BENEFIT PLAN FORM PACKAGES AVAILABLE Are you or your

BENEFIT PLAN FORM PACKAGES AVAILABLE Are you or your clients having a tough time keeping up with all the legal changes? Do you want to either update your current forms or offer new benefit plans to your employees or clients but have no idea where to find forms at a reasonable price? Benefit Express offers employers and benefit administrators form packages that are affordable, up-to-date and easy to use. The following form packages are available: • • • • • COBRA Notice Compliance Forms, Health Savings Account (HSA) Forms and Marketing Material, Health Reimbursement Arrangement Forms, Cafeteria Forms (Premium Conversion, Health Flexible Spending Account and Dependent Care Flexible Spending Account), and Employee Benefit Plans Forms. Each of the form packages conform to the most recent IRS and DOL regulations, contain all of the necessary election forms and allow employers the maximum flexibility in electing provisions. The following explains the contents and price of each of the form packages available. COBRA Notice Compliance Forms Package - Complies with the Final DOL Regulations The COBRA notice compliance forms package includes the following forms and explanations: • • • • • • • • An Explanation of the COBRA rules, A Sample Initial COBRA Notice, A Sample Summary Plan Description provision, A Sample Election Notice with Attachments, A Sample Notice of Qualifying Events from the Employer, A Sample Notice of Qualifying Events from Covered Employees and Qualified Beneficiaries, A Sample Notice of Unavailability of COBRA Coverage, and A Sample Notice of Termination of COBRA Coverage. The entire COBRA Notice Compliance Forms Package is available for only $400. To order, please follow the directions contained below. Health Savings Account (HSA) Forms Package - Complies with the most Recent IRS and DOL Guidance The HSA forms package includes the following forms: • • • • • • • • • An Employer's Guide to HSAs including a complete explanation of the Requirements, as well as HRAs and Health FSAs comparison charts, A Marketing Letter clearly explaining the basics of HSAs, A Transfer/Rollover Form, A Trust or Custodial Agreement, An Employee Disclosure Statement, An Account Application Form (Trust or Custodial Account), A Designation of Beneficiary Form, A (Single and Multiple) Contribution Form (Trustee or Custodial Account), and A Withdrawal Request Form (Trust or Custodial Account). The entire HSA Forms Package is available to you for only $500, including updates for a year. To order, please follow the directions contained below. Health Reimbursement Arrangement (HRA) Forms Package The HRA forms package includes the following forms: • • • • • A Plan Document, An Adoption Agreement, An Enrollment Form, A Claim Reimbursement Form, and A Summary Plan Description. The entire HRA Forms Package is available to you for only $800, including updates for a year. To order, please follow the directions contained below. Cafeteria Plan Forms Package The Cafeteria forms package includes the following forms: • • • • • A Plan Document, An Adoption Agreement, A Salary Reduction Form, A Claim Reimbursement Form, and A Summary Plan Description. The entire Cafeteria Forms Package is available to you for only $1,000, including updates for a year. To order, please follow the directions contained below. Benefit Express 2 www.BenefitExpress.info Employee Benefit Forms Package The Employee Benefit Plan forms package includes the following forms: • • • • A Plan Document, An Adoption Agreement, An Enrollment Form, and A Summary Plan Description with a Claims Procedures Attachment. The entire Employee Benefit Forms Package is available to you for only $700, including updates for a year. To order, please follow the directions contained below. Questions and Order Information Please contact us at sales@mybenefitexpress.com or 847-637-1551 with any questions or samples. Included below for your reference is additional background information as well as additional service offerings. To order, please complete the attached order form and follow the directions contained below. Our Legal Team - Background Information Over 30 years experience as a practicing attorney working exclusively in Employee Benefits. Experience in dealing with qualified plan, health and welfare, fringe benefit and executive compensation issues. An instructor in both the John Marshall Law School's Employee Benefits Graduate program and the Valparaiso University School of Law. Author of the "Simplified Employee Survivor Manual.” Co-author of the “Designing & Administering 401(k) and Simple Retirement Plans Manual." Contributing Editor to the Journal of Pension Benefits on health and welfare issues. Additional Services Available In addition to the form packages discussed above, I can: • • • • • Conduct Life or Webcast presentations, Answer staff or employee questions, Create marketing programs, File for trustee or custodian status for HSAs with the IRS, and Draft customized plan documents and forms. Benefit Express 3 www.BenefitExpress.info ORDER FORM To order any of the forms packages, please specify the forms package requested below, complete the individual information, enclose a check, and return the completed form to the address specified below. PAYMENT IS REQUIRED BEFORE ANY ORDER IS COMPLETED. ALL CHECKS MUST BE MADE PAYABLE TO Benefit Express. Once the completed order form is received, all forms will be sent via e-mail in word format. Available Benefit Forms Packages Please indicate the forms packages requested: □ □ □ □ □ COBRA Notice Compliance Forms - $400, Health Savings Account (HSA) Forms and Marketing Material - $500, Health Reimbursement Arrangement Forms - $700, Cafeteria Forms (Premium Conversion, Health Flexible Spending Account and Dependent Care Flexible Spending Account) - $1000, and Employee Benefit Plan Forms - $700. A check for $ ______ is attached. Individual Information ________________________________________________________________ Contact Name ________________________________________________________________ Name of Company ________________________________________________________________ Address _______________ __________________ Office Phone Office Fax Maria Bradley Benefit Express __________________________ E-mail address Please return the completed Order Form to: 220 W. Campus Drive – Suite 203 Arlington Heights, IL 60004 Benefit Express 4 www.BenefitExpress.info