FlexSave New Client Application

Advisor Information

Account Information

Benefit Year: The benefit period can be either the corporation's fiscal year or calendar year.

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Start Date: The earliest expense date for claims on the account. The effective date must be within the first benefit year.

Unused Benefit to be:

Forfeited Unused.Forfeited.Tooltip

Carry Forward Maximum Any benefit amounts unused in the current benefit year will carry forward at the end of the period. The unused benefit will be added to following year's benefit amount. The carry forward amount is available for one year only. Example: Amount $1,000. Used: $500. Next year start: $1,500.

Carry Forward Receipts Receipts which have not been claimed in the current benefit year may be claimed in the following one. This includes claims for which only partial payment was available or were not submitted in the previous year. This does not include expenses prior to the establishment of the account.

Plan Design

Employee Classification	Add Catastrophic and Travel Insurance?	Maximum Fixed Annual Benefit Amount
Class Level		Health/Dental	Taxable Lifestyle Benefit	% Co-Pay*
Required	Yes No Required	Required	Required	Required	Required Invalid

Funding your Account and Paying the Setup Fee

Pay as you go

Pre-funded

How do you want to pay the $250 Non-refundable setup fee payment?

One time PAD

Credit Card

Do you want to enroll employees now?

Employees will be enrolled through plan administration portal

Enroll employees now

You’re ready to submit this new FlexSave application to HUB!

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