MS Attorney General’s Office

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Cafeteria Plan Enrollment for 2025

Cafeteria Plan Enrollment will be open from October 1, 2024, through October 31, 2024. You are required to complete the enrollment process even if you are declining benefits and/or participation.

Open Enrollment

Instructions

Download Instructions Here

Required Forms

Please make sure you complete and return the following forms.

• Participation Agreement for Cafeteria Plan and Other Post-Tax Deductions
• Vision Application (if adding coverage or making changes to coverage)
• Dental Application (if adding coverage or making changes to coverage)
• Drop Form (Download here)

Representative/Contact Information

Below you will find a PDF listing the representatives, contact information, and products that are offered.

Contacts and Provider Information List

Cafeteria Plan

Your Cafeteria Plan uses pre-tax salary deductions to pay for qualified health and dependent care expenses.

View more information about HOW YOUR PLAN WORKS

• Medical and Dependent Care FSA Brochure
• FSA Worksheet
• Cafeteria Plan Direct Deposit Authorization Form
• Qualified/Non-Qualified Expenses

Medical FSA (MEDFLEX)

• FSA Debit Card Information
• FSA Debit Card Request Form

Dependent Care FSA (CAREFLEX)

• Dependent Care Certification Form
• Dependent Care Qualifying Expenses

Dental

• Delta Dental Rates
• Delta Dental Enrollment Form
• Delta Dental App

Vision

• Superior Vision Benefits and Rates
• Superior Vision Enrollment Form

Cancer

• Colonial Cancer Insurance Information
• Colonial Cancer Wellness Benefits
• Colonial Cancer Rates
• Colonial Cancer Insurance Level 2 Benefits Description
• Colonial Cancer Insurance Level 3 Benefits Description

Accident

• Aflac Accident Rates
• Aflac Enrollment Page
• Aflac Accident Option 2 Benefits Description
• Aflac Accident Option 3 Benefits Description
• Aflac Plus Rider Critical Illness Information

Pre-Paid Legal/Identity Theft

• Legal Shield Information and Rates