CONTRACT 3144C Amendment0 3 4
Heci1-thCoimp
Third party Administrmtprs
AMENDMENT TO FLEXIBLE BENEFITS THIRD -PARTY ADMINISTRATION
CONTRACT
This AMENDMENT to the Flexible Benefits Third Party Administration Contract
(AMENDMENT) is made by and between the City of Ell Segundo, hereinafter referred to as the
Plan Sponsor and HealthComp Administrators, Inc., hereinafter referred to as HealthComp
with respect to the Benefit Plan issued by the Plan Sponsor to the eligible covered participants.
This AMENDMENT is to be in effect as of January 1, 2008, and shall continue until terminated
as provided in the Flexible Benefits Third -Party Administration Contract referenced herein.
RECITALS
WHEREAS, the Plan Sponsor has established a flexible benefit plan pursuant to the
Internal Revenue Service Code Section 125 as amended, (the "Plan ") for eligible employees of
the Plan Sponsor (the "Participants "); and
WHEREAS, HealthComp is in the business of providing administrative services in
conjunction with such Plans; and
WHEREAS, the Plan Sponsor and HealthComp are parties to a Flexible Benefits Third -
Party Administration Contract with an effective date of January 1.2006;
NOW, THEREFORE, with reference to these recitals and in consideration of the
premises and of the mutual promises and covenants contained in the Third -Party Administration
Contract, its exhibits, attachments, documents referenced therein and prior amendments, if any
( "Agreement ") the parties agree as follows:
TERMS OF AMENDMENT
1, Pricing. Exhibit B of the Agreement shall be deleted in its entirety and replaced by
the Exhibit B attached to this AMENDMENT and incorporated herein by reference.
2. Effective Date. This AMENDMENT shall be effective as of January 1, 2008
( "AMENDMENT Effective Date ").
3. Except as expressly provided herein, the terms and conditions of the Agreement
shall remain in full force and effect. In the event of a conflict between this AMENDMENT and
the Agreement, the terms of this AMENDMENT shall prevail.
IN WITNESS WHEREOF, the undersigned have executed this AMENDMENT as of the day and
year below set forth.
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City of El
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HeciItH (Z omp
-third Party Administrators
undo HealthComp Administrators, Inc.
By: /
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(Print or type name)
Title:_ c aa-n sLq P�-
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Date: —D
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By:
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H4eclIth cc) mp
'ihird Party Administro ro ra
EXHIBIT B
Standard Administration. Spending Account .Participant Per Month. (Minimum Monthly
Fee of $195) Standard Administration includes health care spending account and dependent
care spending account. Services include the following:
$6.40 Toll -Free 800 Customer Service Line
Monthly List Billing
Comprehensive Reporting Package (Data Analysis Report;
Posting of Annual Health Care Spending Account Elections,
Annual Employee Statements; Weekly Reimbursement)
Enrollment Kits
Direct Deposit
Flex OnLine
90 -Day run -out of claims at plan year end
$80.00 Hourly rate for services not previously listed.
Optional Administration at additional costs.
Place Initials $ .50 Bank & Payroll Account Reconciliation per Month
Place Initials $ .50 Flex COBRA Administration (per participant per month)
Place Initials $250.00 Preparation of Annual Filing, if Applicable
Place Initials % 50.00 Section 125 Plan Non Discrimination Testing
City of El Segundo I--,' HealthComp Administrators, Inc.
By: /
(Signature)
,e w rer f
(Print or Ty a Name)
Title: C t j::i PAg?r,.cur er
Date:
s (Signature)
(Print or Type Name)
Title: �o
Date: 2.// C7`
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