HomeMy WebLinkAboutFlex Benefit Plan 2007-2011
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City of Oshkosh
Flexible Benefit Plan
Agreement for Service
01/01/2007 - 12/31/2011
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ffi. DI~ERSIFIED BENEFIT SER~ICES, INe.
- Dedicated to Excellence in Benefit Management Solutions
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AGREEMENT between the EMPLOYER designated below and DIVERSIFIED BENEFIT SERVICES, INC. ("DBS")
WHEREAS, DBS is making available a Flexible Benefit Plan, to be established by the Employer and designed to comply
with Section 125 of the Internal Revenue Code (the "Code").
WHEREAS, the Flexible Benefit Plan incorporates professional material, and internally developed corporate information.
NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL PROMISES AND AGREEMENTS HEREIN
CONTAINED, THE RECEIPT AND SUFFICIENCY OF WHICH IS HEREBY ACKNOWLEDGED, THE PARTIES
AGREE AS FOLLOWS:
1. DBS agrees to make available the Flexible Benefit Plan to be used as the Employer Flexible Benefit Plan. Employer
agrees not to disclose details of the Plan to other parties or copy any materials provided, except for auditors, attomeys,
and others to whom disclosure is legally required, unless DBS gives permission to do so.
2. Employer retains DBS as Plan Agent for the Employer Flexible Benefit Plan and authorizes DBS to perfOlID all
functions necessary to prepare, implement, and operate the Employer Flexible Benefit Plan.
3. Employer agrees to provide data that DBS needs in communication and enrollment of the Flexible Benefit Plan.
Employer also agrees to make the necessary payroll deductions and assist DBS for implementing and operating the
program.
4. DBS services may include some or all of the following items (as needed); restatement of a Flexible Benefit Plan
document, summary plan description, ancillary forms, sample board of directors resolution, enrollment of the employees
of the Employer, and claims recordkeeping. Also, annual discrimination testing required under Code Section 125,
specifically the 25% test. The Employer agrees to provide all plan contribution information to DBS, including any group
insurance premium contributions to allow DBS to conduct proper testing. Only the dependent care testing will be
completed if the Employer elects not to provide group insurance premium contribution amounts to DBS. The testing
will be conducted only if the Employer provides timely information on key and highly compensated employees as
requested by DBS. Other package services specified in the attached Schedule A may be provided as noted by the
Employer circling the service package desired.
5. Employer agrees to pay to DBS the fees for services as listed in the attached Schedule A. If the Employer elects to have
the employee pay the monthly ongoing administration fee and an employee terminates with a balance in an account, the
Employer shall be responsible for the monthly fee from that point forward. In addition, Employer recognizes that the
Plan allows employees to submit claims after Plan year-end for a specified period in accordance with the Plan document.
Employer understands and agrees that during this plan year run out period, fees will be invoiced on the same basis as the
previous months of the plan year and will be for the run out period. This will be shown as a separate line item .on the
invoice. In addition, a separate line item on the invoice will be for services pertaining to the new plan year coverage
period.
6. Employer monthly invoices are due upon receipt. If the invoice is not paid within 30 days of the date showing on the
invoice, DBS reserves the right to cease performing services under this Agreement.
7. Any overpayments to employees as a result of the Employer not notifying DBS as to status changes via the DBS Status
Change Notification Form or other agreed upon format by both parties as of the claim cut-off date, will be the
responsibility of the Employer. Any subsequent bank charges as a result of the aforementioned will be the responsibility
of the Employer. Requests by the Employer for processing special checks (meaning checks not processed at the regular
claims processing date) due to an employee filing late claim(s), (meaning claim(s) received by DBS after the claims
deadline date), or for lost or stolen checks will be done for a fee of $25 per check. If an employee or former employee
fails to retain original documentation regarding claims submitted to DBS and the employee or former employee requests
copies of claims and/or documentation from DBS because of an audit by the IRS or another agency, there will be a fee of
$50/hour plus .25 per copy made. This will only be authorized by the Employer and will be billed to the Employer if
authorization is obtained.
8. Employer agrees to pay to DBS the agreed upon fee indicated for other services listed on attached Schedule A by placing
initials next to the service package desired located at the bottom of schedule A. This agreement does not cover any
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ffi. DI~ERSIFIED BENEFIT SER~ICES, INC.
- Dedicated to Excellence in Benefit Management Solutions
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possible future Government imposed costs regarding auditing of Flexible Benefit Plans. Also, it is not within the scope
of this agreement to cover possible future Government imposed costs with regard to filing fees for any Government
forms, documents, or year-end (5500) reports. The term "Government" shall include but not be limited to the United
States Government, Internal Revenue Service, Department of Labor, or a State within the United States.
9. This agreement shall be exclusive and remain in effect for a period of five full plan years wherein both parties have
signed and dated said Agreement ("Initial Term"), after which time it shall be renewed automatically for successive five
plan year periods ("Renewal Terms"), unless one party notifies the other in writing at least 60 days prior to the renewal
date that it does not intend to renew. The renewal date shall be the end ofthe fifth plan year. Notification under Section
9 of this Agreement shall be deemed duly given if delivered by certified or registered mail with postage prepaid to DBS
or the Employer.
10. Notwithstanding the preceding paragraphs, either party may terminate this Agreement for cause at any time. "Cause"
shall be limited to any of the following reasons: (a) if either party fails to perform its duties hereunder and such failure is
not cured within thirty days of receipt of written notice thereof; (b) if all or any portion of the plan fails to comply with
applicable provisions of the Code and regulations thereunder or state regulations; or (c) if some or all of the Plan is not
legally or validly implemented.
11. If the Employer terminates the Agreement without cause during the Agreement period ("Initial Term or Renewal
Term"), the Agreement must be purchased by the Employer. Such Agreement buyout shall be based upon the fees that
would have been charged for the remainder of the agreement period for such services as future enrollment, monthly
administration, miscellaneous, and any package services that may apply. Such fees shall be those as set forth in the
attached Schedule A of the Agreement. Payment of the final invoice shall be due upon receipt. If the final invoice is not
paid as described DBS will not process claims and/or reports until full payment is made by the Employer.
12. If the Employer is purchased by another organization and/or merges and/or affiliates with another organization, the terms
of this Agreement shall remain in full force and shall be binding until the end of the term of the Agreement unless a
buyout of the Agreement is agreed to. Any buyout of the Agreement shall be the fees that would have been charged for
the remainder of the agreement period. Such fees shall be based upon the attached Schedule A of the Agreement
including enrollment, monthly administration, miscellaneous, and any package fees that may apply.
13. DBS shall have the right to retain, at its own cost, outside services in preparing, implementing and operating of the Plan.
14. Nothing contained herein shall obligate Employer to utilize DBS as its agent or broker in providing group benefits to
employees.
15. Employer recognizes that the Plan Document is an important legal document and that it has been prepared based on the
understanding ofDBS of the desired provisions. To ensure that the plan document conforms to the Employer's situation
the Employer should consult with its attorney on the legal and tax implications of the plan. Employer recognizes that
DBS is not a law firm and that DBS employees are not attorneys. Additionally, Employer recognizes that DBS is not an
accounting (CPA) firm.
16. Employer agrees to indemnify and hold harmless DBS, its affiliates, and any of its directors, officers or employees with
respect to any and all claims, liabilities, losses, damages, or expenses, including reasonable attorneys' fees, incurred by
reason of the failure of the Employer to carry out its obligation under this Agreement on a timely and non-negligent
basis, unless such failure is based upon the negligence ofDBS or any of its employees.
17. DBS agrees to indemnify and hold harmless Employer, its affiliates, and any of its directors, officers or employees with
respect to any and all claims, liabilities, losses, damages, or expenses, including reasonable attorneys' fees, incurred by
reason of the failure of DBS to carry out its obligation under this Agreement on a timely and non-negligent basis, unless
such failure is based upon the negligence of Employer or any of its employees.
18. This exclusive Agreement, including Schedule A, constitutes the entire understanding of the parties and may be modified
only in writing executed by both parties. It shall be binding upon both parties and their successors or assigns and shall
be interpreted under the laws of the State of Wisconsin.
19. Plan years covered by the "Initial Term" of this Agreement shall be 01/01/2007 - 12/31/2011.
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ffi. DI~ERSIFIED BENEFIT SER~ICES, INC.
- Dedicated to Excellence in Benefit Management Solutions
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Dated this 15th day of November
,2007.
Title: Acting City Manager
itle: Ci ty Cl erk
ing City Attorney
Diversified Benefit Services. Inc. - "DBS"
By:
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Title: President
Witness:
~i lj)~ ~-AA/J
Title: Compliance & Enrollment
I provisions
have been made to pay the liability which will
accrue under this contract
20A.Jr~ Cl V\N~
City Comptroller
APPROVED
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'::: CITY AT . ~
OSHKOSH, WISCONSIN
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ffi. DI~ERSIFIED BENEFIT SER~ICES, INC.
- Dedicated to Excellence in Benefit Management Solutions
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City of Oshkosh Schedule A
1. Plan Implementation
Fees for plan consultation, Plan Document amendments, updating, restatement, summary plan description changes, client
generated benefit or plan changes that require the updating, changing, or restating of the plan document or summary plan
description will be quoted and billed separately. (Printing of summary plan descriptions will be quoted and billed separately).
Fee: No Charge
2. Group Meetin2:s
Flexible Benefit Plan materials for new employees, group presentationes) with the communication of the Flexible Benefit
plan and explanation of expense worksheet and related materials to employees as needed.
Fee: Included (travel and lodging extra if applicable)
3. Compliance/Emplovee Enrollment/Plan Year Election Entrv/Related Services
(Emplover Choice) (Minimum group fee for all enrollment choices is $75.00.)
A. Individual Emplovee Meetin2:s. Services will include comprehensive individual employee enrollment sessions with
DBS Benefits Enrollers with review of employee flexible benefit plan worksheet/employee guide. The DBS notebook
computer system may be utilized if appropriate. Also includes the completion of enrollment forms and providing
employees with an expense reimbursement kit. This section also includes establishing plan records on the DBS flexible
benefit plan software administration system, preliminary plan compliance, election auditing, and other related in..house
plan year setup services.
B. Emplover self-enrollment. Under option B (1) Employer will provide enrollment forms and/or packets or DBS will
provide the Employer with self-enrollment packets including a worksheet, enrollment form and additional plan material.
An enrollment letter and plan fact sheet will be provided as well. DBS will supply the Employer with claim forms
and/or expense reporting kits as needed. This section also includes establishing plan records on the flexible benefit plan
software administration system, preliminary plan compliance, election auditing, and other related in-house plan services.
Under option B (2) the Employer may choose to have DBS Benefits Enrollers available for a limited period of time at
various sites for individual employee enrollment sessions which also may include benefits fairs. The sites and schedule
would be determined prior to the enrollment sessions. If option "B" Employer self-enrollment is selected and DBS
provides limited enrollment with DBS enrollers then items (1) and (2) below will apply for fee calculation purposes. If
no DBS enrollers are involved then item (1) below will apply for enrollment billing purposes. Under Option (3) DBS
will provide an electronic file of the enrollment packet for Employer to E-mail to eligible employees or to print and
distribute packets to eligible employees.
C. Online Internet enrollment. DBS will provide the Employer with an enrollment instruction letter and plan infonnation
letter that includes a system password for User name and PIN. This will allow employees access to the DBS Website
and Online enrollment system. Employees will receive screen confirmation when submitting their election information
with print capability. The Employer agrees to distribute the enrollment letter with instructions to all eligible employees.
DBS will provide the Employer with copies of completed online enrollment forms if desired. This section also includes
establishing plan records on the flexible benefit plan software administration system, preliminary plan compliance,
election auditing, and other related in-house plan year setup services.
Option A Fee: Individual employee meetings with benefit enrollers: $10.00 per eligible employee for each plan year.
Option B Fee: (1) Employer self-enrollment using paper packets: $1.50 per eligible employee for each plan year plus
$2.00 per FSA participant for each plan year.
(2) Limited enrollment with benefit enrollers:
$200/enroller/day
(travel & lodging extra if applicable)
(3) Self-enrollment using electronic packet file:
$2.00/FSA participant/year
Option C Fee: Online enrollment system:
$2.00/FSA participant/year.
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ffi. DI~ERSIFIED BENEFIT SER~ICES, INC.
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City of Oshkosh Schedule A (continued)
4. Record-keepin2:. Claims processin2:. and Plan Reportin2:
* process claims from plan participants & issue reimbursements
* provide employer aggregate plan reporting for online viewing and printing
* prepare employee statements as needed
* process all family status changes including new hires & terminations
* reissue lost or stolen reimbursement checks
* provide an 800 toll free telephone number for out of area participants
* provide periodic informational notices as needed
* provide a re-enrollment packet after enrollments have been completed for the upcoming plan year
Plan Year
01/01/2007- 12/31/2007
01/01/2008-12/31/2008
01/01/2009- 12/31/2009
01/01/2010- 12/31/2010
01/01/2011-12/31/2011
Monthlv Fee Schedule - (FSA Service Only)
$ 3.00/participant/month for service agreement year one
$ 3.15/participant/month for service agreement year two
$ 3.30/participant/month for service agreement year two
$ 3.45/participant/month for service agreement year two
$ 3.60/participant/month for service agreement year two
The above month fee includes the following categories: Dependent Care Reimbursement Account, and/or the Medical
Expense Reimbursement Account. Employer reports including transaction ledger summary, payments in excess of deposits,
account deposit summary, and check register are included in the online service package for the Employer. Employee aecount
statements and/or reimbursements will be sent to the Employer unless otherwise noted below.
Minimum Monthly Group Administration Fee: $80.00
MISCELLANEOUS COSTS
Enrollment related costs such as travel, lodging, meals (based on client facility locations), related banking fees for account
transactions (from the Employer's bank), and customized materials requested by the client.
Other Services
I. Statements / checks / direct deposit notices mailed directly to plan participants.
Fee: First Class postage reimbursement.
II. Standard Online A.S.A.P. (Advanced Strategic Administrative Program) package for account viewing, emollment
and related reporting services:
Fee: N/C
III. Advanced Online A.S.A.P. (Advanced Strategic Administrative Program) package for account viewing, enrollment
and advanced report filtering services. Includes advanced report filtering, access to plan data in ASCII format and
access to archived plan year data for all plan years:
Fee: $45/month
IV. ACH/EFT service includes account setup with client bank, direct deposit ofFSA reimbursements, and transfer of
claim payments via ACH from the Employer designated account to the DBS Master 125-FSA account and the
mailing of checks and/or direct deposit notices directly to plan participants.
Fee: First Class postage reimbursement.
V. Annual 5500 & SAR Preparation. Includes data gathering, 5500 & SAR form preparation, answers to questions
regarding the form, related W2 questions.
Fee: $350/year (if required).
VI. Debit card service includes bank account and system set-up, preparation, and administration for the medical
reimbursement FSA account. Employer pre-funding of the debit card bank account and additional bank fees due to
insufficient funds in the Employer bank account are the responsibility of the Employer. Fees for lost or stolen cards
are the responsibility of the Employer or Employee.
Fee: $ 1. 5 O/participant/month (minimum group fee: $35.00)
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ffi. DI~ERSIFIED BENEFIT SER~ICES, INC.
- Dedicated to Excellence in Benefit Management Solutions
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