HomeMy WebLinkAbout20083137.tiff RESOLUTION
RE: APPROVE AGREEMENT FOR ADMINISTRATIVE SERVICES AND AUTHORIZE CHAIR
TO SIGN -AMERIFLEX
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement for Administrative Services
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, and AmeriFlex, commencing January 1, 2009, with further terms
and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Agreement for Administrative Services between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County, and
AmeriFlex be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said agreement.
The above and foregoing Resolution was,on motion duly made and seconded, adopted by
the following vote on the 1st day of December, A.D., 2008.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:L ��
iam H. Jerke, Chair
Weld County Clerk tot f6 i� y i& ' n
a JAII
5�+ Robert,:D Masden, Pr --Tem
BY: //r /
Deputy Clerk to the Board '1
Willi F. Garcia (Th
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Date of signature: A Y
2008-3137
AC0020
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AGREEMENT FOR
ADMINISTRATIVE SERVICES
AMERIFLEX
This agreement dated January 1, 2009 outlines the services to be provided to WELD
COUNTY GOVERNMENT ("Company") in the ongoing administration of the Company's
Section 125 Cafeteria/Flexible Benefits Plan ("Plan"), and specifies the responsibilities of the
Company for the Plan Year.
WHEREAS, the Company is the Plan Administrator;
WHEREAS, AmeriFlex ("AmeriFlex") is a Third-Party Administrator engaged as a
subcontractor in the performance of administrative services for the Plan; and
WHEREAS, in no instance shall AmeriFlex be deemed to be, or be, the Plan Administrator.
NOW THEREFORE, in consideration of the mutual promises and covenants contained
herein and other good and valuable consideration the receipt, adequacy and
sufficiency of which is hereby acknowledged, it is hereby agreed as follows:
SECTION I — Administrative Services To Be Provided by AmeriFlex
1. AmeriFlex shall make commercially reasonable efforts to perform the Plan administrative
services detailed as follows (the "Services"):
a. Provide participant an election form for the initial enrollment process if requested. All
newly hired eligible employees and re-enrollment election forms can be downloaded from
the AmeriFlex Web site (www.flex125.com).
b. Process enrollment forms and revocation forms to initiate administrative functions.
c. Provide Company with Flexible Spending Account Reimbursement Claim form, which
includes mailing and faxing instructions for submitting/filing claims. Company
understands claim forms can be downloaded from the AmeriFlex Web site by visiting
www.flex125.com. Company further understands faxing of claims may not
necessarily expedite the claims processing system.
d. Provide reimbursement checks to plan participants (for approved claims) on a
reimbursement basis according to the Company's election on the funding instruction
worksheet found under separate cover. Each reimbursement check will include a
Statement of Account for the FSA activity year-to-date. FSA Debit Card holders can
also receive account information by visiting www.theflexcard.com or
www.flex125.com (employee section).
e. Provide a check register report for all checks printed and mailed upon completion of
scheduled check runs. In addition, if Company has elected the FSA Debit Card
option, debit card charges will be provided on a weekly basis for immediate funding,
unless another funding option is elected. Furthermore, Company agrees to either
pre-fund or allow AmeriFlex to automatic bank draft (via corporate ACH) all claims
transactions if the Company has elected the debit card option.
f. Provide each participant with a Statement of Account (FSA Balance Memo) with each
manual claim processed.
g. Provide the required Internal Revenue Service (IRS) non-discrimination testing,
reported on a quarterly (if premium tracking option is elected) and annual basis.
Testing shall include: the MFSA 70% Eligibility test, and the DCSA 55% Average
Benefits test. If monthly premium record keeping and tracking services are
contracted (please refer to Schedule "A"), the 25% Concentration test, 1000/0 and
75% Health Insurance test, and the Benefit Ratio Health Insurance test shall also be
completed along with the MFSA and DCSA testing. If monthly premium record
keeping and tracking services are not contracted (please refer to Schedule "A"),
AmeriFlex shall not be liable for any non-compliance with IRS non-discrimination
testing requirements.
h. Provide forms to Company for use by Company in communicating changes in census
information, participant terminations, and changes of family status. Company
understands census and change in family status forms can be downloaded from the
AmeriFlex Web site by visiting www.flex125.com.
i. Provide monthly reporting by participant in the event there is at least one FSA plan
participant. If there are no FSA plan participants, reporting shall be on an annual
basis.
j. When requested and if required, provide Form 5500 support services.
k. Provide access to AmeriFlex representatives to answer questions that the Company
may have throughout the plan year and to keep the Company informed of any tax
law changes that may affect their Section 125 Cafeteria/Flexible Benefits Plan.
I. Provide AmeriFlex Customer Service representatives to answer employee phone
inquiries regarding FSA claims and account balances.
m. Design or review (whichever is applicable) a Section 125 Cafeteria/Flexible Benefits
Plan document, a Dependent Care Assistance Plan ("DCSA"), and a Medical Expense
Reimbursement ("MESA") Plan document (to be reviewed by the Company and the
Company's legal counsel).
n. Design or review (whichever is applicable) a Summary Plan Description (SPD), as
required by the USDOL, to be distributed to each plan participant.
2. AmeriFlex, at its own expense, may secure the services of, and subcontract with,
actuaries, computer service firms, printers, or other entities or persons it deems
necessary in performing the Services.
SECTION II - Fees
1. Company and AmeriFlex have agreed to a fee schedule as set forth on Exhibit A.
AmeriFlex will bill Company monthly, quarterly or annually. Unless otherwise set forth
on Exhibit A, AmeriFlex will submit a statement to Company detailing the fees for that
month broken down by the number of plan participants and the employee per
participant charge. The employee count will be the number of active employees as of
the last day of the previous month. Company agrees to pay in full AmeriFlex's bill for
fees upon receipt of the statement. Company shall pay a late payment surcharge of
one and one-half percent (1.50/0) per month for all fees that are over thirty (30) days
past due. If Company is over ninety (90) days past due, the remaining balance of the
amount owed under the Agreement will become due and payable. Company shall have
ninety (90) days to pay all past due amounts. Company shall be responsible for all fees
incurred by AmeriFlex related to the collection of any past due amounts.
2. AmeriFlex will separately charge (at an hourly rate specified in Exhibit A - "Fee
Schedule") for any service not previously mentioned, including but not limited to:
Amendments to the plan document(s) as may or may not be required by tax law
changes, amendments to the Summary Plan Description(s) as may or may not be
required by tax law changes, and/or any additional Cafeteria/Flexible Benefit Plan
benefits to be added to the program that will require a plan document and Summary
Plan Description.
3. AmeriFlex reserves the right to modify at any time any or all services and fees which are
a part of this Agreement by providing the Company with sixty (60) days prior written
notice. The Company shall then have thirty (30) days in which to terminate this
Agreement without prejudice and without any cancellation fees (as described in Section
IV paragraph 2) by providing AmeriFlex with written notice of its intent to terminate the
Agreement. If no such notification is received by AmeriFlex, the modified services
and/or fees shall become effective as announced. AmeriFlex shall have the right to
immediately modify any services or fees in the event of any law changes established by
the IRS and/or the USDOL which affect the reporting and administrative procedures
currently used by AmeriFlex. AmeriFlex shall provide Company with written notice of
any such modifications.
4. If AmeriFlex fails to provide Company with the services set forth herein and such failure
is due to the bad faith, willful misfeasance, or reckless disregard of duties by AmeriFlex
and said failure continues for thirty (30) days after receipt of written notice by Company
of such failure, AmeriFlex shall credit Companies monthly Administration Fees equal to
1/4 (25%) of the fees due in the month in which the failure occurs.
SECTION III — Responsibilities of the Company
1. The Company shall have the following responsibilities in order to assist AmeriFlex in
accurately and correctly providing the Services under this Agreement:
a. Report any changes in the Company's employee census (i.e., employee terminations,
new hires, name changes, benefit election changes, and/or address changes). A
Change of Status form will be provided and can be faxed to AmeriFlex's Enrollment
Department.
b. Report participant changes in family status to AmeriFlex within thirty (30) days of
the event.
c. Distribute participant statements of account to employees.
d. Provide AmeriFlex with adequate funding, according to the funding instruction
worksheet found under separate cover, to process reimbursement requests and debit
card activity. AmeriFlex will not mail any FSA reimbursement checks unless the
Company's AmeriFlex claims account is current.
e. The Company understands that their Medical Expense Reimbursement Plan (MFSA)
may require Company to advance an employee's annual MFSA election to pay an
approved claim per IRS and USDOL regulations. AmeriFlex will not advance, supply,
or provide any funds required to pay MFSA shortfall claims. This potential financial
obligation is the sole responsibility of the Company according to IRS and USDOL
regulations.
f. It is the Company's responsibility to provide AmeriFlex with a list of Key Employees
{as defined in IRC '416(i)(1)(A)} and a list of Highly Compensated Employees {as
defined under IRC '414(q)}. AmeriFlex will not be held liable for any IRS penalties or
adverse tax consequences for a discriminatory plan if Company fails to provide
AmeriFlex with such information and any changes (including, but not limited to,
employees becoming key employees and/or highly compensated employees) during
the plan year. Furthermore, Company agrees to initiate any and all actions required
in the event plan(s) becomes discriminatory.
g. Initiate any action required in the event of tax law changes that directly affect any
legal or administrative function associated with the Section 125 Cafeteria/Flexible
Benefits Plan.
h. Secure legal review (if documents were prepared by AmeriFlex) of the
Cafeteria/Flexible Benefits Plan Document, the Medical Expense Reimbursement Plan
Document, the Dependent Care Assistance Plan Document, and each Summary Plan
Description from Company's legal counsel if Company deems this necessary.
i. If Company is a Partnership, a Sole-Proprietor, a Sub-Chapter S Corporation, or a
Limited Liability Corporation (LLC), Company understands that certain individuals
cannot participate in the pre-taxation of qualified benefits, including Medical and
Dependent Care Flexible Spending Accounts. These individuals include: Partners in a
Partnership, Sole-Proprietors, 2% or more Shareholders of a Sub-Chapter 5
Corporation, and Members in a Limited Liability Corporation (LLC). This is in
accordance with IRC "126(d)(1)(A) and 401(c) and Prop. Treas. Reg. '1.125-1, Q&A
4. It is the Company's responsibility to notify AmeriFlex if the Company is organized
under any of the above structures; and it is the Company's responsibility to notify
AmeriFlex if Company changes its structure at any time.
j. Provide COBRA notices to employees upon enrollment and upon any COBRA
qualifying event if the Company is subject to COBRA.
2. All reports and data provided to AmeriFlex by the Company shall remain the property of
the Company. Upon request, AmeriFlex will provide the Company with all data in the
printed format used by AmeriFlex in its administrative procedures.
SECTION IV — Term and Termination
1. This Agreement shall commence on the date first written above and shall continue in full
force until the last day of the Plan Year This Agreement shall automatically renew for
succeeding periods of twelve (12) consecutive months unless either Party gives prior
written notice of termination at least ninety (90) days prior to such period's termination
date. If this Agreement is not renewed, AmeriFlex will provide a claims run-out service
for the time period requested by the Company, to be billed at the same monthly fee in
effect at the end of the previous plan year.
2. AmeriFlex may terminate this Agreement for the Company's breach of the material
terms of the Agreement if the breach continues for thirty (30) days after written notice
has been provided to AmeriFlex; provided, however, if such breach cannot be cured
within such thirty (30) day period, Company shall have such additional time as
necessary to cure the breach so long as it is diligently pursuing a cure. In the event this
Agreement is terminated, AmeriFlex will be entitled to its administrative fees due
through the end of the contract period. The remaining administrative fees shall be
calculated based on the amount billed for the month prior to termination. Those
provisions which by their nature would survive or otherwise expressly survive the
termination will survive termination. Company may terminate this Agreement for
AmeriFlex's material breach of Section V if the breach continues for thirty (30) days
after written notice has been provided to AmeriFlex; provided, however, if such breach
cannot be cured within such thirty (30) day period, AmeriFlex shall have such additional
time as necessary to cure the breach so long as it is diligently pursuing a cure.
SECTION V — Claims Information/HIPAA Business Associate Contract
Provisions
1. All capitalized terms in this section, not otherwise defined herein, shall have the
meanings given to such terms in the HIPAA Privacy Rule (the "Privacy Rule"). Any
ambiguity in this Section V shall be resolved to permit Company to comply with the
Privacy Rule.
2. HIPAA Privacy Obligations and Activities of AmeriFlex:
a. AmeriFlex shall not disclose Protected Health Information other than as permitted or
required by this Agreement or as required by law.
b. AmeriFlex shall use reasonable safeguards to prevent any use or disclosure of the
Protected Health Information that is not permitted by this Agreement or by law.
c. AmeriFlex shall report to Company any use or disclosure (of which AmeriFlex
becomes aware) of the Protected Health Information that is not permitted by this
Agreement or by law.
d. AmeriFlex shall make reasonable efforts to ensure that any agent of AmeriFlex,
including a subcontractor, to whom AmeriFlex provides Protected Health Information
that is received from the Company, or that is created or received by AmeriFlex on
behalf of Company, will agree to the same restrictions and conditions that apply
throughout this Agreement to AmeriFlex with respect to such information.
e. AmeriFlex agrees to provide access, at the request of Company, to Protected Health
Information in our databases and files to Company or, as directed by Company, to
an Individual in order to meet the requirements under 45 CFR 164.524 as in effect
from time to time.
f. AmeriFlex agrees to make any amendment(s) to Protected Health Information in
their databases and files that the Company directs pursuant to 45 CFR 164.526 as in
effect from time to time at the request of Company or an Individual, as directed by
Company.
g. AmeriFlex agrees to make internal practices, books, and records, including policies
and procedures and Protected Health Information relating to the use and disclosure
of Protected Health Information received from, or created or received by AmeriFlex
on behalf of Company, available to Company as designated by the Secretary of the
Department of Health and Human Services or his designee (hereinafter referred to as
Secretary) for purposes of the Secretary determining Company's compliance with the
Privacy Rule.
h. AmeriFlex agrees to document such disclosures of Protected Health Information and
information related to such disclosures as would be required for Company to respond
to a request by an Individual for an accounting of disclosures of Protected Health
Information in accordance with 45 CFR 164.528 as in effect from time to time.
i. AmeriFlex agrees to provide Company or an Individual, as directed by Company,
information collected in accordance with Section VII (h) of this Agreement, to permit
Company to respond to a request by an Individual for an accounting of disclosures of
Protected Health Information in accordance with 45 CFR 164.528 as in effect from
time to time.
3. HIPAA Privacy Obligations of the Company
a. Company shall notify AmeriFlex of any limitation(s) in its notice of privacy practices
of Covered Entity in accordance with 45 CFR 164.520 as in effect from time to time,
to the extent that such limitation may affect AmeriFlex's use or disclosure of
Protected Health Information.
b. Company shall notify AmeriFlex of any changes in, or revocation of, permission by an
individual to use or disclose Protected Health Information, to the extent that such
changes may affect AmeriFlex's use or disclosure of Protected Health Information.
c. Company shall notify AmeriFlex of any restriction to the use or disclosure of
Protected Health Information that Company has agreed to in accordance with 45 CFR
164.522 as in effect from time to time, to the extent that such restriction may affect
AmeriFlex's use or disclosure of Protected Health Information.
4. Permitted Uses and Disclosures by AmeriFlex
a. Except as otherwise limited in this Agreement, AmeriFlex may use or disclose
Protected Health Information to perform functions, activities, or services for, or on
behalf of, Company as specified in this Agreement, provided that such use or
disclosure would not violate the Privacy Rule, if done by the Company, or the
minimum necessary policies and procedures of the Company.
b. Except as otherwise limited in this Agreement, AmeriFlex may use Protected Health
Information for the proper management and administration of AmeriFlex or to carry
out the legal responsibilities of AmeriFlex.
c. Except as otherwise limited in this Agreement, AmeriFlex may disclose Protected
Health Information for the proper management and administration of AmeriFlex,
provided that disclosures are required by law or that AmeriFlex obtains reasonable
assurances from the person to whom the information is being disclosed that the
information will remain confidential and used or further disclosed only as required by
law or for the purpose for which it was disclosed to the person, and that the person
will notify AmeriFlex of any instances of which it is aware in which the confidentiality
of the information has been breached.
d. Except as otherwise limited in this Agreement, AmeriFlex may use Protected Health
Information to provide Data Aggregation services to Company as permitted by 42
CFR 164.504(e)(2)(i)(B) as in effect from time to time.
e. AmeriFlex may use Protected Health Information to report violations of law to
appropriate Federal and State authorities, consistent with 42 CFR 164.502(j)(1) as in
effect from time to time.
5. Upon termination of this Agreement, for any reason, and at the Company's expense,
AmeriFlex shall return or destroy all Protected Health Information that was provided by
Company, or that was created or received by AmeriFlex on behalf of Company. This
provision also shall apply to Protected Health Information that is in the possession of
subcontractors or agents of AmeriFlex. AmeriFlex shall retain no copies of the Protected
Information.
SECTION VI - Indemnification
1. The Company shall indemnify, defend and hold harmless AmeriFlex from, against and
with respect to any claim, liability, obligation, loss, damage, assessment, judgment,
settlement, cost and expense, reasonable attorney's and accountant's fees, and costs
and expenses reasonably incurred in investigating, preparing, defending against or
prosecuting any litigation or claim, action, suit, proceeding or demand against AmeriFlex
that is caused by any acts, omissions, or conduct arising out of the performance of the
Services , except in relation to matters resulting from, or arising out of, any acts or
omissions of AmeriFlex, its agents, employees, subcontractors, or other representatives
or designees which have been determined to constitute bad faith, willful misfeasance, or
reckless disregard of duties. The Company shall hold AmeriFlex harmless for
overpayments made to FSA participants for Company's failure to notify AmeriFlex of an
FSA participant's termination, change in family status, etc. Company further agrees to
indemnify AmeriFlex from, against and with respect to any claim, liability, obligation,
loss, damage, assessment, judgment, settlement, cost and expense, reasonable
attorney's and accountant's fees, and costs and expenses reasonably incurred in
investigating, preparing, defending against or prosecuting any litigation or claim, action,
suit, proceeding or demand against AmeriFlex that is caused by any acts, omissions, or
conduct arising out of the performance of any Services subcontracted under this
Agreement to third-party FSA debit card providers.
2. AmeriFlex agrees to indemnify the Company and its respective partners, associates, and
employees from, against and with respect to any claim, liability, obligation, loss,
damage, assessment, judgment, settlement, cost and expense, reasonable attorney's
and accountant's fees, and costs and expenses reasonably incurred in investigating,
preparing, defending against or prosecuting any litigation or claim, action, suit,
proceeding or demand against the Company that is caused by any acts, omissions, or
conduct arising out of the performance of the Services by AmeriFlex, its agents,
employees, subcontractors, or other representatives or designees which have been
determined to constitute bad faith, willful misfeasance, or reckless disregard of duties.
SECTION VII - Confidentiality
1. Company and AmeriFlex shall hold in strict confidence, unless compelled to disclose by
judicial or administrative process or by other requirements of law, all documents and
information concerning the other Party furnished to it by the other Party or its
representatives in connection with the transactions contemplated by this Agreement.
(except to the extent that such information shall be shown to have been (a) previously
known by the Party to which it was furnished, (b) in the public domain through no fault
of such Party or (c) later lawfully acquired from such other sources by the Party to which
it was furnished), and each Party shall not release or disclose such information to any
other person or entity. Each Party shall be deemed to have satisfied its obligation to
hold confidential information concerning or supplied by the other Party if it exercises the
same care as it takes to preserve confidentiality for its own similar information.
SECTION VIII — Miscellaneous
1. Subsidiaries, Affiliates, Employees and Agents. The provisions of this Agreement extend
to all subsidiaries and affiliates of the Parties as well as all officers, directors, employees,
agents and other persons now or hereafter employed by or associated with the Parties
or any affiliated entity (ies), affiliate(s), subsidiary (ies) or corporation(s) of which the
Parties own or hold an interest. The Parties agree to take all reasonable precautions to
assure that each and all of the aforementioned persons are aware of and shall be bound
by the provisions of this Agreement.
2. Governing Law and Dispute Resolution. The Parties expressly acknowledge and agree
that this Agreement is made in Cherry Hill, New Jersey. The validity, construction and
performance of this Agreement shall be governed by and interpreted in accordance with
the laws of the State of New Jersey. Notwithstanding any law to the contrary, any
dispute between the Parties relating to the execution, performance, validity,
interpretation or construction of this Agreement that cannot be resolved amicably
between the Parties shall be submitted to the exclusive jurisdiction of the courts of the
State of New Jersey or the United States District Court for the Eastern District of
Pennsylvania. The Parties hereto consent to the exclusive jurisdiction of the courts of
Burlington County, New Jersey or the United States District Court for the Eastern District
of Pennsylvania in any and all actions or proceedings arising under this Agreement.
3. Notices. All notices, consents, requests, demands and other communications hereunder
are to be in writing, and are deemed to have been duly given or made: (a) when delivered
in person, (b) three (3) days after deposited in the United States Postal Service, first class
postage prepaid, (c) in the case of telegraph or overnight courier services, one business
day after delivery to the telegraph company or overnight courier service with payment
provided for, or (d) in the case of telex or telecopy, when sent, verification received, in
each case addressed as follows:
To AmeriFlex: AmeriFlex Compliance Officer
700 East Gate Drive, Suite 510
Mount Laurel, New Jersey 08054
To Company:
or to such other address as either Party may designate by notice to the other Party in
accordance with the terms of this Section.
4. Assignment. Neither this Agreement nor any of the provisions hereof may be assigned
by either Party without the prior written consent of the other Party, which consent shall
not be unreasonably withheld. Nothing in this Agreement, expressed or implied, is
intended to confer any rights or obligations on any person other than the Parties, their
respective successors and permitted assigns.
5. Amendment. This Agreement and any provisions herein contained may not be modified
or amended except by a writing signed by both Parties. The Parties agree to take such
action as is necessary to amend this Agreement from time to time in order for Company
to comply with the requirements of the Privacy Rule and the Health Insurance Portability
and Accountability Act of 1996, Pub. L. No. 104-191 as in effect from time to time.
6. Entire Agreement. This Agreement constitutes the entire understanding between the
Parties and supersedes any prior writings or communications with respect to its subject
matter.
7. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the
Parties hereto and their respective successors and permitted assigns.
8. Severability. Whenever possible, each provision of this Agreement shall be interpreted
in such manner as to be effective and valid under applicable law, but if any provision
shall be prohibited by or invalid under applicable law, such provision shall be ineffective
only to the extent of such prohibition or invalidity, without invalidating the remainder of
such provision or the remaining provisions of this Agreement.
9. Captions. The captions of the paragraphs of this Agreement are for convenience only
and are not intended to affect the interpretation or construction of the provisions herein
contained.
IN WITNESS WHEREOF, the Company and AmeriFlex have executed this Agreement
effective as of the month, day, and year first written above.
WELD COUNTY GOVERNMENT
By in:—/ L G✓
Authorized Signer William H. Jerke, Chair
12/01/2008
AmeriFlex
By /s/ Nicole Petras
Exhibit A
"Fee Schedule"
ONE-TIME CHARGES
Initial plan design, consulting, and installation fee Waived
MONTHLY FEES
Monthly administration fee per participant $5.00
Note: A minimum monthly fee of $60 shall apply.
PRINTING COSTS
One set of plan documents, summary plan description, and election forms are included
during the first year in the one-time setup charges. Additional employee support materials
are available "at cost" for the Company. High resolution PDF's of all AmeriFlex support
materials can be accessed via the AmeriFlex web site at www.flex125.com.
OTHER CHARGES
Annual Non-Discrimination Testing (upon request) Included
Preparation of Annual Financial Report Included
Optional 2.5 Month Extension (at point of application or renewal) Included
Annual Renewal Fee Waived
Stop Payment Fee on Reimbursement Checks (per check) Waived
Hourly Consultant Billing Rate for Services Not Included Within the Agreement $ 125.00
Hourly Clerical Billing Rate for Services Not Included Within the Agreement $ 40.00
The Other Charges are for services that need only to be performed on an as needed basis.
Claims processing, check disbursements, employee statements, company reports, and non-
discrimination testing are included in the monthly fees.
Exhibit A rates are guaranteed for the initial Plan Year, whether a regular Plan Year or a "short"
Plan Year.
ESA DEBIT CARD ADDENDUM
1. This FSA Debit Card Addendum (the "Addendum") is attached to and made part of that
Agreement for AmeriFlex Administrative Services (the "Agreement").
2. This Addendum hereby incorporates the terms and conditions of the Agreement. In the
event of a conflict with the terms and conditions of this Addendum, the provisions of this
Addendum shall control.
3. The term of this Addendum shall begin as of the effective date of the Agreement,
subject, however, to earlier termination by AmeriFlex or Company. This Addendum shall
automatically renew for successive one (1) year terms, unless either Party gives prior
written notice of termination at least sixty (60) days prior to such period's termination
date. This Addendum may be terminated by either Party for a breach of the material
terms of the Addendum if the breach continues for fifteen (15) days after written notice
has been provided to the breaching Party.
4. Company agrees to utilize AmeriFlex's Flex Claims Account for the Plan and authorizes
the disbursement of funds to pay for Card Transactions. Company will pre-fund
employee accounts according to the terms of the selected funding option and maintain
this minimum balance throughout the Term.
5. The Company shall provide AmeriFlex with sufficient assurances that funds will be
available on a timely basis to fund Card Transactions from the Claims Account. When
the Master Account falls below the Minimum Funding Amount, Company agrees to make
additional funds available immediately in an amount sufficient to restore the Master
Account to the Minimum Funding Amount. This can be completed via check, wire
transfer, or ACH.
6. Company accepts responsibility for ensuring that all applicable fees shall be paid to
AmeriFlex. Such fees are due and payable upon receipt (all fees are subject to change
on an annual basis upon 30 days notice). A fee may be assessed to replace cards or to
request additional cards.
7. Company understands that it is responsible to immediately notify AmeriFlex that
termination of an employee participating in the Plan has occurred so that AmeriFlex can
immediately deactivate the participant's card. Company is also responsible for the
immediate retrieval of the card from the employee upon termination. Company will be
held accountable, to the extent permitted by law, for any expenditures made by a
terminated employee with the card as a result of Company's failure to retrieve the card
and/or provide immediate notice to AmeriFlex of employee's termination.
8. If the FSA debit card option is elected by Company, Company understands AmeriFlex is
not responsible for the SIC code assigned to qualified providers by MasterCard®, and
AmeriFlex has no control over the correction of any improperly assigned SIC code. If
Company requests AmeriFlex to "override" the FSA debit card claims system for a
particular SIC code, Company agrees to indemnify and hold AmeriFlex harmless for any
and all non-qualified claims paid via the FSA debit card process. Furthermore, Company
understands it is the responsibility of the FSA participant to refund the Company's FSA
program for any and all qualified or non-qualified overpayments
9. Company also agrees to retrieve the card from any employee who continually attempts
to use the card for Non-Qualified Services.
10.Company agrees to comply with all rules and regulations applicable to the debit card
system as promulgated by the debit card vendor from time to time and to comply with
all MasterCard® operating rules and regulations.
The above Terms and Conditions hereby enumerated are fully accepted by:
WELD COUNTY GOVERNMENT
By: /
4-6
Authorized Company Signer William H. Jerke, Chair
12/01/2008
AmeriFlex
By: /s/ Nicole Petras
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