Virgina Provider Administrative Information

Administered by FBMC Benefits Management

Administrative Information

REQUIRED FORMS
POST-TAX
PRE-TAX CONTRIBUTIONS - 403(B)
VIRGINIA CASH MATCH - 401(A)

REQUIRED FORMS

The FBMC SRA and SDA forms are the only forms that will be accepted to start, stop or change deductions. Vendors will primarily provide these forms directly to employees. Agency Payroll/Benefits Administrators can retrieve forms from the website as a contingency.

There are three forms utilized by various Vendors (copies attached): The forms can be found at http://www.fbmc-benefits.com/VaAdmin/forms.aspx

Post-Tax Salary Deduction Agreement (SDA)
The form is used for all post-tax Miscellaneous Insurance. Vendors are responsible for providing this form to the employee, properly completing the form, and providing it to FBMC when the policy has been issued and deductions should begin.
Pre-Tax Salary Reduction Agreement (SRA)
The Pre-Tax SRA is used for 403(b) tax sheltered annuity deductions. Pre-tax deduction products are available only to Commonwealth of Virginia employees in qualifying agencies. Employees in most “line agencies” are not eligible for these pre-tax deductions; therefore, some Agency Payroll/Benefits Administrators will not utilize this form. This form authorizes the Agency to reduce the employee’s salary by the amount to be sent to the investment provider by the Agency on behalf of the Employee.
Cash Match Form (CMF)
The Cash Match Form is used to either enroll or change provider companies in the Virginia Cash Match program. Eligible Employees may make one change of Provider Company annually.

NOTE: ENSURING THAT THE ORIGINAL ENROLLMENT FORMS ARE COMPLETED CORRECTLY WILL SIGNIFICANTLY LIMIT THE NUMBER OF EXCEPTIONS.

FORM FLOW

POST-TAX

All Post-Tax SDA forms must be initiated between the Vendor/Agent and the Employee. Upon completion, the form will be forwarded by the Vendor/Agent to the Vendor’s main office. When all underwriting requirements have been fulfilled, the original form must be forwarded to FBMC for data entry. FBMC will provide a Change File to the Department of Accounts for setting up the deduction in CIPPS. FBMC must receive SDA forms by the established cut-off date in order for deductions to start, as requested.

The TPA cut-off schedule can be found at the following website.
http://www.doa.virginia.gov/Payroll/TPA/TPA_Main.cfm

If the cut-off date has not been met, the deduction will start on the next scheduled payroll date.

Form flow is provided below.

Employee contacts Vendor.
Vendor processes application.
Vendor provides SDA to FBMC Benefits Management. The form is provided to FBMC Benefits Management only AFTER underwriting (if required) has been completed.

Contact: Benefits Administration
Mail Slot #37
FBMC Benefits Management, Inc.
P.O. Box 1878
Tallahassee, Florida 32302-1878
Phone: 800-872-0345 Ext. 2312 Barbara Reed
Fax: 850-514-5803
E-mail: Breed@fbmc.com
FBMC data-enters the form and produces a Change File and an Enrollment Change Report, which is then published to the client’s secure FTP site for downloading.
The Payroll/Benefits Administrator may notify FBMC via e-mail, letter, or SDA form to stop a post-tax deduction. The Employee must contact the Vendor.

Note: If this process is followed, the number of Exceptions/Discrepancies reported by FBMC Benefits Management to the Payroll/Benefits Administrators will be greatly reduced.

PRE-TAX CONTRIBUTIONS – 403(B)

All Pre-Tax SRAs will be initiated between the Vendor/Agent and the employee. This form only authorizes the agency to reduce the employee’s salary by the amount to be sent to the investment provider by the agency on behalf of the employee. This is not an internal investment provider application form to establish the 403(b) account. FBMC will provide a Change File to the Department of Accounts responsible for settings up the deduction in CIPPS. To ensure that the deductions start on the current payroll, the payroll cut-off dates must be honored. If the cut-off date has not been met, the deduction will start on the next payroll date.

The TPA cut-off schedule can be found at the following website.
http://www.doa.virginia.gov/Payroll/TPA/TPA_Main.cfm

Below is the form flow for Salary Reduction Agreements (SRAs)

Employee contacts Vendor.
Vendor processes application to establish 403(b) account.
Vendor and Employee complete the original SRA.
Vendor and Employee provide the original SRA to Payroll Agency / Benefits Administrator for approval and signoff. The original SRA remains with the Agency for filing.
Agency Payroll/Benefits Administrator provides the employer signed SRA to FBMC via fax.

Contact: Benefits Administration
Mail Slot #37
FBMC Benefits Management, Inc.
P.O. Box 1878
Tallahassee, Florida 32302-1878
Phone: 800-872-0345, Ext. 2270 Shana Bratcher
Fax: 850-514-5803
E-mail: Sbratcher@fbmc.com
FBMC Benefits Management verifies that the SRA is complete; FBMC Benefits Management data-enters the contribution amount and effective date. FBMC Benefits Management then produces a Change Report.
The Department of Accounts imports the payroll deduction of premium and administrative fees into the CIPPS system.
To increase, decrease or stop deductions, changes must be communicated to FBMC via an SRA form. All changes will require written documentation to effect the change. Fax copies are acceptable. Agency Payroll/Benefits Administrators must obtain authorization from FBMC prior to processing any requests for deduction refunds.

VIRGINIA CASH MATCH – 401(A)

Cash Match Agreements (CMA) will be initiated between the Vendor/Agent and the Employee. Most often this application is completed simultaneously with the SRA for the 403(b) plan. The Cash Match Agreement form must be completed and signed by the Employee, and must be executed by the Agency Payroll/Benefits Administrators validating that the Employee is eligible for the cash match. The form will then be forwarded to FBMC for data entry. To ensure that the contributions start on the current payroll, the payroll cut-off dates must be honored. If the cut-off date has not been met, the contribution will start on the next payroll date. FBMC will process the new contributions and add them to the next Change File.

Employees that have multiple, participating providers may elect to change the provider that receives the cash match no more frequently than once each year. Please clearly indicate both the old and new providers on the form so FBMC can make the appropriate changes. To ensure that the deductions start on the current payroll, the payroll cut-off dates must be honored. If the cut-off date has not been met, the deduction will start on the next payroll date.

The TPA cut-off schedule can be found at the following website.
http://www.doa.virginia.gov/Payroll/TPA/TPA_Main.cfm

Below is the form flow for the Cash Match.

Employee contacts Vendor.
Vendor processes application to establish 401(a) account.
Employee completes the original CMA
Vendor and Employee provide the original CMA to Payroll Agency/Benefits Administrator for validation and signoff. The original CMA remains with the Agency for filing
Agency Payroll/Benefits Administrator provides the employer-signed CMA to FBMC via fax or pdf.

Contact: Benefits Administration
Mail Slot #37
FBMC Benefits Management, Inc.
P.O. Box 1878
Tallahassee, Florida 32302-1878
Phone: 800-872-0345, Ext. 2270 Shana Bratcher
Fax: 850-514-5803
E-mail: Sbratcher@fbmc.com
FBMC verifies that the CMA is complete; FBMC data-enters the contribution amount and effective date. FBMC then produces a Change File.
The Department of Accounts imports the cash match contribution identified on the Change File into the CIPPS system.

Note: The Agency Payroll/Benefits Administrator may complete and sign the CMA form on behalf of the Employee for single, participating provider deductions.

FBMC Benefits Management
3101 Sessions Road, Tallahassee, FL 32303
844-822-4968, (fax) 850-514-5803

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