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Provess Flexible Benefits
4050 Katella Avenue, Suite 213
Los Alamitos, CA 90720

Phone: (866) 639-5289
E-Fax: (866) 264-4093
E-mail: admin@provess.com
Palm Springs and Midwest Locations...

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September 2009

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    City of San Jose

    Overview of all Plans administered by Provess Flexible Benefits
     
    Flexible Spending Accounts
     
    Provess administers the Flexible Spending Accounts for the City of San José. The following plans offer employees the ability to save on taxes for out-of-pocket medical and dependent care expenses through pre-tax deductions.
    Medical Reimbursement Account (MRA) - $2,500 maximum election per year
    Dependent Care Assistance Plan (DCAP) - $5,000 maximum election per year
      •Flexible Spending Account Brochure •Flexible Spending Account Guide  
      •Election to Participate •Benefit Election Change Request  
      •Dependent Care Verification •Direct Deposit Enrollment Form  
      •Benefit Reimbursement Voucher    
     
    FSA Plan Year Important Dates
     
      • City of San Jose Plan Year 1/1/2009 - 12/31/2009

    • Eligible dates of Service for Medical Reimbursement Account 1/1/2009 - 3/15/2010

    • Deadline to submit final reimbursement claims for 2009 Plan Year June 15, 2010

    		  
     
    Find out more about our Group Products
      •Group Cancer Insurance Brochure
    		 •Group Accident and Group Cancer Application  
      •Group Accident Insurance Brochure •Group Critical Illness Application  
      •Critical Illness Brochure    
    How to File a Claim
      •How to File a Claim  
      •Wellness Claim Form (Mammograms, PSA, PAP, etc.)  
      •Group Accident/Disability Claim Form  
      •Group Accident/Disability Claim Form  
      •Group Critical Illness Claim Form  

    ** Please note that you must have Adobe Acrobat Reader installed to view and/or print any of the following forms prior to download. Click the underlined text to download the forms.

    acroViewer Download Acrobat reader FREE!
    HOW TO ACCESS YOUR FLEXIBLE BENEFIT ACCOUNT ONLINE AT PROVESS!
      •Instructions  

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