Cost of Living Adjustment (COLA) Adoption Form

Opt in for Cost of Living Adjustment (COLA)

The employer adopts this amendment to the Flexible Spending Account Plan (“Plan”) to adopt the statutory amount under Code Section (125(i) under the Flexible Spending Account.


The Employer has reserved the right to amend the Plan Document. The plan is amended as selected below:


The maximum amount of salary reductions that may be allocated to the Flexible Spending Account by a Participant in or on account of any Plan Year is the statutory amount under Code Section 125 (i), as adjusted for increase in the cost of living. The cost of living adjustment in effect for a calendar year applies to any Plan year beginning with or with such calendar year.


Elect Cost of Living Adjustment


By checking yes to the below box you are agreeing to allow the IRS annual inflation adjustments and maximum annual election.

Opt in for Cost of Living Adjustment (COLA)
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