Baptist Health Public Transportation Benefit Program

BAPTIST HEALTH PUBLIC TRANSPORTATION BENEFIT PROGRAM

For Benefit-Eligible Employees

I understand my initial transit pass (EASY Card) will be sent to the mailing address reflected in PeopleSoft.

I acknowledge this benefit is limited to one transit pass for my individual use only and cannot be used for family members or shared with other employees.

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

Baptist Public Transportation Benefit Program

Employee Name: *

Employee No. *

Work Location: *

Department: *

To request a pass, please select one of the options below. *

Monthly Miami-Dade Metropass

Monthly Miami-Dade Metropass AND Metrorail Parking Permit

Monthly Tri-Rail EDP Pass

To cancel your pass, please check ‘yes’ *

Yes

Would you like to register for the Emergency Ride Home program and receive 6 free taxi rides in the event of an emergency or unscheduled overtime? *