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REV:01-20-23 MI mean Health FSA Plan Year election less disbursements of the Health FSA. 1.3.2.2. Reduce the prior year Health FSA election according to the amount of the Carryover. 1.3.2.3. Establish a Health FSA election for Covered Employees with Carryover amounts that failed to enroll in the Health FSA in the immediately following Health FSA Plan Year. Monthly participant Fees shall apply as of the Carryover Date. 1.3.2.4. Adjudicate and process claims against the carryover amount after the Carryover Date. Upon request, Navia shall apply claims incurred in the immediately following year against unused amounts in the prior year before the Carryover Date. Such adjustments shall be subject to a Fee of $65.00 per adjustment. 2. RESPONSIBILITIES OF EMPLOYER 2.1. IMPLEMENTATION Employer shall timely provide the Plan Application and any other information reasonably necessary for Navia to satisfy its obligations hereunder. 2.2. REPORTING Employer shall submit an approved payroll file or reconcile the EDR against payroll deductions for each processing date through the Website. If Employer cannot or does not perform this responsibility, Navia may charge $65.00 per reconciled report. If Employer fails to provide the approved payroll file or reconcile the EDR for more than forty-five (45) days from the pay date deduction Navia may suspend claim processing. 2.3. FUNDING For the initial term, Navia shall invoice Employer within sixty (60) days after the commencement of the Plan Year an Employer deposit equal to five percent (5%) of the projected annual elections for the Plan (the “Deposit”) or $1,000, whichever is greater with required direct debit authorization. In the event the direct debit authorization is not received, or the direct debit fails the Deposit shall be adjusted from 5% to 10%. At the beginning of each subsequent Plan Year Navia reserves the right to recalculate the Deposit for that Plan Year to be paid by Employer within 30 days after the commencement of such Plan Year. Said sum, or the portion thereof not utilized, shall then be reimbursed to Employer one-hundred and eighty days (180) after the end of the final Plan Year. Employer shall authorize Navia to direct debit for Employer dollars equal to the amount of Covered Employee deductions. In the event funding is not received within ten (10) Business Days after the pay date deduction, Navia may suspend claim processing. 3. FEES Rate Guarantee: 1/1/2023 – 12/31/2025 3.1. Monthly Processing and Administration Fees: $5.30 per month per FSA Covered Employee ($100/month minimum). 3.2. California Assembly Bill No. 1554 Notice (only provided upon Employer’s written request): $3.50 per paper notice mailed. ATTY/AGR.2023.010/Navia Benefit Solutions (Navia Services (Dental HRA) 2023) (Page 23 of 42)