Res 2016-077/approving an administrative services agreement with United Healthcare Services, Inc. for the provision of medical, pharmacy, dental, flexible spending accounts (fsa), retiree, online enrollment tool and cobra benefits administration in a tot

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SAMPLE EXHIBIT E - HEALTH SAVINGS ACCOUNT ENROLLMENT AND CONTRIBUTION ----------------------------------------------------------------------------------------------------------------------------- United will include the following paragraph and Exhibit E only if, and when, the City opts for batch enrollment (directly sending enrollment and other information needed for the creation of HSAs directly to Optum Bank instead This Health Savings Account Enrollment and Contribution Exhibit (the "HSA Exhibit ") is made to the Administrative Services Agreement ( "Agreement ") between United HealthCare Services, Inc. on behalf of itself and its Affiliates, including Optum Bank, Inc., a Utah chartered FDIC insured financial institution, (the "Bank "), and City of San Marcos ( "Customer "in this Agreement), and is effective on [To Be Determined] The Parties hereby agree as follows: 1. HSA Documentation. A deposit and custodial agreement (together with other HSA notices, disclosures or information as each may be amended from time to time, the ° °HSA Documentation ") between eligible employees who are approved by the Bank to establish a HSA ( "Account Holders ") and the Bank governs the rights and obligations of the Account Holder and Bank with regard to the HSA custodial services and nothing in the Agreement or this HSA Exhibit modifies or amends the terms of any HSA Documentation. 2. Contributions. Customer may forward payroll deduction contributions and other contributions to Bank in a manner and form acceptable to Bank. Bank shall have no liability for any payroll deduction files or funds not received by Bank or for any error in crediting contributions to HSAs in reliance on data provided by Customer. Customer's HSA contributions are non - forfeitable and subject to the rules restricting recoupment by employers. 3. Account Holder Employment Termination. Customer shall notify Bank of an Account Holder's termination of employment as soon as administratively feasible and in a manner acceptable to Bank and shall provide Bank with any other information requested by Bank from time to time to comply with applicable law. 4. Representations, Warranties and Obligations. If Customer provides assistance in opening and administering HSAs, then Customer represents and warrants that it has been designated by each prospective Account Holder as their authorized agent and Customer: (i) has verified the identity and eligibility pursuant to Section 223 of the Code of each prospective Account Holder in accordance with applicable laws; (ii) has designed its benefits enrollment systems to prevent fraud in the enrollment process; (iii) will, for a period of seven (7) years, maintain records of (a) Customer's designation as authorized agent, (b) authorizations from each prospective Account Holder authorizing Customer to open and administer a HSA with Bank, (c) prospective Account Holder enrollments and debit card request, and (d) any other information and documents related to Customer opening and administering the HSA; and (iv) agrees to take such actions or provide any information requested by the Bank in order to open and administer a HSA and comply with any statute, regulation or governmental mandate as deemed necessary and appropriate by Bank. 5. Patriot Act Notice. As authorized agent for each Account Holder, Customer hereby: (i) accepts the following Patriot Act Notice: "IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT — To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents" and (ii) represents and warrants that Customer has provided each prospective Account Holder with the Patriot Act Notice during enrollment.