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. 


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.