Baptist Public Transportation Benefit Program


Payroll Deduction Authorization Form
(For Benefit-Eligible Employees)

I authorize Baptist Health South Florida to deduct the amount indicated on a pre-tax basis from my paycheck over two pay periods for the purchase of a discounted Miami-Dade Metropass and/or Tri-Rail Pass.  This pass is valid for one month at a time, and I agree to use it only for my own public transportation needs.

I understand that I may have to pick up my initial transit pass (EASY Card) from the Human Resources office at my Baptist Health facility, and it will be available the second month after I signed up to receive discounted passes.  I further understand that I may cancel my deduction at any time provided I give a 30-day notice. Any current pass in my possession is good for the month indicated and may not be refunded. If my employment with Baptist Health ends at any time after a pass has been ordered, I will not receive a refund of any deducted amount.  The pass is valid for the month indicated regardless of employment status with Baptist Health.

There is a $2.00 fee for the initial registration of your EASY Card.  There will be a $15.00 fee for the replacement of a lost or stolen EASY Card.  Please contact your HR site office or the Benefits Department immediately if your card is lost or stolen.  Any transportation fees incurred during the replacement period will be your sole responsibility.  

 

As it appears on your paycheck)




Deductions will be split in two equal payments.


(Acknowledges the terms set forth above.)

(This acts as your digital signature.)