25A - AGMT FOR FLEX SPENDING - Laserfiche WebLink

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DocuSign Envelope ID: CFCE3443-EF37-4FD4-8DCD-D85D559F77AE Exhibit A: Spending Account Services Fee Guarantee Period Begins on the Effective Date and ends December 31, 2023 Annual Anniversary Date: January 15t 1 Minimum Monthly Fee: $100 FSA (Section 125 Services) 2 & Commuter Benefit Administration3 FSA administration includes Limited and Full Purpose Health FSA and Dependent Care Assistance Plans. Commuter administration includes Qualified Transportation and Parking Plans. Commuter program design requirements apply!. Bundled rate. Monthly Participation Rate: $4.00 per participant per month Included Services List: These services are part of all Spending Accounts unless expressly indicated below. ✓ Implementation • Plan Configuration Support • Initial EDI Testing ✓ Client Relations Manager (CRM) ✓ Benefit Card Administrations (card stacked for multiple plans) ✓ Claim Review ✓ Client & Participant Portals ✓ Daily Reimbursement Remittance ✓ Direct Deposit Reimbursement ✓ Electronic Eligibility Updates ✓ Employer Reporting - scheduled and on demand ✓ Enrollment Processing and Eligibility Updates' ✓ FDIC Insured 'Once the Fee Guarantee Period expires, fees will renew as is on an annual basis unless new fee offerings are presented in writing 60 days prior to the Annual Anniversary Date. 'Participation fees are assessed by Plan Year and will remain billable until the Plan year has closed administration. Section 125 Services include standard and limited Health Flexible Spending Accounts as well as Dependent Care Reimbursement Account administration. A participant is billable as long as they are enrolled in at least one of the aforementioned account types. Igoe reserves the right to increase the monthly participation rate at any time due to increases in Federal Postage rates, changes to Federal legislation governing the provision of these services, or as a result of CPI adjustments (not to exceed 3%annually). 'The per participant fee is bundled across all commuter elections offered. Igoe reserves the right to Increase the monthly participation rate at anytime due to increases in Federal Postage rates, changes to Federal legislation governing the provision of these services, or as a result of CPI adjustments (not to exceed 3 % annually). 4Fot files received prior to the administrative effective date 'Includes 2 benefit cards per account (both initial cards and cards renewed due to standard card expiration) aEnrollment and Account Updates that require manual entry by an Igoe Associate are subject to a processing fee — please refer to the Billable Services List. 7 unnni,nwnv a i�� n i . City of Santa Ana Spending Account Administrative Services Agreement Client Initials: PEPM17 Page 17 25A-19