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Enroll in the FSA and/or DCAP

Download a 2025 enrollment form for new hires and mail, email, or fax it in.

2025 Enrollment Form

State of Washington employees can enroll in the FSA and/or DCAP through the following methods and guidelines:

PEBB eligible employees can enroll through a paper enrollment if one of the following conditions applies.

• When you become eligible for PEBB benefits. You must enroll within 31 days of becoming eligible for PEBB benefits. If you are unsure of your PEBB benefits eligibility date, please consult your local benefits office.
• You may enroll during the plan year if you or an eligible family member has a qualified change in status event that creates a special open enrollment. You must submit your paper enrollment form and evidence of the event that created the special open enrollment to your benefits office within 60 days after the date of the qualifying event.

University of Washington (UW) and Washington State University (WSU) employees must use Workday to enroll in an FSA or DCAP. Please do not use this website or paper forms to enroll.

For more information on the FSA and DCAP benefits, please see the Enrollment Guides on the Forms and Documents page.