Commonwealth of Massachusetts
Qualified Transportation Benefit Plan**

**Also available to benefit eligible UMass employees**

Employee Information
Directions: If this is a new election or you have changed agencies within the Commonwealth, please select your Current/New agency from the first box below to the left. If you have changed agencies, please also select the agency where you were previously enrolled from the From/Old box below to the right.
Current/New Department Code: (Click here for list.)
From/Old Department Code: (Click here for list.)
Employee ID #: (Check your paystub for your Employee ID#)
Employee First Name:
Employee Last Name:
Home Mailing Address:
City:
State:
Zip:
Email:*
Area Code:
Phone Number:
Ext:
*A valid email address is required to remain on your account for the duration of your enrollment into the plan, or as long as you carry an available balance. Benefit Strategies will email you every month with a reminder to check your balance.
Mass Transit Expense Account
I elect to have the following amount of money reduced from my salary before taxes to reimburse me for eligible Mass Transit expenses I incur during the plan year. Please enter the amount below that you would like to elect per month. If you wish to cease your contribution please enter 0.00.
$ / Month (2019PY IRS Max=$265 per month for pre-tax. If your total per month commuter cost is more than $265, please fill the total amount that you need, for example $300 is your monthly pass, we will adjust your account to have $265 pre-tax and $35 post-tax. Please do not include the $1.50 administration fee in the total of your election amount, as that is deducted separately.)
  Benefit/Expense Month:
Click here for 2019 Transit Election Change Process Calendar

I understand the following terms of the Mass Transit Benefit:

1. This monthly election will stay in place at the above rate until you elect to have it changed.

2. The cost of any pass, token, fare card, voucher, or other item that entitles the employee to use Mass Transit for purpose of traveling to or from his/her place of work are considered eligible to use your Benefit Strategies VISA debit card to purchase.

3. Mass Transit may be via:

  • A mass transportation system
  • A private Mass Transit enterprise conducted by a company or individual that is in the business of transporting people in a "commuter highway vehicle." Such a vehicle must have a seating capacity for six or more adults (not including the driver), and at least 80 percent of the vehicle's mileage must be from transporting employees to and from their place of work.  Additionally, the vehicle must be used by a minimum of three commuters (not including the driver). The vehicle may be owned or leased by an employer for use by employees or a third-party provider.  Employees can also own and operate commuter highway vehicles.
  • Effective June 2017 – Benefit Strategies has also approved UberPool & Lyft as authorized merchants for which you can utilize funds from your commuter Transit account for eligible expense to-and-from work. Your current flex Visa card will not work with UberPool or Lyft mobile app as a method of payment – you will need to pay for your ride(s) using your own personal credit card, and then submit a Commuter Choice Claim Form to be reimbursed by Benefit Strategies from your available transit account balance. You can find the Claim Form here.
Parking Expense Account
I elect to have the following amount of money reduced from my salary before taxes to reimburse me for eligible Parking expenses I incur during the plan year. Please enter the amount below that you would like to elect per month. If you wish to cease your contribution please enter 0.00.
$ / Month (2019PY IRS Max=$265 per month for pre-tax. If your total per month commuter cost is more than $265, please fill the total amount that you need, for example $300 is your monthly parking cost, we will adjust your account to have $265 pre-tax and $35 post-tax. Please do not include the $1.50 administration fee in the total of your election amount, as that is deducted separately.)
  Benefit/Expense Month:
Click here for 2019 Parking Election Change Process Calendar

I understand the following terms of the Parking Benefit:

1. This monthly election will stay in place at the above rate until you elect to have it changed.

2. Parking at a location from where I commute to work (e.g., the cost of parking in a lot at the train station so that I can commute in on the train.)

FlexExpress© Card

If you are a current participant in either the Transit or Parking benefit and currently have a FlexExpress© debit card, you will continue to use the same card with the changes made on this form today. If you are canceling your contribution to either benefit temporarily and intend to resume contributions at a later time, please hold on to your FlexExpress© debit card. If you are a new participant to this benefit, you will receive a set of 2 FlexExpress© debit cards in the mail in approximately 7-10 business days from the date when this form is processed in our system, which is after the enrollment window closes. Please click on the above Transit or Parking Election Change Process Calendars to see the deadlines.

I understand that:

1. Any money unclaimed from my reimbursement account(s) at the end of the plan year will be carried over to the next Plan Year.

2. My Social Security benefits may be reduced by this election.

3. I must also agree to the Yearly Certification Form online.

4. The cost to administer the Transit and Parking program is paid by each employee on a pre-tax basis. The monthly administrative fee is $1.50 for Transit alone, Parking alone, or if you choose to participate in both the Transit and Parking programs you only pay the $1.50 administration fee for both.

I agree

Commonwealth of Massachusetts
Qualified Transportation Benefit Plan
Yearly Certification Form

1. I hereby certify that I have been or will be using this benefit for my regular daily direct commute from home to work and return.* Click for more information.I certify that this card will be used only for qualified transportation fringe benefits, Rev. Rul. 2006-57. I will not give, barter, exchange, convey, assign, or otherwise transfer this benefit to any other person.

2. I further certify that the monthly benefit that I will be receiving does not exceed my average monthly commuting costs by public transportation, excluding any parking costs, based on the average number of workdays I commute in the average month. I agree that if my commuting costs change and the monthly benefit I receive exceed my average monthly commuting costs for two or more consecutive months, I will notify Benefit Strategies so that my monthly benefit can be adjusted appropriately. I agree to claim my monthly benefit. I also understand that if I am not receiving the maximum allowable benefit and my commuting costs increase, I can request an increase in my benefit under the State Employee Commuter Benefits Program. I also understand that I will notify Benefit Strategies immediately when I plan to depart from employment.

3. I understand that the debit card remains active for use until midnight of the last day of the benefit month for which I had a payroll deduction contribution, example: Termination ocurrs in May, and payroll deductions are taken in May paycheck for the June benefit month, I’m allowed to use the account until June 30th.

4. I understand I am responsible for purchasing Transit products, and responsible for all requirements of safeguarding these products.

5. The Employee, under penalties of perjury, certifies that he/she has not and will not claim benefits to which are not allowable under IRS and State Tax law.

6. If my employment ends from the Commonwealth of MA (no matter if due to resignation, layoff, retirement), then my Transit/Parking benefit plan will be dropped immediately, and the debit card will be deactivated – at which point I will only be able to submit manual claims for paid eligible expenses that I incurred within 180 days from the date of service, otherwise the funds will be forfeited. If I elect to end my participation and payroll contribution into the Transit/Parking benefit plan, and I still have funds available on the debit card, I can continue to use the debit card and spend down my balance or submit manual claims for paid eligible expenses. Per IRS regulations, refunds cannot be approved.

7. UberPool & Lyft: The undersigned fully understands that eligible commuter transit expenses submitted on the Reimbursement Claim Form are for rides to-and-from work.

END OF YEAR BLACKOUT – The commuter Transit and Parking benefit plan year runs 12/19/2018 and will end 12/18/2019. There will be a blackout period of approximately 7 business days, every December, so Benefit Strategies can process all the enrollments for the new plan year, process any claims for the closing plan year, and do a rollover of unused balances from the closing plan year to the new plan year. During that blackout, members will not have access to their funds on the Visa flex cards, nor will they be able to submit any claims through the online member portal. Members will be notified ahead of time of the blackout dates.

I agree Date: mm/dd/yyyy format

Rev 01.02.19