ERISAfire Wrap+ HRA Addendum Tool

1
Access Code* This field is required.Enter the access code for the broker or professional service firm you work with.
2
Your Email* This field is required.This where we'll send the addendum and any notifications, including the special link you'll need to use if you need to save your progress and come back.
yourname@company.com
3
What is the name of the ERISA plan this addendum should be added to?This is typically something like, ABC Company Welfare Benefit Plan.
4
When will this addendum be effective?If qualified transportation benefits were provided under a different set of plan documents, the effective date of this addendum will be the first day those documents were or will be no longer the controlling documents (generally the first day of the current plan year). If there were no prior qualified transportation documents, or if qualified transportation benefits are being offered for the first time, the effective date of this addendum will be the first day qualified transportation benefits were offered.
Date
Month
Day
Year
5
What is the minimum number of hours per week an employe must work, on average, to be eligible for a qualified transportation benefit?If offered to all employees, enter 1.
Numerals only. The phrase, "hours per week" will follow the number entered here.
6
What is the waiting period for qualified transportation benefits?Here's the waiting period language that will be used. Just fill in the blanks! "Eligible Employees may enroll in the qualified transportation fringe benefits provided under this Section 5.3. and become eligible for such benefits on the first day of the month ________ __ days of continuous service with the Company as an Eligible Employee, provided all enrollment processes are fully and timely completed, as directed by the Plan Administrator."
Please Select
Please Select
coincident with or next following
following
Coverage effective
Days in waiting period
7
What types of qualified transportation benefits are offered, and to which work locations or employee classes are they offered?
Please Select
Please Select
Transit Passes
Transit Reimbursement
Parking Passes
Parking Reimbursement
Please Select
Please Select
Transit Passes
Transit Reimbursement
Parking Passes
Parking Reimbursement
Please Select
Please Select
Transit Passes
Transit Reimbursement
Parking Passes
Parking Reimbursement
Please Select
Please Select
Transit Passes
Transit Reimbursement
Parking Passes
Parking Reimbursement
8
Who is the qualified transportation benefit administrator?If self-administered, enter the plan sponsor company name.
Company Name
9
What is the administrator's mailing address that employees should use for written communications?
Street Address
Suite, Floor, Other (optional)
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Any other important contact information for qualified transportation claims issues?
Phone number
Website
11
Ready to generate the addendum?To save your data and create your document, select "Generate addendum," and submit! To save your progress without creating a document, select "Save progress only," and submit. In both cases, a link to edit your submission data will be emailed to you.
Save progress only
Generate addendum
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