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860520 <br />11.2.2016 <br />SCHEDULE C <br />FEE SCHEDULE <br />One -Time Implementation Fees <br />• Plan Documents & Summary Plan Descriptions <br />• Enrollment Materials <br />• Plan Installation <br />• Implementation of Clarity Quick Claim <br />• Web Based Enrollment Service <br />Implementation Fee $0.00 <br />Debit Card per Participant N/A <br />Administration Services <br />• Process Debit Card Transactions <br />• Review and Process Claims <br />• Integrate with insurance Carriers <br />• Process Reimbursement Checks and Direct Deposit <br />• Provide Plan Reports <br />• Provide Mobile, Online and Text communication of Plan Data <br />Annually <br />• Annual Renewal Fee (Consumer Benefits Only) Waived <br />• Annual Discrimination Test <br />• Annual Dependent Care Test <br />• Annual Concentration Test <br />• Annual Contributions Test <br />Monthly Fees <br />Retiree Billing Per Participant Fee $2.50 <br />Optional Services <br />Next Day Delivery $35.00 <br />Wire Fee (If Client wires plan deposits to Clarity) $25.00 <br />Banking/Misc. Fees <br />Mid -Year Change in Funding $1,000 <br />NSF Fee $50.00 <br />Stop Payment $25.00 <br />ACH Rejects $25.00 <br />Check Re -issuance fee $10.00 <br />16 <br />57 <br />