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DocuSign Envelope ID: EA6C45CD-7691-43D8-B939-A4300A7DD233 <br /> VaVIII ue, SerVites, wtW IIIIG'° liiii liiii ° Sunrnary <br /> Implementation Fee(One-Time) N/C <br /> Administrative Fee(Per Participant per Month Including Debit Card) $4.50 <br /> Participant may have one or both accounts(MRA/Limited FSA and/or DCRA) <br /> Note: 5%of the annual Medical FSA election amounts will be required as pre funding to begin a debit card <br /> reimbursement relationship. <br /> Monthly Minimum Billing Requirement $150.00 <br /> ✓ Open Enrollment Materials and Plan Set Up Included <br /> ✓ Client choice of multiple data transfer or input methods Included <br /> ✓ Nondiscrimination Testing performed on an annual basis and as required Included <br /> ✓ Check Issuance or Direct deposit of Employee Reimbursement Funds Included <br /> ✓ Weekly Balance Reports provided to management via E-status protocol Included <br /> ✓ Robust flores247.com Flex Information Center and Te/eFLEX IVR System Included <br /> ✓ Reminder participant statements provided to all participants Included <br /> with positive balances in their accounts via e-mail or US Mail <br /> ✓ Multiple Open Enrollment options available including electronic Included <br /> (www.fsaenroll.com),spreadsheet or file upload <br /> ✓ End of Year Participant Statements available via Flex Information Center Included <br /> ✓ End of Year Company Financial recap report and 5500 Year End Information Included <br /> ✓ Flores"No-Wait" Dependent Care process requires only one claim/year Included <br /> ✓ Participant and Client Administrator web portals for real-time account access Included <br /> ✓ Weekly and monthly e-mail reporting to designated client contacts Included <br /> ✓ Participants with e-mail addresses on file receive E-status confirmations for Included <br /> claims receipt,claims adjudication,claims rejection, reimbursements,and <br /> reminders for end of plan year details <br /> ✓ Electronic storage of plan documents,forms,articles and videos Included <br /> ✓ Downloadable, bar-coded forms with pre-populated participant data Included <br /> ✓ Secure on-line claims submission and receipt upload at www.flores247.com Included <br /> ✓ Automated Debit Card substantiation reminders entering the on-line account Included <br /> ✓ Flores accuracy while following a published reimbursement schedule Included <br /> ✓ Annual 5500 Schedule C data provided to preparer following run out period Included <br /> ✓ No phone tree...live Account Managers and Operations Specialists Included <br /> ✓ Dedicated Account Manager based in Charlotte, NC Included <br /> Other Possible Service Fees <br /> • Relationship Termination/Cancellation Fee None with 60 days notice <br /> • Custom Data Interface Rare,customer quote <br /> • Paper Enrollment in the second and subsequent years Rare,$2.00 per participant <br /> • Most use electronic www.fsoenroll.com at no charge <br /> • Annual re-enrollment kits(hard copy) $0.35 each <br /> Most use the re-enrollment kit pdf option at no charge <br /> luniiitiiia if accepted <br /> ORANGE COUNTY 11 Flores <br />