This is the 2024 Cafeteria Plan Enrollment Form, which should be used for changes to the 2024 plan only through 12/31/24.

If you are looking for the link to the 2025 Cafeteria Plan Enrollment Form for 2025 Open Enrollment, please follow the instructions on the Open Enrollment page:


Before filling out the Cafeteria Plan Enrollment Form below, please make sure you've read the Cafeteria Plan.
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  • 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.