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CLARITY BENEFIT SOLUTIONS SERVICES AGREEMENT <br />On this day of <br />is hereby contracting with BeneFlex, Inc. DBA Clarity Benefit Solutions ("Clarity") to provide Client with TPA <br />services as set forth in this Agreement. Clarity and Client are the "Parties" hereto. This Agreement <br />encompasses the following General Terms and Conditions as well as the specific Terms and Conditions for <br />the Services selected in the Services secticn below, all of which are incorporated as a material portion of the <br />Agreement. <br />TERMS AND CONDITIONS <br />1. SERVICES <br />860520 <br />11.2.2016 <br />The Clarity sales representative has initialed in the spaces provided below the "Services" which the Client has <br />selected, as confirmed by the signature of the Client's authorized represented on this Agreement. Client <br />warrants that it has full power and authority to execute this Agreement; that it has chosen the Services initialed; <br />and has read and agreed to the Terms and Conditions for those Services contained in this Agreement. <br />Flexible Spending Account <br />Client authorizes Clarity to create a plan document, provide online communication and enrollment services; <br />establish Medical Reimbursement accounts and provide administrative services in accordance with Section 125 of <br />the IRS code; establish Dependent Care accounts and provide administrative services in accordance with Section <br />129 of the IRS code. Clarity will provide compliance testing and, if required, prepare IRS Form 5500 for Client's review <br />and final approval. <br />Health Reimbursement Arrangement <br />Client authorizes Clarity to create a plan document, provide online communication, establish reimbursement <br />accounts and provide administrative services in accordance with Section 105 of the IRS code. Clarity will <br />provide compliance testing, and, if required, preps a IRS Form 5500 for Client's review and final approval. <br />Calculate PCORI fee and prepare IRS form 720 (please see Schedule C for Pricing). <br />= Health Savings Account <br />Client authorizes Clarity to establish Health Savings Account in accordance with Section 223(c)(1)(A) of the <br />Internal Revenue Code <br />Commuter Benefit Program <br />Client authorizes Clarity to establish Transit and Parking accounts and provide administrative services in <br />accordance with Section 132f of the IRS code. <br />COBRA/Retiree Billing Administration <br />Client authorizes Clarity to provide COBRA and Retiree Billing administrative services in accordance with <br />Schedule A of this Agreement. <br />Wage Parity Cell Phone Program <br />Client authorizes Clarity to establish a Cell Phone Reimbursement account in accordance with NY CLS Pub Health <br />§ 3614-c. <br />ERISA Wrap Document <br />Client authorizes Clarity to create an ERISA wrap document in accordance with The Employee Retirement <br />Income Security Act of 1974. Services include Plan Document, Summary Plan Description, Record Retention <br />for 7 years and if required preparation of form 5500. <br />Premium Only Plan <br />Client authorizes Clarity to create a medical insurance premium only plan document in accordance with Section <br />125 of the IRS code. <br />42 <br />