New Hire & Mid-Year Enrollment Form

Commonwealth of Massachusetts

In order to enroll you will need to complete the following enrollment form.
1. New hires MUST complete and submit their enrollment no later than 21 days after their hire date.
2. Employees who are eligible to enroll in a benefit due to a qualifying life event change have 60 days to complete and submit their enrollment. IMPORTANT NOTE: If your enrollment is due to a qualifying life event, you MUST complete and submit the Change Form, along with your enrollment. The Change Form can be found on massfsatasc.com under the Resources link.
ALL FIELDS ARE REQUIRED AND REQUIRE AN ANSWER OR A VALUE. PLEASE READ THE INSTRUCTIONS FOR EACH QUESTION.
AN EMAIL ADDRESS IS REQUIRED TO LOG INTO YOUR TASC ACCOUNT ONCE LIVE. SHARED EMAIL ADDRESSES CANNOT BE USED IF THE EMAIL IS SHARED WITH ANOTHER PERSON EMPLOYED WITH THE COMMONWEALTH OF MA WHO IS ALSO PARTICIPATING IN THESE BENEFITS.
You will be asked for your Employee ID and asked to select your Agency Type and Agency Name (division). This information is on your paycheck and it can also be located by viewing the GIC Agency Listing on massfsatasc.com under the Resources link. If you are unable to locate your Employee ID, or don’t have one, enter “N/A” into this field.
Please read about both benefit offerings – the Health Care Spending Account (HCSA) and the Dependent Care Assistance Program (DCAP), then select ‘Yes’ or ‘No’ based on your enrollment needs.
When all fields are completed, review and agree to TASC’s Terms & Conditions by checking the box and then click the ‘SUBMIT’ button at the bottom of the form.
If you are a new hire and submitted your enrollment within your 21 day window, but want to change what you’ve submitted – and are still within your 21 day window to enroll - return to this page to enter new information. MAKE SURE TO USE THE SAME EMAIL ADDRESS USED IN YOUR FIRST ENROLLMENT SUBMISSION AND ENSURE EVERY FIELD HAS A VALUE. PLEASE READ INSTRUCTIONS FOR EACH QUESTION, and ensure that you complete the entire form, anew.

1. First Name(Required)

2. Contact Middle Name(Required)

Enter your middle name. If you don't have one, enter N/A.

3. Last Name(Required)

4. Employee ID Number(Required)

Your Employee ID information is on your paycheck. If you are unable to locate your Employee ID #, or don’t have one, enter “N/A” into this field. ***** YOU MUST USE THE SAME EMPLOYEE ID NUMBER EVERYTIME YOU ENTER NEW INFORMATION IN THIS FORM *****

5. Hire Date(Required)

When you click in the field a calendar will appear. To change the year, click on the year (i.e. 2023) and select the year from the drop down.

6. Date of Birth(Required)

When you click in the field a calendar will appear. To change the year, click on the year (i.e. 2023) and select the year from the drop down.

7. Email(Required)

******YOU MUST USE THE SAME EMAIL ADDRESS EVERY TIME YOU ENTER NEW INFORMATION IN THIS FORM. YOUR PERSONAL EMAIL ADDRESS IS PREFERRED AND SHARED EMAIL ADDRESSES CANNOT BE USED. *****

8. Phone Number(Required)

Enter your 10-digit phone number with area code.

Phone Type

9. Street Address(Required)

10. Address 2(Required)

If you do not have a value for this field, then enter NA.

This field is hidden when viewing the form

11. Address Type

12. City(Required)

13. State(Required)

14. Postal Code(Required)

Must be a minimum of 5 digits (e.g. 02110)

15. Agency Type

See GIC Agency Listing. When you select your agency type, a new drop down menu will appear to select your agency name. Take your time and scroll through list to find your agency name. If your agency name is not listed, scroll to bottom and select ‘not listed.

15. A. Agency Name - HRCMS - Commonwealth of MA(Required)

15. A. Agency Name - Other - Commonwealth of MA(Required)

15. A. Agency Name - UMass Commonwealth of MA(Required)

15. B. Since you selected 'Not Listed' in 15 A., enter the name of the agency here.(Required)

16. Would you like to enroll in the health care spending account(HCSA)?(Required)

If you select 'Yes' in this question, you must enter an annual election amount in 16 A. If you don't want to enroll in the Health Care Spending Account, you must select 'No.’

Yes

16. A. HCSA/Healthcare Individual Election Amount

Since you selected 'Yes' on question 16, enter an election amount between $250 and $3,300 for HCSA - Healthcare FSA. Enter as whole number without $ sign - like 250 or 1000.

Please enter a number from 250 to 3300.

This field is hidden when viewing the form

HCSA/Healthcare Individual Effective Date

17. Would you like to enroll in the dependent care assistance program(DCAP)?(Required)

If you select 'Yes' in this question, you must enter an annual election amount in 18 A. If you don't want to enroll in the Dependent Care Assistance Program, you must select 'No.’ This benefit includes daycare expenses of your child, or other legal dependent who is physically or mentally incapable of self-care, so that the participant (or spouse) can work, look for work, or attend school full-time. See Dependent Care FSA Qualifications here.

Yes

17. A. DCAP/Dependent Care Individual(Required)

Since you selected 'Yes' on question 17, enter an election amount between $250 and $5,000 for Dependent Care Assistance Program - FSA. Enter as whole number without $ sign - like 250 or 1000. **IF ELECTING MID-YEAR, YOUR ELECTION AMOUNT CANNOT EXCEED $192.30 BIWEEKLY OR $96.15 WEEKLY.**

Please enter a number from 250 to 5000.

This field is hidden when viewing the form

DCAP/Dependent Care Effective Date

This field is hidden when viewing the form

Completion Date

WHEN YOU CLICK SUBMIT IT IS CONSIDERED 'SUBMITTED' IF YOU RECEIVE A MESSAGE ON THE SCREEN THAT SAYS 'Thank you for submitting your enrollment form on massfsatasc.com.' IF YOU DO NOT SEE THIS MESSAGE YOU HAVE NOT SUCCESSFULLY SUBMITTED THE FORM AND YOU WILL NEED TO CHECK THE FORM TO ENSURE THE REQUIRED FIELDS HAVE BEEN COMPLETED.

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