Exhibit_1_-_Employee_Account_Summary.xlsx

This is an Employee Account Summary reporting template for the Oklahoma Education and Health Care Authority (OEIBA) Program administered by the Office of Management and Enterprise Services (OMES) Central Purchasing division on behalf of the Oklahoma Health Care Authority Employees Group Insurance Division. The template is designed for HSA Administrators to submit quarterly member account detail reports tracking enrollment, deposits, disbursements, and account balances for employees enrolled in the HealthChoice High Deductible Health Plan (HDHP). The report requires submission of comprehensive account data including total enrollees, annual election information, employee and employer deposits, total deposits, other deposits, total disbursed amounts, forfeiture balance, available balance, and balance due for each quarter (Q1 through Q4). Completed reports must be submitted electronically as Excel files within 60 days following the close of each quarter to the secure email domain EGIDVendorReporting@omes.ok.gov.

The reporting template establishes standardized quarterly account management and reconciliation procedures for HSA administration services. Suppliers are required to maintain detailed member account records and provide transparent financial reporting that tracks all deposits, disbursements, and account balances throughout the plan year. The electronic submission requirement and 60-day reporting deadline ensure timely financial reconciliation and program oversight by the contracting agencies, enabling proper monitoring of HSA account activity and member fund management under the OEIBA program.