Common use of OTHER IMPORTANT TERMS AND CONDITIONS Clause in Contracts

OTHER IMPORTANT TERMS AND CONDITIONS. I understand that: • Before the first day of each plan year I will be offered the opportunity to make my benefit election for the new year. If I do NOT complete and return a new election form prior to the first day of the new year, I will be treated as having elected NOT to participate in reimbursement accounts effective for the new plan year. • I understand that my Employer has chosen to issue me a WEX Health™ Visa® Benefits Card for use with my flexible spending account, and I will receive a second card for my spouse or dependents.. I also understand that I am required to submit appropriate proof of qualified expenses within 60 days of the date the expense is incurred. • I am solely responsible for notifying the Employer if I have reason to believe that an expense for which I have obtained reimbursement is not a qualifying expense. I understand that, upon notification, I must immediately re-pay my Employer for the amount of any non- qualified reimbursement and that my Card may be immediately suspended or revoked for failure to comply. • This agreement will automatically terminate if the Plan is terminated or discontinued, or if I cease to receive compensation from the Employer which, before redirection hereunder, is at least equal to the amount of that redirection. • The Plan Administrator may reduce or cancel my compensation redirection or otherwise modify this agreement in the event he believes it is required in order to satisfy federal law. • Any amounts that are not used during a plan year to provide benefits will be forfeited and may not be paid to me in cash or used to provide benefits in a later plan year. Plans that offer the rollover provision are subject to the aforementioned forfeiture for account balances over the rollover limit. See your plan documents for additional details. Plans that offer the grace extension allow dates of service after the plan year end up to the final grace date. See your plan documents for additional details. • My Social Security benefits may be slightly reduced as a result of my election. Enrollment & WEX Health® Benefits Card Agreement WEX Health® BENEFITS CARD AGREEMENT (applicable only if offered by your employer) As a participant in one or more of your employer plans, you may be eligible to receive two WEX Health® Visa® Cards with your name on them. You agree to use them in accordance with this Agreement and the Cardholder Agreement that will be provided to you in the envelope with the two WEX Health® Visa® Cards. You understand that the WEX Health® Visa® Card is restricted to certain merchant categories and is not accepted at all Visa® locations. You understand that you may not obtain a cash advance with the WEX Health™ Card at any merchant, bank or ATM. You understand that the WEX Health® Visa® Card is to be used exclusively for qualified expenses as defined by the plan(s) in which you participate. If the WEX Health™ Card is issued pursuant to employer plans and you use the card to pay for an expense that is not a qualified expense, you are indebted to your employer and must repay the full amount of the non-qualified expense. You agree to save all receipts and invoices related to any expense paid using the WEX Health® Visa® Card. If required, you agree to submit copies of these documents attached to a signed claim form for review by Admin America, the Plan Service Provider. Failure to submit the receipt(s) when required will cause the expense to be treated as a non-qualified expense and you will be required to remit payment to your employer. Payment may be in the form of an offsetting claim, a personal check, electronic draft from your personal checking or savings account, a post-tax deduction from your paycheck, or other options established by your employer.

OTHER IMPORTANT TERMS AND CONDITIONS. I understand that: • Before the first day of each plan year I will be offered the opportunity to make my benefit election for the new year. If I do NOT complete and return a new election form prior to the first day of the new year, I will be treated as having elected NOT to participate in reimbursement accounts arrangements effective for the new plan year. • I understand that my Employer has chosen to issue me a WEX Health™ Visa® Benefits Card for use with my flexible spending account, and I will receive a second card for my spouse or dependents.. I also understand that I am required to submit appropriate proof of qualified expenses within 60 days of the date the expense is incurred. • I am solely responsible for notifying the Employer if I have reason to believe that an any expense for which I have obtained reimbursement is not a qualifying expense. I understand thatalso agree to indemnify and reimburse the Employer on demand for any liability it incurs for failure to withhold federal, upon notificationstate or local income tax or Social Security tax from any reimbursement I receive for a non-qualifying expense, I must immediately re-pay my Employer for up to the amount of any non- qualified reimbursement and that my Card may be immediately suspended or revoked for failure to complyadditional tax actually owed by me. • This agreement will automatically terminate if the Plan is terminated or discontinued, or if I cease to receive compensation from the Employer which, before redirection hereunder, is at least equal to the amount of that redirection. • The Plan Administrator may reduce or cancel my compensation redirection or otherwise modify this agreement in the event he believes it is required in order to satisfy federal law. • Any amounts that are not used during a plan year to provide benefits will be forfeited and may not be paid to me in cash or used to provide benefits in a later plan year. Plans that offer the rollover provision are subject to the aforementioned forfeiture for account balances over the rollover limit. See your plan documents for additional details. Plans that offer the grace extension allow dates of service after the plan year end up to the final grace date. See your plan documents for additional details. • My Social Security benefits may be slightly reduced as a result of my election. Enrollment & WEX Health® This agreement (1) is subject to the terms of the employer's Flexible Benefits Card Agreement WEX Health® BENEFITS CARD AGREEMENT Plan, Health Care Reimbursement Plan and/or Dependent Care Assistance Plan in effect as amended from time to time, (applicable only if offered 2) shall be governed by your employer) As a participant in one or more of your employer plans, you may be eligible to receive two WEX Health® Visa® Cards with your name on them. You agree to use them and construed in accordance with this Agreement applicable laws, (3) shall take effect as a sealed instrument under applicable laws, and (4) to the Cardholder Agreement that will be provided extent allowed by law, revokes any prior election and compensation redirection agreement relating to you in such plan(s) for the envelope with the two WEX Health® Visa® Cardscorresponding Plan Year. You understand that the WEX Health® Visa® Card is restricted Employee's Signature: Date: Accepted and agreed to certain merchant categories and is not accepted at all Visa® locations. You understand that you may not obtain a cash advance with the WEX Health™ Card at any merchant, bank or ATM. You understand that the WEX Health® Visa® Card is to be used exclusively for qualified expenses as defined by the plan(s) in which you participate. If the WEX Health™ Card is issued pursuant to employer plans and you use the card to pay for an expense that is not a qualified expense, you are indebted to your employer and must repay the full amount of the non-qualified expense. You agree to save all receipts and invoices related to any expense paid using the WEX Health® Visa® Card. If required, you agree to submit copies of these documents attached to a signed claim form for review by Admin America, the Plan Service Provider. Failure to submit the receipt(s) when required will cause the expense to be treated as a non-qualified expense and you will be required to remit payment to your employer. Payment may be in the form of an offsetting claim, a personal check, electronic draft from your personal checking or savings account, a post-tax deduction from your paycheck, or other options established by your employer.Employer's Authorized Representative:

OTHER IMPORTANT TERMS AND CONDITIONS. I understand that: • Before the first day of each plan year I will be offered the opportunity to make my benefit election for the new year. If I do NOT complete and return a new election form prior to the first day of the new year, I will be treated as having elected NOT to participate in reimbursement accounts effective for the new plan year. • I understand that my Employer has chosen to issue me a WEX Health™ Visa® Benefits s Card for use with my flexible spending account, and I will receive a second card for my spouse or dependents.. I also understand that I am required to submit appropriate proof of qualified expenses within 60 days of the date the expense is incurred. • I am solely responsible for notifying the Employer if I have reason to believe that an expense for which I have obtained reimbursement is not a qualifying expense. I understand that, upon notification, I must immediately re-pay my Employer for the amount of any non- qualified reimbursement and that my Card may be immediately suspended or revoked for failure to comply. • This agreement will automatically terminate if the Plan is terminated or discontinued, or if I cease to receive compensation from the Employer which, before redirection hereunder, is at least equal to the amount of that redirection. • The Plan Administrator may reduce or cancel my compensation redirection or otherwise modify this agreement in the event he believes it is required in order to satisfy federal law. • Any amounts that are not used during a plan year to provide benefits s will be forfeited and may not be paid to me in cash or used to provide benefits s in a later plan year. Plans that offer the rollover provision are subject to the aforementioned forfeiture for account balances over the rollover limit. See your plan documents for additional details. Plans that offer the grace extension allow dates of service after the plan year end up to the final grace date. See your plan documents for additional details. • My Social Security benefits s may be slightly reduced as a result of my election. Enrollment & WEX Health® Benefits Card Agreement WEX Health® BENEFITS S CARD AGREEMENT (applicable only if offered by your employer) As a participant in one or more of your employer plans, you may be eligible to receive two WEX Health® Visa® Cards with your name on them. You agree to use them in accordance with this Agreement and the Cardholder Agreement that will be provided to you in the envelope with the two WEX Health® Visa® Cards. You understand that the WEX Health® Visa® Card is restricted to certain merchant categories and is not accepted at all Visa® locations. You understand that you may not obtain a cash advance with the WEX Health™ Card at any merchant, bank or ATM. You understand that the WEX Health® Visa® Card is to be used exclusively for qualified expenses as defined by the plan(s) in which you participate. If the WEX Health™ Card is issued pursuant to employer plans and you use the card to pay for an expense that is not a qualified expense, you are indebted to your employer and must repay the full amount of the non-qualified expense. You agree to save all receipts and invoices related to any expense paid using the WEX Health® Visa® Card. If required, you agree to submit copies of these documents attached to a signed claim form for review by Admin America, the Plan Service Provider. Failure to submit the receipt(s) when required will cause the expense to be treated as a non-qualified expense and you will be required to remit payment to your employer. Payment may be in the form of an offsetting claim, a personal check, electronic draft from your personal checking or savings account, a post-tax deduction from your paycheck, or other options established by your employer.

OTHER IMPORTANT TERMS AND CONDITIONS. I understand that: •  Before the first day of each plan year I will be offered the opportunity to make my benefit election for the new year. If I do NOT complete and return a new election form prior to the first day of the new year, I will be treated as having elected NOT to participate in reimbursement accounts effective for the new plan year. •  I understand that my Employer has chosen to issue me a WEX Health™ Visa® Benefits Card for use with my flexible spending account, and I will receive a second card for my spouse or dependents.. I also understand that I am required to submit appropriate proof of qualified expenses within 60 days of the date the expense is incurred. •  I am solely responsible for notifying the Employer if I have reason to believe that an expense for which I have obtained reimbursement is not a qualifying expense. I understand that, upon notification, I must immediately re-pay my Employer for the amount of any non- qualified reimbursement and that my Card may be immediately suspended or revoked for failure to comply. •  This agreement will automatically terminate if the Plan is terminated or discontinued, or if I cease to receive compensation from the Employer which, before redirection hereunder, is at least equal to the amount of that redirection. •  The Plan Administrator may reduce or cancel my compensation redirection or otherwise modify this agreement in the event he believes it is required in order to satisfy federal law. •  Any amounts that are not used during a plan year to provide benefits will be forfeited and may not be paid to me in cash or used to provide benefits in a later plan year. Plans that offer the rollover provision are subject to the aforementioned forfeiture for account balances over the rollover limit. See your plan documents for additional details. Plans that offer the grace extension allow dates of service after the plan year end up to the final grace date. See your plan documents for additional details. •  My Social Security benefits may be slightly reduced as a result of my election. Enrollment & WEX Health® Benefits Card Agreement WEX Health® BENEFITS CARD AGREEMENT (applicable only if offered by your employer) As a participant in one or more of your employer plans, you may be eligible to receive two WEX Health® Visa® Cards with your name on them. You agree to use them in accordance with this Agreement and the Cardholder Agreement that will be provided to you in the envelope with the two WEX Health® Visa® Cards. You understand that the WEX Health® Visa® Card is restricted to certain merchant categories and is not accepted at all Visa® locations. You understand that you may not obtain a cash advance with the WEX Health™ Card at any merchant, bank or ATM. You understand that the WEX Health® Visa® Card is to be used exclusively for qualified expenses as defined by the plan(s) in which you participate. If the WEX Health™ Card is issued pursuant to employer plans and you use the card to pay for an expense that is not a qualified expense, you are indebted to your employer and must repay the full amount of the non-qualified expense. You agree to save all receipts and invoices related to any expense paid using the WEX Health® Visa® Card. If required, you agree to submit copies of these documents attached to a signed claim form for review by Admin America, the Plan Service Provider. Failure to submit the receipt(s) when required will cause the expense to be treated as a non-qualified expense and you will be required to remit payment to your employer. Payment may be in the form of an offsetting claim, a personal check, electronic draft from your personal checking or savings account, a post-tax deduction from your paycheck, or other options established by your employer.

OTHER IMPORTANT TERMS AND CONDITIONS. I understand that: •  Before the first day of each plan year I will be offered the opportunity to make my benefit election for the new year. If I do NOT complete and return a new election form prior to the first day of the new year, I will be treated as having elected NOT to participate in reimbursement accounts arrangements effective for the new plan year. • I understand that my Employer has chosen to issue me a WEX Health™ Visa® Benefits Card for use with my flexible spending account, and I will receive a second card for my spouse or dependents.. I also understand that I am required to submit appropriate proof of qualified expenses within 60 days of the date the expense is incurred. •  I am solely responsible for notifying the Employer if I have reason to believe that an any expense for which I have obtained reimbursement is not a qualifying expense. I understand thatalso agree to indemnify and reimburse the Employer on demand for any liability it incurs for failure to withhold federal, upon notificationstate or local income tax or Social Security tax from any reimbursement I receive for a non-qualifying expense, I must immediately re-pay my Employer for up to the amount of any non- qualified reimbursement and that my Card may be immediately suspended or revoked for failure to complyadditional tax actually owed by me. •  This agreement will automatically terminate if the Plan is terminated or discontinued, or if I cease to receive compensation from the Employer which, before redirection hereunder, is at least equal to the amount of that redirection. •  The Plan Administrator may reduce or cancel my compensation redirection or otherwise modify this agreement in the event he believes it is required in order to satisfy federal law. •  Any amounts that are not used during a plan year to provide benefits will be forfeited and may not be paid to me in cash or used to provide benefits in a later plan year. Plans that offer the rollover provision are subject to the aforementioned forfeiture for account balances over the rollover limit. See your plan documents for additional details. Plans that offer the grace extension allow dates of service after the plan year end up to the final grace date. See your plan documents for additional details. •  My Social Security benefits may be slightly reduced as a result of my election. Enrollment & WEX Health® This agreement (1) is subject to the terms of the employer's Flexible Benefits Card Agreement WEX Health® BENEFITS CARD AGREEMENT Plan, Health Care Reimbursement Plan and/or Dependent Care Assistance Plan in effect as amended from time to time, (applicable only if offered 2) shall be governed by your employer) As a participant in one or more of your employer plans, you may be eligible to receive two WEX Health® Visa® Cards with your name on them. You agree to use them and construed in accordance with this Agreement applicable laws, (3) shall take effect as a sealed instrument under applicable laws, and (4) to the Cardholder Agreement that will be provided extent allowed by law, revokes any prior election and compensation redirection agreement relating to you in such plan(s) for the envelope with the two WEX Health® Visa® Cardscorresponding Plan Year. You understand that the WEX Health® Visa® Card is restricted Employee's Signature: Date: Accepted and agreed to certain merchant categories and is not accepted at all Visa® locations. You understand that you may not obtain a cash advance with the WEX Health™ Card at any merchant, bank or ATM. You understand that the WEX Health® Visa® Card is to be used exclusively for qualified expenses as defined by the plan(s) in which you participate. If the WEX Health™ Card is issued pursuant to employer plans and you use the card to pay for an expense that is not a qualified expense, you are indebted to your employer and must repay the full amount of the non-qualified expense. You agree to save all receipts and invoices related to any expense paid using the WEX Health® Visa® Card. If required, you agree to submit copies of these documents attached to a signed claim form for review by Admin America, the Plan Service Provider. Failure to submit the receipt(s) when required will cause the expense to be treated as a non-qualified expense and you will be required to remit payment to your employer. Payment may be in the form of an offsetting claim, a personal check, electronic draft from your personal checking or savings account, a post-tax deduction from your paycheck, or other options established by your employer.Employer's Authorized Representative:

OTHER IMPORTANT TERMS AND CONDITIONS. I understand that: • Before the first day of each plan year I will be offered the opportunity to make my benefit election for the new year. If I do NOT complete and return a new election form prior to the first day of the new year, I will be treated as having elected NOT to participate in reimbursement accounts effective for the new plan year. • I understand that my Employer has chosen to issue me a WEX HealthXxxxx™ Visa® Prepaid Benefits Card for use with my flexible spending account, and I will receive a second card for my spouse or dependents.. I also understand that I am required to submit appropriate proof of qualified expenses within 60 days of the date the expense is incurred. • I am solely responsible for notifying the Employer if I have reason to believe that an expense for which I have obtained reimbursement is not a qualifying expense. I understand that, upon notification, I must immediately re-pay my Employer for the amount of any non- qualified reimbursement and that my Card may be immediately suspended or revoked for failure to comply. • This agreement will automatically terminate if the Plan is terminated or discontinued, or if I cease to receive compensation from the Employer which, before redirection hereunder, is at least equal to the amount of that redirection. • The Plan Administrator may reduce or cancel my compensation redirection or otherwise modify this agreement in the event he believes it is required in order to satisfy federal law. • Any amounts that are not used during a plan year to provide benefits will be forfeited and may not be paid to me in cash or used to provide benefits in a later plan year. Plans that offer the rollover provision are subject to the aforementioned forfeiture for account balances over the rollover limit. See your plan documents for additional details. Plans that offer the grace extension allow dates of service after the plan year end up to the final grace date. See your plan documents for additional details. • My Social Security benefits may be slightly reduced as a result of my election. Enrollment & WEX HealthXxxxx® Prepaid Benefits Card Agreement WEX HealthXxxxx® PREPAID BENEFITS CARD AGREEMENT (applicable only if offered by your employer) As a participant in one or more of your employer plans, you may be eligible to receive two WEX HealthXxxxx® Prepaid Visa® Cards with your name on them. You agree to use them in accordance with this Agreement and the Cardholder Agreement that will be provided to you in the envelope with the two WEX HealthXxxxx® Prepaid Visa® Cards. You understand that the WEX HealthXxxxx® Prepaid Visa® Card is restricted to certain merchant categories and is not accepted at all Visa® locations. You understand that you may not obtain a cash advance with the WEX HealthXxxxx™ Card at any merchant, bank or ATM. You understand that the WEX HealthXxxxx® Prepaid Visa® Card is to be used exclusively for qualified expenses as defined by the plan(s) in which you participate. If the WEX HealthXxxxx™ Card is issued pursuant to employer plans and you use the card to pay for an expense that is not a qualified expense, you are indebted to your employer and must repay the full amount of the non-qualified expense. You agree to save all receipts and invoices related to any expense paid using the WEX HealthXxxxx® Prepaid Visa® Card. If required, you agree to submit copies of these documents attached to a signed claim form for review by Admin America, the Plan Service Provider. Failure to submit the receipt(s) when required will cause the expense to be treated as a non-qualified expense and you will be required to remit payment to your employer. Payment may be in the form of an offsetting claim, a personal check, electronic draft from your personal checking or savings account, a post-tax deduction from your paycheck, or other options established by your employer.