; check box 􀂅)\u003Cbr>􀂅 Termination from the plan (Must be a qualifying event within IRS guidelines.)\u003Cbr>Upon termination, the Navia Benefit Card will be turned off and manual claims may be submitted for the time period the account was active. |\n| This change is due to the qualifying event noted below: |\n| 􀂅 Change in legal marital status, including marriage, divorce, death of spouse, legal separation, or annulment.\u003Cbr>􀂅 Change in number of dependents under Code Section 152, including birth, adoption, placement for adoption, or death.\u003Cbr>􀂅 Change in the employment status of the participant, including (a) termination or commencement of employment,(b) commencement of or return from an unpaid leave of absence,(c) change in employment status that results in the participant, spouse, or dependent child becoming or ceasing to be eligible under the individual’s plan (such as switching from part-time to full-time [or from full-time to part-time] employment status.)\u003Cbr>􀂅 Dependent child satisfies or ceases to satisfy dependent eligibility requirements, e.g., attainment of age, student status or any similar circumstances as provided under the Health Benefit plan.\u003Cbr>􀂅 A change in dependent care provider or rates.\u003Cbr>DATE OF QUALIFYING EVENT:   (Change cannot be processed without date of qualifying event.)\u003Cbr>Please Note: A qualifying event must have occurred and the requested change must be consistent with that event.\u003Cbr>Contact Carmen Gonzales at (661)636-4416 to discuss possible qualifying events\u003Cbr>|\n\nSISC Flex Plan Elections and Salary Reduction Authorization  \nSISC Flex Plan is pro-rated if a mid-year election is made.  \nNumber of Pay Periods remaining $ Per Pay Period remaining  \nHealth Care Expense Account  \n$3,050.00 yearly maximum   = $   \nNumber of Pay Periods remaining $ Per Pay Period remaining  \nLimited Purpose Health Care Expense Account  \n$3,050.00 yearly maximum   = $   \nNumber of Pay Periods remaining $ Per Pay Period remaining  \nDependent Care Expense Account  \n(Daycare or Eldercare Expense)   = $   \n$5,000.00 yearly family maximum  \nI hereby authorize and direct my employer to reduce my salary pre-tax by the amount necessary to pay for the benefit(s) as shown above for the plan year indicated above.  \nEmployee Signature   Date:    \nReturn the completed form to your employer.  \nEmployer’s Use Only:  \nEffective date of change:   First Payroll Deduction:    \nReceived and approved by authorized employer administrator:   Date:    \n(This change form must be received, processed, and approved by the SISC Flex office before the change becomes effective.)  \nPlease see the reverse side for important information regarding the above benefits  \nReturn completed form to SISC Flex via:  \nSecure E-mail System: [https://securemail.siscschools.org](https://securemail.siscschools.org) Mail: P.O. Box 1808  \nE-mail Address: [cagonzales@siscschools.org](cagonzales@siscschools.org) Fax: (661)636-4063 Bakersfield, CA 93303-1808  \nAdditional Information   \nHealth Care Expense Account  \n▪ Reimbursement will only be available for qualifying medical care expenses as set forth in the Plan ","cbCaidwK7t7tzvqY","https://ap.wps.com/l/cbCaidwK7t7tzvqY","pdf",289074,"English","# Employee Information\n## Type of change requested\n## Qualifying event details\n## Plan elections and salary reduction authorization\n## Submission instructions\n## Additional information","[{\"question\":\"What information must be completed to request a change in the SISC Flex benefits for 2024?\",\"answer\":\"The form requires employee name details, the type of requested change, the qualifying event and its date, and a signed salary reduction authorization for the plan year.\"},{\"question\":\"What is a qualifying event and why is its date required?\",\"answer\":\"A qualifying event is a permitted life or employment change under IRS rules that makes the requested benefit change allowable. The form states processing cannot occur without the qualifying event date.\"},{\"question\":\"How should the completed change form be submitted to SISC Flex?\",\"answer\":\"Submit via the secure e-mail system, mail to the provided P.O. Box address, or e-mail to the listed address, and fax to the provided number.\"}]","SISC Flex Change Form - 2024 Plan Year | PDF",1789787048]