1Employer Details2Benefits: Basics3Contact Details4Benefits: Advanced5Renewal: Payroll Changes6Renewal: Preferences7Submission Summary8Renewal: Confirmation Employer DetailsHome Open Enrollment FAQ for Employers and Brokers Employer Name Benefits: BasicsOpen Enrollment FAQ for Employers and BrokersWhich benefits do you have with Admin America, Inc.?Check all that apply Medical FSA Dependent Care FSA Limited Purpose FSA Transit / Parking FSA HRA HSA To send enrollment information via a spreadsheet census, please use the below template(s): FSA Census Spreadsheet & Generic Election Form FSA Census Template Generic FSA Election Form To obtain all custom open enrollment materials, click here and complete the plan design questions. HRA Census Spreadsheet & HRA Election Form HRA Census Template HRA Election Form HSA Census Spreadsheet & HSA Election Form HSA Census Template HSA Election Form Admin America FSA Benefit Renewal Date MM slash DD slash YYYY Admin America HRA Benefit Renewal Date MM slash DD slash YYYY Admin America HSA Benefit Renewal Date MM slash DD slash YYYY Which of the below applies to this renewal? Select All Our Admin America Inc benefits have NOT changed and should be continued "as-is" (note: this excludes election and enrollment changes) Our payroll schedule(s) have NOT changed Our main contacts have NOT changed Contact DetailsOpen Enrollment FAQ for Employers and BrokersContact Name First Last Contact Type Broker Contact Employer Contact Contact Title Contact Email Contact PhoneContact Phone Extension Benefits: AdvancedOpen Enrollment FAQ for Employers and BrokersDo you allow your participants to elect up to the IRS maximum for the Medical FSA benefit?SelectYesNoWhat are the maximum IRS election amounts?What is the maximum amount you allow your participants to contribute to the Medical FSA per plan year?Please enter a number less than or equal to 2850.Do you allow your participants to elect up to the IRS maximum for the Dependent Care FSA benefit?SelectYesNoWhat are the maximum IRS election amounts?What is the maximum amount you allow your participants to contribute to the Dependent Care FSA per plan year?Please enter a number less than or equal to 5000.Do you allow your participants to elect up to the IRS maximum for the Limited Purpose FSA benefit?SelectYesNoWhat are the maximum IRS election amounts?What is the maximum amount you allow your participants to contribute to the Limited Purpose FSA per plan year?Please enter a number less than or equal to 2850.Do you allow your participants to elect up to the IRS maximum for the Transit / Parking FSA benefit?SelectYesNoWhat are the maximum IRS election amounts?What is the maximum amount you allow your participants to contribute to the Transit / Parking FSA per month?Please enter a number less than or equal to 280.Does the employer contribute to any FSA benefit? Yes No Is the employer contribution uniform or conditional / variable?SelectUniformConditional / VariableHow much does the employer contribute to the Medical FSA benefit for the benefit year?How much does the employer contribute to the Dependent Care FSA benefit for the benefit year?How much does the employer contribute to the Limited Purpose FSA benefit for the benefit year?How much does the employer contribute to the Transit / Parking FSA benefit for the benefit year?How long is your run out?Run out refers to the final filing date, or how many days after the plan year end date participants may submit prior year claims for reimbursement.Select18017517016516015515014514013513012512011511010510095908580757065605550454035302520151050OtherDo you allow rollover for your Medical FSA participants? Yes No I want to learn more about roll overHow much will you allow to rollover to the following plan year? $500.00 $550.00 Do you allow grace for your Medical FSA participants? Yes No I want to learn more about grace extensionNote, your run out must be equal to or greater than your grace period How long is your grace period? 2 1/2 months (~75 days) Do you allow rollover for your Limited Purpose FSA participants? Yes No How much will you allow to rollover to the following plan year? $500.00 $550.00 I want to learn more about roll overDo you allow grace for your Limited Purpose FSA participants? Yes No I want to learn more about grace extensionHow long is your grace period? 2 1/2 months (~75 days) Do you allow grace for your Dependent Care FSA participants? Yes No I want to learn more about grace extensionHow long is your grace period? 2 1/2 months (~75 days) Would you like any Medical FSA rollover to enter into a Limited Purpose FSA account (the Medical FSA benefit year, Limited Purpose FSA benefit year, and/or the HSA benefit year must have the same benefit year start date in order to be eligible for this option)This option applies to all participants moving from a Medical FSA plan into an HSA plan. This option must be uniform and cannot be applied on an individual basis. Yes No Not Applicable Which of the following apply to this renewal? The medical insurance plan has changed The medical insurance carrier has changed The employee HRA responsibility has changed The employee HRA reimbursement has changed None of these apply Other Please complete an HRA Amendment Form HRA Plan Amendment Abstract Do you allow HRA funds to rollover to the next year? Yes No How much do you allow to rollover? Remaining Balance Is there a maximum HRA balance (including any rollover amounts)? Yes No What is the maximum HRA balance (including any rollover amounts)?Individual MaximumIndividual + SpouseIndividual + Child(ren)Family Renewal: Payroll ChangesWhat is the first paycheck date after the start of the benefit year that deductions will be taken?All deduction dates must occur within the corresponding benefit yearDatePayroll Frequency Which payroll frequency has changed?Old Payroll FrequencyNew Payroll Frequency Renewal: PreferencesOpen Enrollment FAQ for Employers and BrokersDo you have a file feed with an outside EDI Vendor setup with Admin America, Inc for your benefits? Yes No What is an EDI Vendor?Who is your EDI Vendor?SelectADPBenefitSolverBeneTracBroker Builder SolutionsBswiftCertipayeBenefits GroupEmployee NavigatorEmpyreanInfinityHRPaycomPaylocityPlan SourcePrincipal eBenefitsSmartBenUltimate SoftwareWeb Benefits DesignOtherEDI Vendor Name Please review your plan settings with Employee Navigator. If you send COBRA data through Employee Navigator and you are setup with COBRA only, your open enrollment information will need to be submitted to Admin America, Inc. outside of Employee Navigator. Are all of your Admin America, Inc benefits setup with EDI? Yes No Which Admin America, Inc benefits do you have setup with EDI? Medical FSA Dependent Care FSA Limited Purpose FSA Transit / Parking FSA HRA HSA Do you use your own or your broker's online BenAdmin system to collect Admin America, Inc elections?This excludes the Admin America, Inc consumer portal online enrollment option. Yes No Do you use your own or your broker's online BenAdmin system for enrollments not sent through EDI? Yes No Do you want to allow your participants to elect their Admin America FSA benefit(s) through their Admin America Participant Portal?This option is available for current participants only. Yes No What is your estimate enrollment submission date to Admin America, Inc? MM slash DD slash YYYY How will you submit enrollments to Admin America, Inc?If you are submitting a census, you do not need to submit forms. I will enter the enrollments through the Admin America, Inc Employer Portal I will submit a completed Admin America, Inc census template I will submit completed Admin America, Inc enrollment forms Download the Employer Portal Guide by clicking on the link below. Instructions on how to add a new participant and enroll them in a plan can be found on pages 27-31. Instructions on how to search for a participant already in the system can be found on page 32. Instructions on how to enroll a participant already in the system into a plan can be found from the last bullet point on page 28-31. Employer Portal Training Guide How will you submit enrollments to Admin America, Inc that do not come over EDI?If you are submitting a census, you do not need to submit forms. I will enter the enrollments through the Admin America, Inc Employer Portal I will submit a completed Admin America, Inc census template I will submit completed Admin America, Inc enrollment forms Download the Employer Portal Guide by clicking on the link below. Instructions on how to add a new participant and enroll them in a plan can be found on pages 27-31. Instructions on how to search for a participant already in the system can be found on page 32. Instructions on how to enroll a participant already in the system into a plan can be found from the last bullet point on page 28-31. Employer Portal Training Guide Submission Summary{all_fields} Renewal: ConfirmationYour Email Enter your name below to acknowledge that you are renewing with Admin America, Inc and the information you have submitted is accurate. Inaccurate information submitted to Admin America, Inc. that results in an audit will incur an audit fee of $150.00 per audit hour. Submission Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Δ
