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HomeMy WebLinkAbout2016-129N Indian River County Board of County Commissioners Section 125 Plan ----------------------------------- Effective October 1, 2015 Page 1 PREAMBLE The Employer hereby establishes a Cafeteria Plan("Plan")for the purpose of providing its eligible Employees an opportunity to elect among the tax-free benefits available under the Plan. The Plan is intended to qualify as a cafeteria plan under Section 125 of the Internal Revenue Code. The Effective Date of this Plan is October 1, 2015. This is an amendment or restatement of the Section 125 Plan dated October 1, 2011. The Plan Sponsor, Plan Administrator, a benefits committee, and/or a third party claims administrator is hereby granted discretionary authority to determine eligibility for benefits and/or to construe the terms of the plan. ARTICLE 1 —DEFINITIONS 1.01 "Benefit Plan(s) or Policy(ies)" means those Qualified Benefits available to eligible Employees under this Plan as amended or restated from time to time. 1.02 "Change in Status" means any of the events included under Section 125 or regulations issued under Section 125 that the Plan Administrator in its sole discretion decides to recognize on a uniform and consistent basis as a reason to enroll, change an election, or terminate participation mid-year. 1.03 "Code" means the Internal Revenue Code of 1986 as amended. 1.04 "Compensation"means the cash wages or salary paid to an Employee by the Employer. 1.05 "Dependent" means the legal spouse and/or dependent child(ren) of the Participant. Dependent children may be covered by the medical, dental and vision plans through the end of the calendar year in which the child reaches age 26. The term "child" includes any of the following: • A natural child • A step child • A legally adopted child • A child placed for adoption • A child for whom legal guardianship has been awarded to the Participant or the Participant's spouse • A newborn (up to age 18 months) of a covered dependent (Florida only) • A foster child 1.06 "DOL" means the United States Department of Labor. 1.07 "Effective Date" means the effective date of this Plan stated in the Preamble. 1.08 "Employee" means any individual who is considered to be in a legal employee-employer relationship with the Employer for federal tax-withholding purposes. The term "Employee" shall not include any leased employee (as that term is defined in Code Section 414(n)) or any self- Page 2 employed individual who received from the Employer "net earnings from "self-employment" within the meaning of Code Section 401(c)(2)unless such individual is also an Employee. 1.09 "Employer" means the Indian River County Board of County Commissioners and affiliated political subdivisions that have elected to participate. 1.10 "FMLA"means the Family and Medical Leave Act. 1.11 "Highly-Compensated Employee" means an individual defined under Code Sections 105(h), 125(e) or 414(q), as amended, as a "highly-compensated individual" or "highly- compensated employee." 1.12 "Ineligible Class"means one or more Employees that may not participate in the plans due to their employment status. 1.13 "IRS" means the Internal Revenue Service. 1.14 "Key Employees" means an individual who is a "key employee" as defined in Code Section 125(b)(2), as amended. 1.15 "Open Enrollment"means a period of time established by the Plan Administrator before the beginning of a Plan Year in which all eligible Employees may elect to participate in Qualified Benefits, change prior elections, or cease participation. The effective date of such elections shall be the first day of the coming Plan Year. 1.16 "Participant" means an Employee who elects a Qualified Benefit as defined herein. 1.17 "PPACA" means the Patient Protection and Affordable Care Act. 1.18 "Plan"means this document. 1.19 "Plan Administrator" means the Employee or legal representative appointed by the Indian River County Board of County Commissioners to serve in this capacity. 1.20 "Plan Year" means twelve month period of coverage beginning each October l sl and continuing to the following September 301'. 1.21 "Policy" means a document provided by an insurer that defines the benefits and terms of participation of a Qualified Benefit under this Plan. 1.22 "Qualified Benefit" means any benefit excluded from the Employee's taxable income under Chapter 1 of the Code other than Sections 106(b), 117, 124, 127 or 132 and any other benefit permitted by the Income Tax Regulations(i.e. any life insurance coverage that is included in gross income by virtue of exceeding the dollar limitation on nontaxable coverage under Code Section 79). Notwithstanding the previous sentence,long-term care insurance is not a"Qualified Benefit". Page 3 1.23 "Qualifying Event" means an event which would create an opportunity, under certain conditions, for an Employee to enroll in benefits, change benefit elections or cease participation in Qualified Benefits offered under this Plan at times other than during open enrollment. 1.24 "Section 125" means Code Section 125 which is titled"Cafeteria Plans". ARTICLE 2 —ELIGIBILITY AND PARTICIPATION 2.01 Eligibility to Participate. Each active Employee who is eligible to participate in for a health insurance plan sponsored by the Employer is eligible to participate in this Plan and underlying Qualified Benefits. No enrollment in this Plan is necessary. Participation is automatic if the Employee enrolls in one or more Qualified Benefits. The provisions of this Article are not intended to override any eligibility requirement(s) or waiting period(s) specified in applicable Benefit Plans or Policies, and the terms of eligibility and participation for the Benefit Plans and Policies shall be subject to the requirements of their respective governing documents. 2.02 Termination of Participation. Participation ends on the earlier o£ • The date your eligibility ends; • The date your employment ends; or • The date this Plan is terminated Certain laws such as COBRA and FMLA may allow you to continue participating in the Benefit Plans or Policies available under this Plan; however, you may not be eligible to use this plan to obtain tax-free benefits. Page 4 2.03 Qualifying Leave under FMLA. Notwithstanding any provision to the contrary in this Plan, if a Participant goes on a qualifying leave under the Family and Medical Leave Act, then to the extent required by the FMLA, the Participant will be entitled to continue Participant's Benefit Plans or Policies that provide health coverage on the same terms and conditions as if the Participant were still an active Employee. The Plan Administrator will establish a procedure for the payment of premiums and contributions for other benefits with the intent of providing a means for the Participant to have continuous coverage while on leave. Generaily, payment of premiums and contributions shall be made before the month of coverage. Such rules and payment options will be administered in accordance with regulations issued under Code Section 125 and in accordance with the FMLA. 2.04 Non-FMLA Leave. If a person goes on an unpaid leave that does not affect eligibility under this Plan or the Benefit Plans or Policies chosen by the Participant, then the Participant will continue to participate and the premiums or contributions will be paid by one of the options described in the immediately preceding provision. If a Participant goes on an unpaid leave that affects eligibility under this Plan or the Benefit Plans or Policies, coverage will terminate at the end of the month that leave becomes effective. Upon return from an unpaid leave, participation in the Plan will be in accordance with Article 3.02 If such policy requires coverage to continue during the leave but permits a Participant to discontinue premiums or contributions while on leave, the Participant will, upon returning from leave, be required to repay the premiums or contributions not paid by the Participant while on leave. Page 5 ARTICLE 3 - BENEFIT ELECTIONS 3.01 Election of Contributions. An Employee may elect to participate in any of the Qualified Benefits offered under this Plan provided the eligibility requirements have been met. The premiums and/or contributions for such Qualified Benefits will be tax-free under this Plan if permitted under federal, state or local law. The election of any Qualified Benefit will serve as an election to participate in this Plan. Such elections are optional, subject to the rules stated herein and in the Benefit Plans and/or Policies. The Employee may retain any or all earned income (cash) in lieu of benefits. The Employer may contribute to any or all Qualified Benefits however the Employee has no right to such contributions unless the Qualified Benefit is elected and the Employee pays a corresponding premium and/or contribution. 3.02 Newly-eligible Employees. Employees that become eligible to participate in this Plan, either due to new employment or regaining eligibility including returning from non-FMLA leave, shall have 30 days to make an election to participate in any or all of the Qualified Benefits. Such election shall take effect on the first day of the month following 30 days of employment or return from non-FMLA leave. Elections may be made via electronic enrollment and/or paper form, as required by the Employer. Some Qualified Benefits may require the separate approval of the benefit provider and the election of a Qualified Benefit which is not guaranteed. 3.03 Open Enrollment. An Open Enrollment period will be established by the Employer before the start of each Plan Year. Both current Participants and newly-eligible Employees may elect from the Qualified Benefits made available for the coming Plan Year using the Employer-designated electronic enrollment system. The Open Enrollment period is a limited time that has a deadline for making elections that ends days or weeks before the new Plan Year starts. Once the Open Enrollment ends, no further elections for the new Plan Year will be accepted. Failure to make an election may have one or more of the following consequences: a. You may be automatically re-enrolled in the same Qualified Benefit(s) you had before the new Plan Year if the same option(s) continues to be available. b. You may be enrolled in the Qualified Benefit(s) that most closely matches the Qualified Benefit(s)you had before the new Plan Year began(as determined by the Employer). c. You may be excluded from participating in the Qualified Benefit(s) for the new Plan Year. The Employer has sole discretion regarding which of the above options apply to each available Qualified Benefit if an eligible Employee fails to make an election during the Open Enrollment period. Page 6 3.04 Mid-Plan Year Election Changes. An eligible Employee may enroll in Qualified Benefits, change prior elections, or cease participation in Qualified Benefits during a Plan Year only under the following conditions: a. The Employee or a Dependent experiences a Qualifying Event that is listed under Section 125 of the Internal Revenue Code, as amended. Such Qualifying Events include but are not limited to marriage, divorce, legal separation, adding an eligible dependent, losing an eligible dependent, or a change in employment that affects eligibility for coverage including changes pursuant to FMLA. b. The Employee must notify the Human Resources Department of the Employer of the Qualifying Event and any desired changes in elections in writing on an Employer-approved form or electronic enrollment system on or before 30 days after the Qualifying Event. c. Any requested changes in elections (whether a new election, change or ceasing participation) must be on account of the Qualifying Event and consistent with the nature of the Qualifying Event. Except for special enrollment rights required by HIPAA for birth, adoption or placement for adoption for a child, all election changes will be prospective and will take effect on the date determined by the Plan Administrator. 3.05 Effect of Termination of Employment and Loss of Eligibility on Elections Termination of employment or cessation of eligibility will automatically revoke any elections made under this Plan. The effective date of such revocations will be determined by the Plan Administrator and may vary for each Qualified Benefit. Participants may have rights to continue certain Qualified Benefits under COBRA. Rehires that meet all eligibility requirements may make new elections in the Qualified Benefits subject to availability and timing with respect to the Plan Year. ARTICLE IV—BENEFIT FUNDING 4.01 Source of Benefit Funding The cost of Qualified Benefits may be funded through any or all of the following: • Employee pre-tax contributions • Employee post-tax contributions • Conditional Employer contributions The Employee's cost of each Qualified Benefit shall be reduced by conditional Employer contributions, if any. The Employee's contributions, if any, shall be pre-tax if made via payroll deductions and permitted by Section 125. Employee contributions made by some Page 7 means other than payroll deduction shall be post-tax. Employer contributions for each Qualified Benefit and benefit level under the Qualified Benefit shall be the same for similarly-situated Participants except as stated in 4.02. 4.02 Reduction of Elections to Prevent Discrimination If the Employer determines that the Plan may fail to satisfy any requirement of Section 125 or any limitation on pre-tax contributions allocable to Key Employees or Highly- Compensated Employees, the Plan Administrator may take such actions as deemed appropriate under rules uniformly applicable to similarly situated Participants, to assure compliance with such requirement or limitation. Such action may include, without limitation, a modification or revocation of a Highly-Compensated Employee or Key Employee's election without consent of such Employee. ARTICLE V- BENEFITS 5.01 Qualified Benefits Eligible Employees may elect one or more of the following Qualified Benefits: • Medical Insurance • Dental Insurance • Vision Insurance • Health Care Flexible Spending Account • Dependent Care Flexible Spending Account • Health Savings Account Contributions • Other select health insurance plans that qualify under Code Sections 105 and 106 and that are not funded by the Employer 5.02 Cash Benefit Any earned income not used to purchase Qualified Benefits with pre-tax contributions under this Plan or post-tax contributions shall be paid to the Employee as normal compensation. Page 8 ARTICLE VI—PLAN ADMINISTRATION 6.01 Allocation of Authority The Indian River County Board of County Commissioners, an applicable governing body, or an authorized officer of the Employer shall appoint a Plan Administrator that keeps the records for the Plan and shall control and manage the operation and the administration of then Plan. The Plan Administrator shall have the exclusive right to interpret the Plan and to decide how all matters arising thereunder, including the right to make determinations of fact, and construe and interpret possible ambiguities, inconsistencies, or omissions in the Plan. In the case of an insured Benefit Plan or Policy, the insurer shall be the named fiduciary-with respect to benefit claim determinations thereunder, and with respect to benefit claims shall have all of the powers of the Plan Administrator described herein. All determinations of the Plan Administrator with respect to any matter hereunder shall be conclusive and binding on all persons. Without limiting the generality of the foregoing, the Plan Administrator shall have the following powers and duties. a. To require any person to furnish reasonable information for the purpose of the proper administration of the Plan as a condition to receiving any benefits under the Plan. b. To make and enforce such rules and regulations and prescribe the use of such forms as the Plan Administrator may deem necessary for the efficient administration of the Plan. c. To decide on questions concerning the Plan and the eligibility of any Employee to participate in the Plan and to make and revoke elections under the Plan, in accordance with the provisions of the Plan. d. To determine the amount of benefits which shall be payable to any person in accordance with the provisions of the Plan; to inform the Employer or insurer as appropriate, of the amount of such benefits; and to provide a full and fair review to any Participant whose claim has been denied in whole or in part. e. To designate other persons to carry out any duty or power which may or may not otherwise be a fiduciary responsibility of the Plan Administrator, under the terms of the Plan. f. To keep records or all acts and determinations, and to keep such records, books of account, and data and other documents as may be necessary for the proper operation of the Plan. g. To do all things necessary to operate and administer the Plan in accordance with its provisions. Page 9 6.02 Payment of Administrative Expenses The Employer shall pay all reasonable expenses incurred in administering the Plan. 6.03 Reporting and Disclosure Obligations Unless specified otherwise, it shall be the Employer and Plan Administrator's sole responsibility to comply with all filings, reporting, and disclosure requirements, imposed by the DOL and/or IRS. Furthermore, the Employer and Plan Administrator shall be required to amend the Plan as is necessary to ensure compliance with applicable tax and other laws and regulations. 6.04 Indemnification The Plan Administrator shall be indemnified by the Employer against claims, and the expenses of defending against such claims, resulting from any action or conduct relating to the administration of the Plan except claims arising from gross negligence, willful neglect, or willful misconduct. ARTICLE VII—PLAN FUNDING The Plan shall be funded with amounts withheld from Compensation pursuant to Participant elections and contributions the Employer may choose to make to offset the Participant's cost of certain Qualified Benefits. The Employer may elect to pay all, part or none of the cost of each Qualified Benefit or tier within each benefit. The Employer will apply all such amounts, without regard to their source,to pay for the Qualified Benefits provided herein as soon as administratively feasible and shall comply with all applicable regulations promulgated by the DOL taking into considerations any enforcement procedures adopted by the DOL. ARTICLE VIII—CLAIM PROCEDURES The Plan has established procedures for reviewing claims denied under this Plan and those claims review procedures are set forth in the respective policies and other documents for each Qualified Benefit. The Plan's claim review process as set forth in such policies and documents shall only apply to issues germane to the pre-tax benefits available under this plan (i.e. such as a determination of a Change in Status, change in cost or coverage, or eligibility and participation matters under this Plan), and to the extent offered under the Plan, claims for benefits under the Flexible Spending Accounts. Page 10 ARTICLE IX—AMENDMENT OR TERMINATION OF THE PLAN 9.01 Permanency While the Employer fully expects this Plan will continue indefinitely, due to unforeseen, future contingencies, permanency of the Plan shall be subject to the Employer's right to amend or terminate the Plan, as provided in Sections 9.02 and 9.03 below. Nothing in this Plan is intended to be or shall be construed to entitle any Participant, retired or otherwise, to vested or non-terminable benefits. 9.02 Employer's Right to Amend The Employer reserves the right to amend at any time any or all provisions of the Plan. All amendments shall be made in writing and shall be approved by the Employer in accordance with its normal procedure for transacting business (e.g. by approval by the Board of County Commissioners or designated officer). Such amendments shall apply retroactively or prospectively as set forth on the amendment. Each Benefit Plan shall be amended in accordance with the terms specified therein, or, if no amendment procedure is prescribed, in accordance with this section. 9.03 Employer's Right to Terminate The Employer reserves the right to discontinue or terminate the Plan without prejudice at any time and for any reason without notice. Such decision to terminate the Plan shall be made in writing and shall be approved by the Employer in accordance with its normal procedure for transacting business. 9.04 Determination of the Effective Date of Amendment or Termination Any such amendment, discontinuance, or termination shall be effective as of such date as the Employer shall determine. ARTICLE X—GENERAL PROVISIONS 10.01 Not an Employment Contract Neither this Plan nor any action taken with respect to it shall confer upon any person the right to continue employment with any Employer. 10.02 Applicable Laws The provisions of the Plan shall be construed, administered, and enforced according to applicable federal law and the laws of the state of the principal place of business of the Employer to the extent not preempted. Page 11 10.03 Post-Mortem Payments Any benefit payable under the Plan after the death of the Participant shall be paid to his surviving spouse (if any), otherwise to his estate. If there is doubt as to the right of any beneficiary to receive any amount, the Plan Administrator may retain such funds until the rights thereto are determined, without liability for any interest. 10.04 Nonalienation of Benefits Except as expressly provided by the Plan Administrator, no benefit under the Plan shall be subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, or charge, and any attempt to do so shall be void. No benefit under the Plan shall in any manner be liable for or subject to the debts, contracts, liabilities, engagements, or torts of any person, 10.05 Mental or Physical Incompetency Every person receiving or claiming benefits under the Plan shall be presumed to be mentally and physically competent and of age until the Plan Administrator receives written notice, in a form and manner acceptable to it, that such person is mentally or physically incompetent or a minor, and that a guardian, conservator or other person legally vested with the care of his estate has been duly appointed. 10.06 Inability to Locate Payee If the Plan Administrator is unable to make payment to any Participant or other person to whom a payment is due under the Plan because it cannot ascertain the identity or whereabouts of such Participant or other person after reasonable efforts have been made to identify or locate such person, such payment and all subsequent payments otherwise due to such Participant or other person shall be forfeited one year after the date any such payment became first due. 10.07 Requirement for Proper Forms All communications in connection with the Plan made by a Participant shall become effective only when duly executed on any forms as may be required and furnished by, and filed with, the Plan Administrator. 10.08 Source of Payments The Employer and any insurance company contracts purchased or held by the Employer or funded pursuant to this Plan shall be the sole sources of benefits under the Plan. No Employee or beneficiary shall have any right to, or interest in, any assets of the Employer upon termination of employment or otherwise, except as provided from time to time under the Plan to such Employee or beneficiary. Page 12 10.09 Multiple Functions Any person or group of persons may serve in more than one fiduciary capacity with respect to the Plan. 10.10 Tax Effects Neither the Employer, its agents, the Plan Administrator makes any warranty or other representation as to whether any pre-tax contributions made to or on behalf of any Participant hereunder will be treated as excludable from gross income for local, state, or federal income tax purposes. If for any reason it is determined that any amount paid for the benefit of a Participant or beneficiary is includable in an Employee's gross income for local, state or federal income tax purposes, under no circumstances shall the recipient have any recourse against the Plan Administrator or the Employer with respect to any increased taxes or other losses or damages suffered by the Employee as a result. 10.11 Gender and Number Masculine pronouns include the feminine as well as the neutral genders, and the singular shall include the plural, unless indicated otherwise by the context. 10.12 Headings The Article and Section headings contained herein are for convenience of reference only, and shall not be construed as defining or limiting the matter contained thereunder. 10.13 Incorporation by Reference The actual terms and conditions of the separate component Benefit Plans or Policies offered under this Plan are contained in separate, written documents governing each respective benefit, and shall govern in the event of a conflict between the individual plan document, and this Plan as to substantive content. To that end, each such document , as amended or substantially replaced, is hereby incorporated by reference as if fully recited herein. 10.14 Severability Should any part of this Plan subsequently be invalidated by a court of competent jurisdiction, the remainder thereof shall be given effect to the maximum extent possible. Page 13 10.15 Effect of Mistake In the event of a mistake as to the eligibility or participation of an Employee,the allocations made to the account of any Participant, or amount of distributions made or to be made to a Participant or other person, the Plan Administrator shall, to the extent it deems possible, cause to be allocated or cause to be withheld or accelerated, or otherwise make adjustment of, such amounts as will in its judgment accord to such Participant or other person the credits to the account or distributions to which he is properly entitled. Such action by the Plan Administrator may include withholding of any amounts due to the Plan or the Employer from Compensation paid by the Employer,or other actions as it deems necessary to collect from the Participant or other person overpayments or improper benefits received by the Participant or other person. 10.16 Provisions Relating to Insurers No insurer shall be required or permitted to issue an insurance policy or contract that is inconsistent with the purposes of this Plan, nor be bound to take any action not in accordance with the terms of any policy or contract with this Plan. The insurer shall not be deemed to be a party to this Plan, nor shall it be bound to interpret the construction or validity of the Plan. The insurer shall be protected from its good faith reliance on the written representations and instructions of the Plan Administrator, and shall not be responsible for the initial or continued qualified status of the Plan. 10.17 Jurisdiction This Plan shall be construed and enforced according to the laws of the State of Florida,except to the extent those laws are preempted by the laws of the United States of America. ' The venue for any actions shall be Indian River County or in federal court in the Southern District of Florida Page 14 IN WITNESS WHEREOF, the Employer has executed this Plan as of the date set forth below. EMPLOYER'S ACKNOWLEDGEMENT As evidenced by the formal execution of this document, the undersigned Employer adopts this Plan, which is an amendment and restatement of an earlier Plan dated October 1, 2011. In doing so, the undersigned Employer acknowledges that the Plan Document is an important legal instruments with significant legal and tax implications. The Employer also acknowledges that it has read this Plan Document in its entirety, has consulted independent legal and tax counsel other than representatives of JAG Enterprises, LLC (d.b.a. Benefits Workshop), to the extent considered necessary, and accepts full responsibility for participation of the Employees hereunder and then operation of the Plan. The Employer acknowledges that,as Employer and Plan Administrator, it shall have sole responsibility to comply with all filings, reporting, disclosure and other requirements imposed by the DOL, IRS, or any other government agency. Furthermore, the Employer further acknowledges that it shall bear sole responsibility for amending the Plan as necessary to ensure compliance with applicable tax, labor, and other laws and regulations. It is also understood and agreed that JAG Enterprises, LLC (d.b.a. BenefitsWorkshop), and its agents, and representatives, are not providing legal or tax advice to the undersigned Employer in connection with this Plan and no representations are made by it with respect to the operation of the Plan pursuant to any documents electronic or otherwise provided by JAG Enterprises, LLC (d.b.a. BenefitsWorkshop)to the Employer. The Plan shall be construed and enforced according to the Internal Revenue Code of 1986, as amended from time to time, the applicable regulations thereto, and the laws of the state of the principal place of business of the Employer. IN WITNESS WHEREOF, the Employer has caused this Plan to be executed on the day of August 16, 2016 to ratify the adoption of the Plan as of the Effective Date. WITNESS: ........... Employer: Indian River Count > °' °�,; By: c Bob Solari Title: Chairman �9y.•, f :�Q; Date. August 16, 2016 9��UNN•F;•'• ATTEST: Jeffrey R. Smith, Clerk of Court and APPROVED AS TO FORM Comptroller AND LEGAL SUFFICIENCY BY: Qu,'— BY Deputy Clerk 4YLAN REINGOLD Page 15 COUNTY ATTORNEY Indian River County Board of County Commissioners Dependent Care Flexible Spending Account Flan Document Introduction The Indian River County Board of County Commissioners has established this Dependent Care Flexible Spending Account Plan (the "Plan") to meet the needs of those of its Employees who are Participants in the Plan. The purpose of this Plan is to provide for the work-related custodial dependent care for certain Participants, their spouses and their dependents. The Plan is intended to qualify as a dependent care assistance plan as defined in Section 129 of the Internal Revenue Code of 1986, as amended (the "Code"). This is an amendment or restatement of the Health Care Flexible Spending Account Plan dated October 1, 2011. The Plan Sponsor, Plan Administrator, Benefit Administrator, a benefits committee, and/or a third party claims administrator is hereby granted discretionary authority to determine eligibility for benefits and/or to construe the terms of the plan. Definitions a. Benefit Administrator- means an individual appointed by the Board of County Commissioners or other governing body of the Employer. b. Benefits -means the amounts paid to Participants under the Plan as reimbursements for Eligible Employment Related Expenses incurred by a Participant. c. Code—means the Internal Revenue Code of 1986 as amended. d. Dependent- means any individual who is a dependent of a Participant within the meaning of Code Section 152(a). e. Earned Income - means all income derived from wages, salaries, tips, self-employment and other employee compensation but does not include any amounts received (i) under the Plan or any other dependent care assistance program under Code Section 129; or(ii) as a pension or annuity. f. Effective Date—means October 1, 2015. g. Eligibility Requirement- means the requirement(s) for participation set forth herein. h. Eligible Employee - means any individual employed by the Employer for purposes of the Federal Insurance Contributions Act. i. Eligible Employment Related Expenses - means all Employment Related Expenses incurred by a Participant which are paid to a person who is not: • a Dependent of the Participant; • the Participant's Spouse; or • a child of the Participant under the age of 19. j. Employ- means the Indian River County Board of County Commissioners and affiliated political subdivisions that have elected to participate. k. Employment Related Expenses - means expenses incurred for Qualifying Services or for the cost of sending a child of the Participant to a Qualifying Day Care Center. 1. Participant - means any Employee who has satisfied the eligibility requirements under Article III of the Plan. in. Plan Administrator- means the Indian River County Board of County Commissioners or its designee, if any. n. Plan Year- The initial Plan Year for this Plan Document is October 1, 2015 to September 30, 2016. Subsequent Plan Years shall be twelve (12) month periods beginning each October 1 and ending on the following September 30. o. QualifyiniZ Day Care Center- means: • a day care center which complies with all applicable laws and regulations; • provides care for more than six individuals, other than individuals who reside at the day care center; and • receives a fee payment or grant for providing Qualifying Services for the individuals. p. Qualifying Individual - means: • a Dependent of a Participant who is under the age of 13; • a Dependent of a Participant who is physically or mentally incapable of caring for himself; or • the Spouse of a Participant, if he is physically or mentally incapable of taking care of himself. 2 q. Qualifying Services - means Services performed: O in the home of the Participant; or outside the home of the Participant for the care of a Dependent who is under the age of 13, or for the care of a Qualifying Individual other than a Dependent under the age of 13, who regularly spends at least eight(8) hours a day in the Participant's household. r. Services -means custodial services performed to enable a Participant or Spouse to remain gainfully employed and which are related to the care of a Qualifying Individual. s. Spouse-means the spouse of a Participant but shall not include an individual separated or divorced from a Participant. t. Student- means an individual who, during each of five calendar months during a Plan Year, is a full-time student at an educational institution. Efi2ibifity The Employee may elect to participate in the Plan upon completion of the Eligibility Requirements specified by the Employer in the Section 125 Plan in Section 2.01. If the Eligible Employee elects to participate in the Plan during open enrollment and makes the required contributions, coverage shall begin on the October 1 immediately following the election. If the Eligible Employee elects to participate or change an election in the Plan during the Plan Year as allowed due to new eligibility or a qualifying event, coverage shall begin on the first day of the month following the election. In addition to the qualifying events defined in the Section 125 Document that permit mid-year election changes, Eligible Employees may begin participation, change contributions or cease participation if the cost of Qualifying Services changes in a manner consistent with the requested election change. Participation shall continue until the earlier of the last day of the Plan Year or the date coverage ceases. Each Employee who terminates employment with the Employer during a Plan Year that is later rehired and becomes eligible for this Plan during the same Plan Year shall be treated as a newly- eligible employee for the purposes of election rights. 3 Termination of Eligibility The eligibility of a Participant will cease upon the earlier of the following: The date your eligibility ends; Y The date your employment ends; or O The date this Plan is terminated Benefits Each Participant in the Plan shall be eligible to receive Benefits under the Plan for all Eligible Employment Related Expenses incurred by the Participant after he became a Participant in the Plan, subject however to the limitations herein. Claim for Benefits Each Participant who desires to receive a Benefit under the Plan for Eligible Employment Related Expenses incurred for Qualifying Services shall, upon request, submit to the Benefit Administrator or its designee a written statement containing the following information: a. name of the Dependent for whom the Qualifying Services are to be performed; b. the nature of the Qualifying Services performed for the Participant, the cost for which he wishes to be reimbursed; c. the relationship, if any, of the person performing the Qualifying Services to the Participant; d. if the Qualifying Services are being performed by a child of the Participant,the age of that child; e. a statement as to where the Qualifying Services will be performed; £ if the Qualifying Services are being performed in a day care center, a statement that (a)the day care center complies with all applicable laws and regulations; (b)the day care center provides care for more than six individuals (other than individuals residing at the center); and(c)the amount of compensation paid to the center; g. if the Participant is married, a statement of(a)the Spouse's compensation if he is employed, or(b) if the Participant's Spouse is not employed, a statement that(1)he is incapacitated or(2)he is a full-time student attending an educational institution and the months during the year which he will attend the educational institution; h. the name, address, and the Federal Tax Identification Number or Social Security Number of the individual or organization providing the care. The Federal Tax Identification Number or Social Security Number is not required if the individual or organization is tax- exempt. 4 If the Participant is eligible to receive Benefits under the Plan, he shall submit a statement stating the amount of Eligible Employment Related Expenses incurred by the Participant to the Benefit Administrator or its designee within ninety(90) days after the date participation ends within the Plan Year or the ninety(90)days after end of the Plan Year, whichever is earlier. Within thirty(30) days of receiving the statement,the Benefit Administrator or its designee shall pay the Participant the Benefits to which he is entitled under the Plan. Limitations on Benefits A Participant may not receive Benefits for Eligible Employment Related Expenses incurred for any month in excess of his Earned Income for that month. If the Participant is married, he/she may not ' receive benefits for any month in excess of the lesser of: a. his Earned Income for the month; or b. the Earned Income of his/her Spouse for that month. A Spouse who is not employed during any month in which the Participant incurs Eligible Employment Related Expenses, and is either incapacitated or a Student, shall be deemed to have Earned Income for that month of: a. $250, if there is one Qualifying Individual for whom the Participant incurs Eligible Employment Related Expenses; or b. $500, if there is more than one Qualifying Individual for whom the Participant incurs Eligible Employment Related Expenses. A Participant may not receive Benefits for Eligible Employment Related Expenses for any calendar year in excess of$5,000.00. A married Participant who files a separate individual tax return may not receive Benefits for Eligible Employment Related Expenses for any calendar year in excess of$2,500.00. Funding Contributions required to pay Benefits under this Plan shall consist of contributions by the Participant. Plan Administrator The Plan Administrator shall be the named fiduciary of the Plan and shall have the authority to manage the operation and administration of the Plan and to adopt such rules and regulations consistent with the Plan as it shall deem appropriate to administer the Plan. All determinations by the Plan Administrator shall be binding upon Participants, their spouses and dependents. 5 Claims Procedure A Participant shall make a claim for Benefits by making a request in accordance with the Claim for Benefits section. If a claim is wholly or partially denied, notice of a decision shall be furnished to the Participant within a reasonable period of time, not to exceed ninety(90) days after receipt of the claim by the Benefit Administrator or its designee, unless special circumstances require an extension of time for processing the claim. If an extension of time is required, written notice of the extension shall be furnished to the Participant prior to the termination of the initial ninety(90) day period. In no event shall the extension exceed a period of ninety(90) days from the end of the initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the Benefit Administrator or its designee expects to render a decision. The Benefit Administrator or its designee shall,upon request,provide a Participant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant,the following: a. a specific reason or reasons for the denial; b. specific reference to pertinent Plan provisions upon which the denial is based; c. a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why that material or information is necessary; d. an explanation of the Plan's claim review procedure. The purpose of the review procedure is to provide a procedure by which a Participant, under the Plan, may have reasonable opportunity to appeal a denial of a claim to the Benefit Administrator or its designee for a full and fair review. To accomplish that purpose, the Participant, or his duly authorized representative may: a. request review upon written application to the named fiduciary; b. review pertinent Plan documents; and c. submit issues and comments in writing. A Participant or his duly authorized representative shall request a review by filing a written application for review with the Benefit Administrator or its designee at any time within sixty(60) days after receipt of written notice of the denial of the claim. 6 Decision on review of a denied claim shall be made in the following manner: a. The decision on review shall be made by the Benefit Administrator or its designee,which may, at its discretion, hold a hearing on the denied claim. The Benefit Administrator or its designee shall make its decision not later than sixty(60) days after the Benefit Administrator or its designee receives the request for review,unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible,but not later than one hundred twenty(120)days after receipt of the request for review. If an extension of time for review is required, written notice of the extension shall be furnished to the Participant prior to the commencement of the extension. b. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the Participant, and specific references to the pertinent Plan provisions on which the decision is based. c. In the event that the decision on review is not furnished within the time period set forth, the claim shall be deemed denied on review. If a dispute arises with respect to any matter under this Plan,the Benefit Administrator or its designee may refrain from taking any other or further action in connection with the matter involved in the controversy until the dispute has been resolved. Amendment and Termination This Plan may be amended, suspended or terminated at any time by the Board of County Commissioners or other governing body of the Employer. Gender and Number Masculine pronouns include the feminine as well as the neutral genders, and the singular shall include the plural, unless indicated otherwise by the context. Miscellaneous This Plan shall not be deemed to constitute a contract between the Employer and any Participant or Employee or to be a consideration or an inducement for the employment of any Participant or Employee. Nothing contained in this Plan shall be deemed to give any Participant or Employee the right to be retained in the service of the Employer or to interfere with the right of the Employer to discharge any Participant or Employee at any time regardless of the effect the discharge shall have upon him as a Participant of this Plan. This Plan shall be construed and enforced according to the laws of the State of Florida, except to the extent those laws are preempted by the laws of the United States of America. The venue for any actions shall be Indian River County or in federal court in the Southern District of Florida 7 IN WITNESS WHEREOF, the Employer has caused this indenture to be executed on the I hth day of August 12016 .sw.y • mis By: Bob Solari _ t t sQ s Title: Chairman ��� •oQ:� ••.,ER COON..• ATTEST: Jeffrey R. Smith, Clerk of Court and Comptroller APPROVED AS TC.' FORM n�_ AND LEGAL SUFFtC: EN By: BY Title: Deputy ClerkDYLAN REINGOLD (BOUNTY ATTORNEY 8 Indian River County Board of County Commissioners Health Care Flexible Spending Account Plan Document Introduction The Indian River County Board of County Commissioners has established this Health Care Flexible Spending Account Plan (the 'Plan") to meet the needs of those of its Employees who are Participants in the Plan. The purpose of this Plan is to provide for the medical protection for certain Participants, their spouses and their dependents. The Plan will provide benefits only for certain items of health care expenses which are not covered by any other type of employee benefit plan or individual insurance. The Plan is intended to qualify as a self-insured medical reimbursement plan as defined in Section 105 of the Internal Revenue Code of 1986, as amended (the "Code"). The Effective Date of this Plan is October 1, 2015. This is an amendment or restatement of the Health Care Flexible Spending Account Plan dated October 1, 2011. The Plan Sponsor, Plan Administrator, Benefit Administrator, a benefits committee, and/or a third party claims administrator is hereby granted discretionary authority to determine eligibility for benefits and/or to construe the terms of the plan. Definitions a. Anticipated Contributions - means the total amount of contributions the participant is expected to make during the plan year. b. Benefit Administrator - means an individual appointed by the Board of County Commissioners or other governing body of the Employer. c. Benefit Period—the period beginning on the date participation begins within a given Plan Year and ending on the earlier of the date participation ends for that Plan Year or the date two and one-half months after the end of the Plan Year. d. Code—means the Internal Revenue Code of 1986 as amended. e. Coverage Period-means a period of time during the Plan Year in which benefits are stable due to a regular contribution amount. f. Effective Date—October 1, 2015. g. Eligibility Requirement means the requirement(s) for participation stated herein. h. Employer-means the Indian River County Board of County Commissioners and affiliated political subdivisions that have elected to participate. 1 i. Employee - means any person who is employed by the Employer for purposes of the Federal Insurance Contributions Act. j. HSA — means Health Savings Account authorized under Section 223 of the Internal Revenue Code. k. IRS—means the Internal Revenue Service. 1. Participant-means any Employee who has satisfied the eligibility requirements of the Plan and who elects to make contributions to the Plan and actually makes such contributions. in. Plan Administrator - means the Indian River County Board of County Commissioners or its designee, if any. n. Plan Year—The initial Plan Year for this Plan Document is October 1, 2015 to September 30, 2016. Subsequent Plan Years shall be twelve (12) month periods beginning each October 1 and ending on the following September 30. o. QDRO—means Qualified Domestic Relations Order. Eligibility The eligible Employee may elect to participate in the Plan upon completion of the Eligibility Requirements specified by the Employer in the Section 125 Plan in Section 2.01. If the eligible Employee elects to participate in the Plan during open enrollment and makes the required contributions, coverage shall begin on the October 1 immediately following the election if the election is made during open enrollment, or the first day of the month following 30 days of eligibility for mid-year elections. If the Eligible Employee elects to participate or change an election in the Plan during the Plan Year as allowed due to new eligibility or a qualifying event, coverage shall begin on the first day of the month following the election. Participation shall continue until the earlier of the last day of the Plan Year or the date coverage ceases. Each Employee who terminates employment with the Employer during a Plan Year that is later rehired and becomes eligible for this Plan during the same Plan Year shall be treated as a newly- eligible employee for the purposes of election rights. Termination of Eligibility The eligibility of a Participant will cease upon the earlier of the following: • The date your eligibility ends; • The date your employment ends; or • The date this Plan is terminated 2 If eligibility ceases during a Plan Year,the former Participant may not make a new election for the remainder of the Plan Year. Participation in the Health Care Flexible Spending Account may be continued beyond the termination of eligibility as permitted under the Family Medical Leave Act (FMLA) as described in section 2.03 of the Section 125 or the Consolidated Omnibus Budget Reconciliation Act (COBRA). Continuation of Coverage Participants and qualified dependents may have a right to continue coverage under the provisions of COBRA through the end of the plan year in which coverage would otherwise cease. Benefits The Employer shall establish minimum and maximum annual Employee contributions for each Plan Year, subject to statutory limits. Such minimum and maximum annual Employee contributions shall be communicated to Employees during the annual enrollment period or upon eligibility, as applicable. The amount available for reimbursement shall be the Employee's Anticipated Contributions during the Plan Year minus the amount already reimbursed during the Plan Year via check, direct deposit, debit card transaction or other means. Not later than ninety(90) days following the date upon which the Participant submits appropriate claim information,the Employer shall reimburse the Participant up to the Anticipated Contribution for a given Coverage Period for all eligible expenses incurred by the Participant during the Plan Year and defined as reimbursable under Code Section 105 for himself and his spouse and/or his tax dependents, if any. The Employer shall not reimburse the Participant 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 such reimbursements must comply with Code Section 213(d), 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. The IRS and other government entities may further restrict or limit which expenses are eligible. The Plan Administrator shall have final discretion as to which expenses are eligible for reimbursement. 3 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 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. Benefit Period The Participant shall be permitted to submit requests for reimbursement of eligible expenses incurred during the period beginning on the date participation begins within a given Plan Year and ending on the earlier of the date participation ends for that Plan Year or two and one-half months following the end of the Plan Year. Claims Procedure A Participant shall make a claim for Benefits by making a request in accordance with the terms of this Plan Document. Requests must be received within ninety(90)days after the date participation ends within the Plan Year or ninety(90) days after the end of the Plan Year, whichever is earlier. If a claim is wholly or partially denied, notice of a decision shall be furnished to the Participant within a reasonable period of time, not to exceed ninety(90) days after receipt of the claim by the Benefit Administrator or its designee, unless special circumstances require an extension of time for processing the claim. If an extension of time is required, written notice of the extension shall be furnished to the Participant prior to the termination of the initial ninety (90) day period. In no event shall the extension exceed a period of ninety (90) days from the end of the initial period. The extension notice shall indicate the special circumstances requiring an extension of time and the date on which the Benefit Administrator or its designee expects to render a decision. The Benefit Administrator or its designee shall, upon request, provide a Participant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: a. a specific reason or reasons for the denial; b. specific reference to pertinent Plan provisions upon which the denial is based; c. a description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why that material or information is necessary; d. an explanation of the Plan's claim review procedure, as set forth below. 5 The purpose of the review procedure, set forth herein is to provide a procedure by which a Participant, under the Plan, may have reasonable opportunity to appeal a denial of a claim to the Benefit Administrator or its designee for a full and fair review. To accomplish that purpose, the Participant, or his duly authorized representative may: a. request review upon written application to the named fiduciary; b. review pertinent Plan documents; and c. submit issues and comments in writing. A Participant or his duly authorized representative shall request a review by filing a written application for review with the Benefit Administrator or its designee at any time within sixty(60) days after receipt of written notice of the denial of his claim. Decision on review of a denied claim shall be made in the following manner: a. The decision on review shall be made by the Benefit Administrator or its designee, which may, in its discretion, hold a hearing on the denied claim; the Benefit Administrator or its designee shall make its decision not later than sixty (60) days after the Benefits Administrator or its designee receives the request for review, unless special circumstances require extension of time for processing, in which case a decision shall be rendered as soon as possible, but not later than one hundred twenty (120) days after receipt of the request for review. If an extension of time for review is required, written notice of the extension shall be furnished to the Participant prior to the commencement of the extension. b. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the Participant, and specific references to the pertinent Plan provisions on which the decision is based. c. In the event that the decision on review is not furnished within the time period set forth above, the claim shall be deemed denied on review. If a dispute arises with respect to any matter under this Plan, the Benefit Administrator or its designee may refrain from taking any other or further action in connection with the matter involved in the controversy until the dispute has been resolved. Repayment of Excess Reimbursements If it is determined that a Participant has received reimbursements (including via debit card) in excess of the amount of eligible expenses, the Benefit Administrator or its designee shall give the Participant written notice of any excess amount, and the Participant shall repay the amount of such excess to the Employer within sixty(60) days of such notice. 6 Coordination of Benefits The Plan is intended solely to pay benefits for unreimbursed health care expenses as defined by IRC Section 213(d), with the exception that reimbursement of premiums is not permitted. Accordingly, it shall not be considered a group health plan for coordination of benefits purposes, and its benefits shall not be taken into account when determining benefits under any other plan. Disposition of Unused Funds If an Employee's contributions exceed the amount reimbursed after the end of the claim filing period for the Plan Year (or the date of any final action by the Benefit Administrator, whichever is later), all excess contributions will be forfeited. The Employer may use any remaining funds as it sees fit except it may not return the funds to the Participants to offset any forfeiture. Funding Contributions required to pay benefits under this Plan shall consist of contributions by the Participants under the Employer's Flexible Benefit Plan, and other funds from the general assets of the Employer, if needed. Continuation of Coverage under COBRA Participants in this Plan may have rights to continue participation under Code Section 4980B (commonly known as COBRA)if the participant or a family member experience a qualifying event that would otherwise cause coverage to end. Participants are notified of specific rights under COBRA via a separate notice. HIPAA Privacy Federal regulations including the Health Insurance Portability and Accountability Act define the rights and obligations of participants, the Employer and the Plan with regard to protecting the privacy of personal health information. Plan Administrator The Plan Administrator shall be named fiduciary of the Plan and shall have the authority to manage the operation and administration of the Plan and to adopt such rules and regulations consistent with the Plan as it shall deem appropriate to administer the Plan. All determinations by the Plan Administrator shall be conclusive and binding on all Participants, their spouses and dependents. 7 Amendment and Termination This Plan may be amended, suspended or terminated at any time by the governing body of the Employer. Gender and Number Masculine pronouns include the feminine as well as the neutral genders, and the singular shall include the plural, unless indicated otherwise by the context. Miscellaneous This Plan shall not be deemed to constitute a contract between the Employer and any Participant or Employee or to be consideration or an inducement for the employment of any Participant or Employee. Nothing contained in this Plan shall be deemed to give any Participant or Employee the right to be retained in the service of the Employer or to interfere with the right of the Employer to discharge any Participant or Employee at any time regardless of the effect the discharge shall have upon him as a Participant of this Plan. This Plan shall be construed and enforced according to the laws of the State of Florida, except to the extent those laws are preempted by the laws of the United States of America. The venue for any actions shall be Indian River County or in federal court in the Southern District of Florida IN WITNESS WHEREOF, the Employer has caused this indenture to be executed on the 16th day of August 52016 •'y GOhtMlssi.•�• By: Bob Solari e t Title: Chairman �y•. �� a bei COUNROVED AS TO FORM ATTEST: Jeffrev R. Smith, Clerk of Courtaria".... LEGAL SUFFICIENCY Comptroller By: BY PLAN REINGOLD Title: Deputy Clerk 19--.4NTY ATTORNEY 8