Flexible Spending

Flexible Spending

Please answer the questions below so that we can send the Flexible Spending Account document to the email address you provide on this form.
Please confirm your benefit eligibility on the benefits webpage before completing this form.

Also be sure to review the plan details on the website prior to enrolling.
First Name
Last Name
Email
Please use your City email address if you have one. example@example.com
Department
Employee Status
You have to have a qualifying event to be eligible to modify your flexible spending benefit. For a list of qualifying events click here.
Do you have a qualifying event?
You are not eligible to modify your flexible spending benefit at this time. Outside of a qualifying event, your next opportunity will be during Fall Open Enrollment.
File Upload

Please upload your qualifying event documentation.
Cancelof
Attachment
What would you like to do with your flexible spending benefit?
Please verify that you are human
Next Steps

After you click the Submit button below, we will send the Flexible Spending Account document to the email address you provided on this form. It will come from "City of Cambridge Benefits Team via Adobe Acrobat Sign".

Once you complete and sign the document, the form will be sent to Human Resources for eligibility review and processing. You will be given an option to download your completed form.

If you don't see the form in your inbox within 10 minutes of submitting this form, please check your spam/junk folders. If you still do not see the form, please contact the Benefits office benefits@cambridgema.gov or call 617-349-1770.
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