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Before filling out the
Warning
titlePlease Note:
This is the 2024 Cafeteria Plan Enrollment Form , which should be used for changes to 2024 benefits only through 12/31/24.

Please follow the link below for the correct coverage term. If you want coverage in both years, you must submit both forms. 

2024 Cafeteria Plan Enrollment Form - for coverage before  below, please make sure you've read the Cafeteria Plan.


Info
titleCafeteria Plan Enrollment Information

Important Update for 2025–2026 Plan Year Transitions

If you are making Cafeteria Plan changes that take effect before December 31, 2025, you are required to complete both of the following forms to ensure your elections are processed correctly for each plan year:

  1. 2025 Cafeteria Plan Enrollment Form

 - for coverage after  
Info

  2. 2026

Before filling out the

  1. Cafeteria Plan Enrollment Form

below, please make sure you've read the Cafeteria Plan.
HTML

Please review and submit both forms as applicable to prevent any delay or disruption in your benefit coverage.

<iframe src="https://docs.google.com/forms/d/e/1FAIpQLScfqH2PzWVEpqRf90EA2SlQsd0K5Gw5Us_mU9Nyq9gfIaitRg/viewform" width="700" height="520" frameborder="0" marginheight="0" marginwidth="0">Loading…</iframe>

Note
titleTroubleshooting Tips
  • If you do not see the form abovebelow, make sure you are logged in to your reliant.org Google Account on this browser. You can do this at mail.reliant.org or drive.reliant.org. Refresh this page after you sign in.
  • You will need to use the scroll bar within the form to navigate down to more questions.
  • If you are on a mobile device or using Internet Explorer and have trouble reading the form, you can use this alternate link.
  • If you still have trouble, please contact benefits@reliant.org.
HTML
<iframe width="640px" height="480px" src="https://forms.office.com/Pages/ResponsePage.aspx?id=mQyCDiYyukSdFUu93fOo6Fllr14NMJtKue9ASEXWYbRURVhSUUVRRloxUEY5MFlETlY4RDBDMTJIVy4u&embed=true" frameborder="0" marginwidth="0" marginheight="0" style="border: none; max-width:100%; max-height:100vh" allowfullscreen webkitallowfullscreen mozallowfullscreen msallowfullscreen> </iframe>