SEBB 2020 - FSA / DCAP 

COVID-19 Medical FSA and DCAP Change Form 

July 1-31, 2020 ONLY

SEBB DCAP Website       SEBB FSA Website       NAVIA Benefit Solutions Website

Change in Status Form  ** open in pdf for a fillable form, or print and scan **

Additional forms, documents and enrollment information can be found through the websites above.