Step 1 of 6 16% In response to COVID-19, the IRS has amended several regulations. For details see the Webinar posted on the Admin America Blog. If you need to submit a Flexible Benefits Plan Amendment Request Form based on these IRS amendments, click HERE. Complete this questionnaire to receive open enrollment materials based on the benefit(s) you hold with Admin America, Inc. Which benefit(s) do you have with Admin America?There may be a slight delay when selecting the below options. Check all that apply: Medical FSA Dependent Care FSA Limited Purpose FSA Transit / Parking FSA HRA HSA Admin America Benefit FSA Renewal DateSelect optionJanuary 1/1February 2/1March 3/1April 4/1May 5/1June 6/1July 7/1August 8/1September 9/1October 10/1November 11/1December 12/1Admin America Benefit HRA Renewal DateSelect optionJanuary 1/1February 2/1March 3/1April 4/1May 5/1June 6/1July 7/1August 8/1September 9/1October 10/1November 11/1December 12/1Admin America Benefit HSA Renewal DateSelect optionJanuary 1/1February 2/1March 3/1April 4/1May 5/1June 6/1July 7/1August 8/1September 9/1October 10/1November 11/1December 12/1Do you have a file feed with an outside EDI Vendor setup with Admin America for the Admin America benefit(s) you are renewing? Yes No What is an EDI Vendor? How will you submit enrollments to Admin America?Census templates take priority over enrollment forms I will enter the enrollments through the Admin America Employer Portal I will submit a completed Admin America census template I will submit completed Admin America enrollment forms Your Email Address Do you offer debit cards for use with your benefitsDebit Cards are offered by Admin America at no additional administrative cost Yes No Do you offer grace extension? Yes No I want to learn more about grace extensionWhat is the length of your grace extension?Select option75 days after the plan year end dateOtherDo you offer rollover? Yes No Please Note: IRS regulations do not allow both rollover and grace extension at the same time for the Medical FSA or Limited Purpose FSA plans.I want to learn more about rolloverWhat is the amount of your rollover?Select20% of the statutory maximum annual employee contribution$500OtherDo you allow your participants to elect up to the federal maximum on the benefit? Yes No What are the maximum IRS election amounts?Does the employer contribute to any FSA benefit? Yes No 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 Do you allow your participants to receive claim reimbursements via direct deposit into their personal bank account? Yes No Available with all HSA plans. Optional with all other plans. Would you like to download the Employee Direct Deposit Setup Guide? Yes No Download the Direct Deposit Set-Up Guide by clicking on the link below: Direct Deposit Setup Guide Would you like to download the Employer Portal User Guide? Yes No Download the Employer Portal Guide by clicking on the link below: Employer Portal Training Guide Would you like to sign up for the Employer Portal Training Webinar? Yes No FSA, HRA, & HSA Employer Portal Training occurs several times. Please register for the date and time that works best for you: Signup Here During this training session we will review the Employer Portal for FSA, HRA, & HSA lines of service. After registering, you will receive a confirmation email containing information about joining the webinar. 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your employees: Select All HSA Participant Distribution and Contribution Guide HRA and HSA Dual Account Management Select the HSA open enrollment material you would like to provide to your employees: Select All HSA Participant Distribution and Contribution Guide HRA and HSA Dual Account Management Select the HSA open enrollment material you would like to provide to your employees: Select All HSA Participant Distribution and Contribution Guide Select the HSA open enrollment material you would like to provide to your employees: Select All HSA Participant Distribution and Contribution Guide HRA and HSA Dual Account Management Select the HRA open enrollment material you would like to provide to your employees: Consumer Portal Login Guide for PC and Mobile App Based on the answers provided, the materials below have been customized to your plan. Click the links below to download your materials. EMPLOYER & BROKER FORMS FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet TemplateFSA Census Spreadsheet TemplateFSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template FSA Census Spreadsheet Template HRA Census Spreadsheet Template HSA Census Spreadsheet Template HRA Plan Amendment Abstract Employer Portal Training Guide Non-Discrimination Test Letter EMPLOYEE FORMS HRA Enrollment Form HSA Enrollment Form Transit / Parking FSA Enrollment Form Transit/Parking FSA Enrollment Form (Fill this form with your maximum election) Dependent Care FSA Enrollment Form Dependent Care FSA Enrollment Form (Fill this form with your maximum election) Dependent Care FSA Enrollment Form Dependent Care FSA Enrollment Form (Fill this form with your maximum election) Limited Purpose FSA Enrollment Form Limited Purpose FSA Enrollment Form (Fill this form with your maximum election) Limited Purpose FSA Enrollment Form Limited Purpose FSA Enrollment Form (Fill this form with your maximum election) Medical FSA Enrollment Form Medical FSA Enrollment Form (Fill this form with your maximum election) Medical FSA Enrollment Form Medical FSA Enrollment Form (Fill this form with your maximum election) Dependent Care & Limited Purpose FSA Enrollment Form Dependent Care & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election) Dependent Care & Limited Purpose FSA Enrollment Form Dependent Care & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election) Medical & Dependent Care FSA Enrollment Form Medical & Dependent Care FSA Enrollment Form (Fill this form with your maximum election) Medical & Dependent Care FSA Enrollment Form Medical & Dependent Care FSA Enrollment Form (Fill this form with your maximum election) Medical & Limited Purpose FSA Enrollment Form Medical & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election) Medical & Limited Purpose FSA Enrollment Form Medical & Limited Purpose FSA Enrollment Form (Fill this form with your maximum election) Medical, Limited Purpose & Dependent Care FSA Enrollment Form Medical, Limited Purpose & Dependent Care FSA Enrollment Form (Fill this form with your maximum election) Medical, Limited Purpose & Dependent Care FSA Enrollment Form Medical, Limited Purpose & Dependent Care FSA Enrollment Form (Fill this form with your maximum election) Commuter Benefits Fact Sheet 2021 Dependent Care Fact Sheet Medical FSA Fact Sheet Medical FSA Fact Sheet Medical FSA Fact Sheet Medical FSA Fact Sheet Limited Purpose FSA Fact Sheet Limited Purpose FSA Fact Sheet Limited Purpose FSA Fact Sheet Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical FSA Fact Sheet Medical FSA Fact Sheet Limited Purpose FSA Fact Sheet Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical FSA Fact Sheet Medical FSA Fact Sheet Limited Purpose FSA Fact Sheet Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Limited Purpose FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Medical & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical, Limited Purpose & Dependent Care FSA Fact Sheet Medical FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical FSA Fact Sheet (Fill this form with your maximum election and rollover) Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover) Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover) Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover) Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and rollover) Medical FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical FSA Fact Sheet (Fill this form with your maximum election and grace period) Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period) Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period) Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period) Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical, Limited Purpose & Dependent Care FSA Fact Sheet (Fill this form with your maximum election and grace period) Medical FSA Fact Sheet (Fill this form with your maximum election) Medical FSA Fact Sheet (Fill this form with your maximum election) Limited Purpose FSA Fact Sheet (Fill this form with your maximum election) Limited Purpose FSA Fact Sheet (Fill this form with your maximum election) Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election) Medical & Limited Purpose FSA Fact Sheet (Fill this form with your maximum election) Medical & Dependent FSA Fact Sheet (Fill this form with your maximum election) Medical & Dependent FSA Fact Sheet (Fill this form with your maximum election) Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election) Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election) Medical, Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election) Medical, Limited Purpose & Dependent FSA Fact Sheet (Fill this form with your maximum election) PHI Use or Disclosure Form HRA Reimbursement Documentation Form FSA Reimbursement Documentation Form Direct Deposit Setup Guide Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission Electronic Claim Filing or Submission FSA Reimbursement for Non-Debit Card Expenses Consumer Portal Login Guide for PC and Mobile App Your Prepaid Benefits Card TPA Stream FAQ HRA and HSA Dual Account Management Do you want to save the current list of forms for later view? Yes No If you would like to have access to this page again, click 'Save and Continue Later' for a link to your forms. This link will expire after 30 days. We recommend that you download all forms within this 30 day period. NameThis field is for validation purposes and should be left unchanged. Δ
