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Qualified Domestic Relations Order A court with jurisdiction over the employee, spouse and/or dependents covered by this Plan may through the issuance of a QDRO may allocate all or a portion of the available benefits under this Plan for the exclusive benefit of any or all of such persons as long as the total of all benefits for a Participant, the Participant's spouse and the Participant's dependents does not exceed 100%of the Anticipated Contributions for the Plan Year. Eligible Expenses for HSA Plan Participants HSA participants are those that are eligible to make contributions to a Health Savings Account plan qualified under Section 223 of the Internal Revenue Code. Expenses eligible for reimbursement under this Limited-Purpose Health Care Flexible Spending Account Plan include those incurred during the Benefit Period for the prevention, diagnosis, cure, mitigation, or treatment of disease, for the purpose of affecting any structure or function of the body, or for the treatment and cure of bodily injury resulting from accidents and for transportation primarily for and essential to medical care for himself, his spouse and his covered dependents, as defined in Code Section 105. Additionally,reimbursable expenses must be for dental,vision or hearing care, and out-of-pocket expenses incurred after the calendar year deductible under the Employer's HSA- compatible medical insurance plan as evidenced by an Explanation of Benefits. Medical expenses covered by the Employee's HSA plan, the Employer-sponsored medical insurance plan, or paid by any other plan or insurance program are not eligible. Covered persons include the Participant and any individuals considered by the IRS as spouse or dependents for income tax purposes. The Participant may not be reimbursed for any amounts payable under any other employee benefit plan or policy or any individual insurance by which the Participant, his spouse, or dependents are covered. All reimbursements must comply with Code Section 213 and/or specific guidance issued by the IRS related to the Plan,however,the Employer may restrict or limit such coverage by means of administrative rules provided such rules are made known to Employees prior to the beginning of each Plan Year or the date of the Employee's eligibility, as applicable. Eligible Expenses for non-HSA Plan Participants Expenses eligible for reimbursement for Participants not eligible to make contributions to a Health Savings Account plan include those incurred during the Benefit Period for the prevention, diagnosis, cure, mitigation, or treatment of disease, for the purpose of affecting any structure or function of the body, or for the treatment and cure of bodily injury resulting from accidents and for transportation primarily for and essential to medical care for himself,his spouse and his covered dependents, as defined in Code Section 105. Additionally, reimbursable expenses must be for medical, dental, vision or hearing care. Medical expenses covered by any Employer-sponsored medical insurance plan, or paid by any other plan or insurance program are not eligible. Covered persons include the Participant and any individuals considered by the IRS as spouse or dependents for income tax purposes. 4