FormsStaffBenefits → Flexible Spending Account Calendar Year 2026 Election

Flexible Spending Account Calendar Year 2026 Election

for Employees with a Qualifying Life Event Only

About this Form

Form number: 450-3

Audience:  MCPS Staff

Last revised: July 2026


Related Forms

Form 450-1 - Optional Employee Term Life Insurance

Form 450-2 - Optional Dependent Term Life Insurance

Form 455-20 - Employee Benefit Plan Enrollment 2025

PLEASE NOTE: To enroll in a flexible spending account using this form, please complete, sign electronically or manually, and return to the Employee and Retiree Service Center (ERSC). You may fax the signed form to 301-279-3651 or 301-279-3642, or email a PDF of the signed form to ERSC@mcpsmd.org. Please only submit your elections via one method. Submitting via multiple methods can cause errors and delay the processing of your elections. Please visit the ERSC website for additional information.

Adobe PDF Flexible Spending Account Calendar Year 2026 Election
for Employees with a Qualifying Life Event Only
70 KEnglish

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