WilmerHale Commuter Choice

Transit Election and Change Form

Employee First Name:    
Employee Last Name: Last Four Digits of SSN:
Home Mailing Address: City:
State: Zip:
Email: Daytime Telephone:
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 (Please enter the monthly election - up to $270 will be pre-tax, any amount over $270 will be post-tax)
  Benefit Month Effective:

I understand and agree to the following:

  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 the 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 vehicles 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.
  4. Any money unclaimed from my reimbursement account(s) at the end of the plan year will be carried over to the next Plan Year on the first day of the plan year as long as you are a benefits eligible active employee.
  5. My Social Security benefits may be reduced by this election.
  6. As a participant in the plan, you will be receiving a Benefit Strategies debit Visa card. This card can be used to purchase passes on line or at participating merchants for my regular daily direct commute from home to work and return. 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.
I agree and understand the above.