HomeMy WebLinkAbout2005-063 _J
05 O (A
CLERK OF THE CIRCUIT COURT OF INDIAN RIVER COUNTY FLEXIBLE BENEFIT PLAN
PLAN DOCUMENT
AMENDED AND RESTATED OCTOBER 01 , 2004
The Employer recognizes that the Plan Document Is an Important legal document and that It has
been prepared based on The Flex Company of America ; Ino,'s understanding of the Employer's r
desired provisions , It may not conform to the Employer's situation and the Employer should
consult with Its attorney on the legal and tax Implications of the Plan , The Employer Is responsible
for reviewing all legal documents , The Flex Company of America, Inc, Is not engaged In the
practice of law or giving tax advice and cannot be responsible for the legal and tax aspects of the
Plan nor its appropriateness for the Employer's situation ,
ADOPTION INFORMATION
PLAN TYPE : Section 125 Flexible Benefit Plan
EMPLOYER AND PLAN SPONSOR : Clerk of the Circuit Court of Indian River County
2000 16th Avenue
Vero Beach , FL 32960
EMPLOYEE CLASSIFICATION : All employees who work 25 or more hours per week .
PLAN NUMBER : 501
EFFECTIVE DATE : January 1 , 1995
PLAN YEAR : October 1 - September 30
NEW HIRE ELIGIBILITY : First day following 30 days of employment.
PLAN SERVICE PROVIDER : The Flex Company of America , Inc .
P . O . Box 2490
Brookfield , WI 53008-2490
262-789-8181
PLAN YEAR MAXIMUM MEDICAL EXPENSE REIMBURSEMENT REDUCTION : $4000
CLAIMS PROCESSING SCHEDULE : Every day - All paper claims must be received at least 3
business days prior to this day.
WHEN MUST CLAIMS BE RECEIVED BY THE FLEX COMPANY AFTER PLAN YEAR END :
Claims for expenses incurred in the prior Plan Year must be received no later than December
31 st.
TERMINATION GUIDELINES :
MEDICAL EXPENSE REIMBURSEMENT ACCOUNT EMPLOYEE TERMINATION GUIDELINES :
NUMBER OF DAYS TO INCUR CLAIMS : For a medical expense to be eligible , it
MUST be INCURRED prior to the employee 's last day of employment .
NUMBER OF DAYS TO SUBMIT CLAIMS AFTER LAST DAY OF EMPLOYMENT : 30 days
DEPENDENT DAY CARE REIMBURSEMENT ACCOUNT EMPLOYEE TERMINATION GUIDELINES :
NUMBER OF DAYS TO INCUR CLAIMS : The terminated employee has the
remainder of the Plan Year to incur eligible day care expenses .
WHEN MUST CLAIMS BE RECEIVED BY THE FLEX COMPANY AFTER LAST DAY OF
EMPLOYMENT : Claims for expenses incurred in the prior Plan Year must be
received no later than December 31st.
' TABLE OF CONTENTS
ARTICLE I
DEFINITIONS
ARTICLE II
PARTICIPATION
2 . 1 ELIGIBILITY . , , . . . 11 3
2 . 2 EFFECTIVE DATE OF PARTICIPATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 . 3 APPLICATION TO PARTICIPATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 . 4 TERMINATION OF PARTICIPATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2 . 5 TERMINATION OF EMPLOYMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2 . 6 DEATH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ARTICLE III
CONTRIBUTIONS TO THE PLAN
3 . 1 SALARY REDIRECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . 5
3 . 2 APPLICATION OF CONTRIBUTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3 . 3 PERIODIC CONTRIBUTIONS . . , , , . . . . . 11 . . . . . . 11 . . . . 11 . . . . 11 . . . . . 11 6
ARTICLE IV
BENEFITS
4 . 1 BENEFIT OPTIONS , , , . . . . . . . . . . . " I . . . . . . . . 0 . . . . . . a 6
4 . 2 MEDICAL EXPENSE REIMBURSEMENT PLAN BENEFIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . 6
4 . 3 DEPENDENT DAY CARE REIMBURSEMENT PLAN BENEFIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
4 . 4 GROUP SPONSORED BENEFIT PLANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . 6
4 . 5 NONDISCRIMINATION REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . 7
ARTICLE V
PARTICIPANT ELECTIONS
5 . 1 INITIAL ELECTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
5 . 2 SUBSEQUENT ANNUAL ELECTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
5 . 3 FAILURE TO ELECT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
5 . 4 CHANGE OF ELECTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
ARTICLE VI
MEDICAL EXPENSE REIMBURSEMENT PLAN
6 . 1 ESTABLISHMENT OF PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
6 . 2 DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
6 . 3 FORFEITURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
6 . 4 LIMITATION ON ALLOCATIONS , . . . . . . . . . I ' ll , . . . . . . . . . . . I ' ll . . . . . . . . . . . . . . . ot . . . . .
. P - sewu . . . . . . . . . . . . . . . . . . . . . . 12
6 . 5 NONDISCRIMINATION REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . 12
6 . 6 COORDINATION WITH CAFETERIA PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . 12
6 . 7 MEDICAL EXPENSE REIMBURSEMENT PLAN CLAIMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
6 . 8 DEBIT AND CREDIT CARDS . " , , " , , . . . . . . . . . 0 . 0sagoo ' s . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
ARTICLE VII
DEPENDENT DAY CARE REIMBURSEMENT PLAN
7 . 1 ESTABLISHMENT OF PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
7 . 2 DEFINITIONS , . , , , . , . . . . . . . . . . . . . . . . . . . * a@ . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . memo * . . . . . . . . . . . . . . . . . . . . 15
7 . 3 DEPENDENT DAY CARE REIMBURSEMENT PLAN ACCOUNTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
7 . 4 INCREASES IN DEPENDENT DAY CARE REIMBURSEMENT PLAN
ACCOUNTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
7 . 5 DECREASES IN DEPENDENT DAY CARE REIMBURSEMENT PLAN
ACCOUNTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
7 . 6 ALLOWABLE DEPENDENT DAY CARE REIMBURSEMENT PLAN
REIMBURSEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
7 . 7 ANNUAL STATEMENT OF BENEFITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . 17
7 . 8 FORFEITURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
7 . 9 LIMITATION ON PAYMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
7 . 10 NONDISCRIMINATION REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 17
7 . 11 COORDINATION WITH CAFETERIA PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . 18
7 . 12 DEPENDENT DAY CARE REIMBURSEMENT PLAN CLAIMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
ARTICLE VIII
BENEFITS AND RIGHTS
8 . 1 CLAIM FOR BENEFITS ' . , , ' . . , . . , . " . . . . . . . . . . . . . d . . . . . . . . . . . . . . . . . . . . . .
. . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
8 . 2 APPLICATION OF FORFEITURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ARTICLE IX
ADMINISTRATION
9 . 1 PLAN ADMINISTRATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
9 . 2 EXAMINATION OF RECORDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
9 . 3 PAYMENT OF EXPENSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
9 . 4 INSURANCE CONTROL CLAUSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
9 . 5 INDEMNIFICATION OF ADMINISTRATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . 21
ARTICLE X
AMENDMENT OR TERMINATION OF PLAN
10 . 1 AMENDMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
10 . 2 TERMINATION , . . , . . . . . " I ' ll , . . . . . . . . . . . . . . . . . . mass . . . . . . as . . . . . . . . . . . . . . . .
. . . . @as . . . . . . a . . . . . . . . . . . . . . . . . . . @to . . . . . . . o , , 22
ARTICLE XI
MISCELLANEOUS
11 . 1 PLAN INTERPRETATION . . . . . . . . . . I ' ll . . . . . . . . . . . . . . . . . seem . . . . . . . ape . . . . . . .
. . . . . . . . . . . . . . , some . . . . . . . . . . . . . . . . . . . . 22
11 . 2 GENDER AND NUMBER . . . . , , , . . . . . . 1 . 11 . . . . . . . . . . . . . . . . . . . 0 . 06 * * . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
11 . 3 WRITTEN DOCUMENT , , , " . . . . . . . " logo . . . . . . 0 a 0 0 0 a . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . mass . . . . . . . a . . . . . . . . . . . . . . . . . . . . . 22
11 . 4 EXCLUSIVE BENEFIT . . . . . . . . . . . . . . . . seem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . a . . . . . . . a a a , * . . . . . . . 22
11 . 5 PARTICIPANT' S RIGHTS . . . " , , . . . . . . . . awesome . . . . . . me . . . . . . . . . . . . . . . mass . . . . . . so * & & .
. . . . . . . . . . . . . . . . . . . rose * & . . . . . . 23
11 . 6 ACTION BY THE EMPLOYER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
11 . 7 EMPLOYER'S PROTECTIVE CLAUSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 23
11 . 8 NO GUARANTEE OF TAX CONSEQUENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . 23
11 . 9 INDEMNIFICATION OF EMPLOYER BY PARTICIPANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. 24
11 . 10 FUNDING . , , , , , . . . . . . . . . . . . " I ' ll " , . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . @ * a . . . . . . . . . . . . . . . . . . . . . . . . . . 24
11 . 11 GOVERNING LAW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . mass . . . . . . . . . . . . . . . . . . . . . . . . . 24
11 . 12 SEVERABILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
11 . 13 CAPTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
11 . 14 CONTINUATION OF COVERAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
11 . 15 FAMILY AND MEDICAL LEAVE ACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
11 . 16 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT . . . . . . . . . . . . . . . . . . . . . . . . . 25
11 . 17 UNIFORM SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT . . . . . . . . . . 25
11 . 18 COMPLIANCE WITH HIPAA PRIVACY STANDARDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . 25
CLERK OF THE CIRCUIT COURT OF INDIAN RIVER COUNTY FLEXIBLE BENEFIT PLAN
INTRODUCTION
The Employer has amended this Plan effective October 01 , 2004. The concept of
this Plan is to allow Employees to choose among different types of benefits based on their own
particular goals , desires and needs . This Plan is a restatement of a Plan which was originally
effective on January 01 , 1995 . The Plan shall be known as Clerk of the Circuit Court of Indian
River County Flexible Benefit Plan (the " Plan " ) .
The intention of the Employer is that the Plan qualify as a " Cafeteria Plan " within
the meaning of Section 125 of the Internal Revenue Code of 1986 , as amended , and that the
benefits which an Employee elects to receive under the Plan be includible or excludable from
the Employee's income under Section 125(a ) and other applicable sections of the Internal
Revenue Code of 1986 , as amended .
ARTICLE I
DEFINITIONS
1 . 1 "Administrator" means the individual( s ) or corporation appointed by the Employer
to carry out the administration of the Plan . The Employer shall be empowered to appoint and
remove the Administrator from time to time as it deems necessary for the proper administration
of the Plan . In the event the Administrator has not been appointed , or resigns from a prior
appointment , the Employer shall be deemed to be the Administrator.
1 . 2 "Affiliated Employer" means the Employer and any corporation which is a
member of a controlled group of corporations ( as defined in Code Section 414( b ) ) which
includes the Employer; any trade or business (whether or not incorporated ) which is under
common control ( as defined in Code Section 414( c )) with the Employer; any organization
(whether or not incorporated ) which is a member of an affiliated service group ( as defined in
Code Section 414( m ) ) which includes the Employer; and any other entity required to be
aggregated with the Employer pursuant to Treasury regulations under Code Section 414(0 ) .
1 . 3 " Benefit" means any of the optional benefit choices available to a Participant as
outlined in Section 4 . 1 .
1 . 4 " Cafeteria Plan Benefit Dollars " means the amount available to Participants ,
pursuant to Article III , to purchase Benefits . Each dollar contributed to this Plan shall be
converted into one Cafeteria Plan Benefit Dollar.
1 . 5 " Code " means the Internal Revenue Code of 1986 , as amended or replaced from
time to time .
1 . 6 " Compensation " means the amounts received by the Participant from the
Employer during a Plan Year.
1 . 7 " Dependent" means any individual who qualifies as a dependent under an
Insurance Contract or under Code Section 152 ( as modified by Code Section 105 ( b ) ) .
1 . 8 " Effective Date " means January 01 , 1995 .
1 . 9 " Election Period " means the period immediately preceding the beginning of each
Plan Year established by the Administrator, such period to be applied on a uniform and
1
nondiscriminatory basis for all Employees and Participants . However, an Employee 's initial
Election Period shall be determined pursuant to Section 5 . 1 .
1 . 10 " Eligible Employee" means any Employee who has satisfied the provisions of
Section 2 . 1 .
An individual shall not be an " Eligible Employee" if such individual is not reported
on the payroll records of the Employer as a common law employee . In particular, it is expressly
intended that individuals not treated as common law employees by the Employer on its payroll
records are not " Eligible Employees" and are excluded from Plan participation even if a court or
administrative agency determines that such individuals are common law employees and not
independent contractors .
1 . 11 " Employee" means any person who is employed by the Employer. The term
Employee shall include leased employees within the meaning of Code Section 414( n )( 2 ) :
1 . 12 " Employer" means Clerk of the Circuit Court of Indian River County and any
Affiliated Employer ( as defined in Section 1 . 2 ) which shall adopt this Plan ; any successor which
shall maintain this Plan ; and any predecessor which has maintained this Plan . Indian River
County Property Appraiser, Indian River County Tax Collector, Indian River County Supervisor
of Elections , Indian River County Board of County Commissions and Any other Employer( s )
specified by Clerk of the Circuit Court of Indian River County are Affiliated Employers who will
adopt this Plan .
1 . 13 " Insurance Contract" means any contract issued by an Insurer underwriting a
Benefit .
1 . 14 " Insurance Premium Payment Plan " means the Employer Sponsored Benefit
Plan ( s ) contained in Section 4 . 1 of this Plan , which provides for the payment of Premium
Expenses .
1 . 15 " Insurer" means any insurance company that underwrites a Benefit under this
Plan .
1 . 16 " Key Employee " means an Employee described in Code Section 416 ( i )( 1 ) and
the Treasury regulations thereunder.
1 . 17 " Participant" means any Eligible Employee who elects to become a Participant
pursuant to Section 2 . 3 and has not for any reason become ineligible to participate further in the
Plan .
1 . 18 " Plan " means this instrument, including all amendments thereto .
1 . 19 " Plan Year" means the 12- month period beginning October 01 and ending
September 30 . The Plan Year shall be the coverage period for the Benefits provided for under
this Plan . In the event a Participant commences participation during a Plan Year, then the initial
coverage period shall be that portion of the Plan Year commencing on such Participant' s date of
entry and ending on the last day of such Plan Year.
1 . 20 " Premium Expenses " or " Premiums" mean the Participant's cost for the Benefits
described in Section 4 . 1 .
1 . 21 " Premium Reimbursement Account" , referred to as " Employer Sponsored Benefit
Plan ( s )" , means the account established for a Participant pursuant to this Plan to which part of
2
his Cafeteria Plan Benefit Dollars may be allocated and from which Premiums of the Participant
shall be paid or reimbursed .
1 . 22 "Salary Redirection " means the contributions made by the Employer on behalf of
Participants pursuant to Section 3 . 1 . These contributions shall be converted to Cafeteria Plan
Benefit Dollars and allocated to the funds or accounts established under the Plan pursuant to
the Participants' elections made under Article V.
1 . 23 " Salary Redirection Agreement" means an agreement between the Participant
and the Employer under which the Participant agrees to reduce his Compensation or to forego
all or part of the increases in such Compensation and to have such amounts contributed by the
Employer to the Plan on the Participant's behalf. The Salary Redirection Agreement shall apply
only to Compensation that has not been actually or constructively received by the Participant as
of the date of the agreement ( after taking this Plan and Code Section 125 into account) and ,
subsequently does not become currently available to the Participant .
1 . 24 " Spouse" means the legally married husband or wife of a Participant as
determined under Federal Law ,
ARTICLE II
PARTICIPATION
2 . 1 ELIGIBILITY
Any Eligible Employee as defined in the Adoption Information shall be eligible to
participate hereunder . However, any Eligible Employee who was a Participant in the Plan on the
effective date of this amendment shall continue to be eligible to participate in the Plan .
2 . 2 EFFECTIVE DATE OF PARTICIPATION
An Eligible Employee shall become a Participant effective as of the date on
which he satisfies the requirements of Section 2 . 1 .
2 . 3 APPLICATION TO PARTICIPATE
An Employee who is eligible to participate in this Plan shall , during the applicable
Election Period , complete the election process to participate . The election shall be irrevocable
until the end of the applicable Plan Year unless the Participant is entitled to change his Benefit
elections pursuant to Section 5 . 4 hereof.
An Eligible Employee may also be required to execute a Salary Redirection
Agreement during the Election Period for the Plan Year during which he wishes to participate in
this Plan . Any such Salary Redirection Agreement shall be effective for the first pay period
beginning on or after the Employee's effective date of participation pursuant to Section 2 . 2 .
Notwithstanding the foregoing , an Employee who is eligible to participate in this
Plan and who is covered by the Employer's insured Benefits , if offered under this Plan , shall
automatically become a Participant to the extent of the Premiums for such insurance unless the
Employee elects , during the Election Period , not to participate in the Plan .
3
2 . 4 TERMINATION OF PARTICIPATION
A Participant shall no longer participate in this Plan upon the occurrence of any
of the following events :
( a ) His termination of employment , subject to the provisions of
Section 2 . 5 ;
( b ) His death , subject to the provisions of Section 2 . 6 ;
( c ) The termination of this Plan , subject to the provisions of Section
10 . 2 ; or
( d ) His failure to meet the employee classification , as defined in the
Adoption Information .
2 . 5 TERMINATION OF EMPLOYMENT
If a Participant' s employment with the Employer is terminated for any reason
other than death , his participation in the Plan shall be governed in accordance with the
following :
( a ) With regard to Benefits which are insured , the Participant' s
participation in the Plan shall cease , subject to the Participant' s right to continue
coverage under any Insurance Contract for which premiums have already been
paid .
( b ) With regard to the Dependent Day Care Reimbursement Plan , the
Participant's participation in the Plan shall cease and no further Salary
Redirection contributions shall be made . However, such Participant may submit
claims for employment related Dependent Care Expense reimbursements for the
remainder of the Plan Year in which such termination occurs , based on the level
of his Dependent Day Care Reimbursement Plan Account as of his date of
termination .
( c ) With regard to the Medical Expense Reimbursement Plan , the
Participant's participation in the Plan shall cease and no further Salary
Redirection contributions shall be made . However , such Participant may submit
claims for expenses incurred during the portion of the Plan Year preceding his
date of termination up to 30 days after his termination .
( d ) In the event a Participant terminates his participation in the
Medical Expense Reimbursement Plan during the Plan Year , if Salary
Redirections are made other than on a pro rata basis , upon termination the
Participant shall be entitled to a reimbursement for any Salary Redirection
previously paid for coverage or benefits relating to the period after the date of the
Participant's separation from service regardless of the Participant's claims or
reimbursements as of such date .
( e ) This Section shall be applied and administered consistent with
such further rights a Participant and his Dependents may be entitled to pursuant
to Code Section 4980B and Section 11 . 14 of the Plan .
4
2 . 6 DEATH
If a Participant dies , his participation in the Plan shall cease . However, such
Participant's beneficiaries , or the representative of his estate , may submit claims for expenses
or benefits for the remainder of the Plan Year or until the Cafeteria Plan Benefit Dollars
allocated to each specific benefit are exhausted . A Participant may designate a specific
beneficiary for this purpose . If no such beneficiary is specified , the Administrator may designate
the Participant's Spouse , one of his Dependents or a representative of his estate .
ARTICLE III
CONTRIBUTIONS TO THE PLAN
3 . 1 SALARY REDIRECTION
Benefits under the Plan shall be financed by Salary Redirections sufficient to
support Benefits that a Participant has elected hereunder and to pay the Participant's Premium
Expenses . The salary administration program of the Employer shall be revised to allow each
Participant to agree to reduce his pay during a Plan Year by an amount determined necessary
to purchase the elected Benefit . The amount of such Salary Redirection shall be specified in the
Salary Redirection Agreement and shall be applicable for a Plan Year. Notwithstanding the
above , for new Participants , the Salary Redirection Agreement shall only be applicable from the
first day of the pay period following the Employee's entry date up to and including the last day of
the Plan Year. These contributions shall be converted to Cafeteria Plan Benefit Dollars and
allocated to the funds or accounts established under the Plan pursuant to the Participants'
elections made under Article V .
Any Salary Redirection shall be determined prior to the beginning of a Plan Year
( subject to initial elections pursuant to Section 5 . 1 ) and prior to the end of the Election Period
and shall be irrevocable for such Plan Year . However, a Participant may revoke a Benefit
election or a Salary Redirection Agreement after the Plan Year has commenced and make a
new election with respect to the remainder of the Plan Year, if both the revocation and the new
election are on account of and consistent with a change in status and such other permitted
events as determined under Article V of the Plan and consistent with the rules and regulations
of the Department of the Treasury . Salary Redirection amounts shall be contributed on a
pro rata basis for each pay period during the Plan Year. All individual Salary Redirection
Agreements are deemed to be part of this Plan and incorporated by reference hereunder.
3 . 2 APPLICATION OF CONTRIBUTIONS
As soon as reasonably practical after each payroll period , the Employer shall
apply the Salary Redirection to provide the Benefits elected by the affected Participants . Any
contribution made or withheld for the Medical Expense Reimbursement Plan Fund or
Dependent Day Care Reimbursement Plan Account shall be credited to such fund or account .
Amounts designated for the Participant' s Employer Sponsored Benefit Plan ( s ) shall likewise be
credited to such account for the purpose of paying Premium Expenses .
5
3 . 3 PERIODIC CONTRIBUTIONS
Notwithstanding the requirement provided above and in other Articles of this Plan
that Salary Redirections be contributed to the Plan by the Employer on behalf of an Employee
on a level and pro rata basis for each payroll period , the Employer and Administrator may
implement a procedure in which Salary Redirections are contributed throughout the Plan Year
on a periodic basis that is not pro rata for each payroll period . However, with regard to
the
Medical Expense Reimbursement Plan , the payment schedule for the required contributions
may not be based on the rate or amount of reimbursements during the Plan Year. In the event
Salary Redirections are not made on a pro rata basis , upon termination of participation , a
Participant may be entitled to a refund of such Salary Redirections pursuant to Section 2 . 5 .
ARTICLE IV
BENEFITS
4 . 1 BENEFIT OPTIONS
If so offered by the Employer, each Participant may elect to have the amount of
his Cafeteria Plan Benefit Dollars applied to any one or more of the following optional Benefits :
( 1 ) Medical Expense Reimbursement Plan
( 2 ) Dependent Day Care Reimbursement Plan
In addition , each Participant shall have a sufficient portion of his Cafeteria Plan
Benefit Dollars applied to the following insured benefits unless the Participant elects not to
receive such benefits :
( 3 ) Group Sponsored Benefit Plans
4 . 2 MEDICAL EXPENSE REIMBURSEMENT PLAN BENEFIT
Each Participant may elect coverage under the Medical Expense Reimbursement
Plan option , in which case Article VI shall apply .
4 . 3 DEPENDENT DAY CARE REIMBURSEMENT PLAN BENEFIT
Each Participant may elect coverage under the Dependent Day Care
Reimbursement Plan option , in which case Article VII shall apply .
4 . 4 GROUP SPONSORED BENEFIT PLANS
( a ) The Employer may select additional health policies or allow the
purchase of additional health policies by and for Participants , which policies will
provide uniform benefits for all Participants electing this Benefit . These benefits
can include health , dental , vision , Employee group term life insurance ( up to
$ 50 , 000 death benefit) , disability, accident , cancer and intensive care insurance
plans .
( b ) The rights and conditions with respect to the benefits payable from
any additional Contract shall be determined therefrom , and such Contract shall
be incorporated herein by reference .
6
4 . 5 NONDISCRIMINATION REQUIREMENTS
( a ) It is the intent of this Plan to provide benefits to a classification of
employees which the Secretary of the Treasury finds not to be discriminatory in
favor of the group in whose favor discrimination may not occur under Code
Section 125 .
( b ) It is the intent of this Plan not to provide qualified benefits as
defined under Code Section 125 to Key Employees in amounts that exceed 25%
of the aggregate of such Benefits provided for all Eligible Employees under the
Plan . For purposes of the preceding sentence , qualified benefits shall not include
benefits which (without regard to this paragraph ) are includible in gross income .
( c) If the Administrator deems it necessary to avoid discrimination or
possible taxation to Key Employees or a group of employees in whose favor
discrimination may not occur in violation of Code Section 125 , it may require
reduced contributions or non -taxable Benefits in order to assure compliance with
this Section . Any act taken by the Administrator under this Section shall be
carried out in a uniform and nondiscriminatory manner.
ARTICLE V
PARTICIPANT ELECTIONS
5 . 1 INITIAL ELECTIONS
An Employee who meets the eligibility requirements of Section 2 . 1 on the first
day of, or during , a Plan Year may elect to participate in this Plan for all or the remainder of
such Plan Year, provided he elects to do so before his effective date of participation pursuant to
Section 2 . 2 . However, if such Employee does not complete the benefit election process before
such date , his Election Period may extend 30 calendar days after such date , or for such further
period as the Administrator shall determine and apply on a uniform and nondiscriminatory basis .
However, any election during the extended election period pursuant to this Section 5 . 1 shall not
be effective until the first pay period following the later of such Participant's effective date of
participation pursuant to Section 2 . 2 or the date of the receipt of the election by the
Administrator or Plan Service Provider, and shall be limited to the Benefit expenses incurred for
the balance of the Plan Year for which the election is made .
Notwithstanding the foregoing , an Employee who is eligible to participate in this
Plan and who is covered by the Employer's insured benefits , if offered under this Plan , shall
automatically become a Participant to the extent of the Premiums for such insurance unless the
Employee elects , during the Election Period , not to participate in the Plan .
5 . 2 SUBSEQUENT ANNUAL ELECTIONS
During the Election Period prior to each subsequent Plan Year, each Participant
shall be given the opportunity to elect which spending account Benefit options he wishes to
select and purchase with his Cafeteria Plan Benefit Dollars . Any such election shall be effective
for any Benefit expenses incurred during the Plan Year which follows the end of the Election
Period . With regard to subsequent annual elections , the following options shall apply :
( a ) A Participant or Employee who failed to initially elect to participate
may elect different or new Benefits under the Plan during the Election Period ;
7
( b ) A Participant may terminate his participation in the Plan by
notifying the Administrator or Plan Service Provider in writing during the Election
Period that he does not want to participate in the Plan for the next Plan Year;
( c) An Employee who elects not to participate for the Plan Year
following the Election Period will have to wait until the next Election Period before
again electing to participate in the Plan , except as provided for in Section 5 . 4 .
5 . 3 FAILURE TO ELECT
Any Participant failing to complete an election pursuant to Section 5 . 2 by the end
of the applicable Election Period shall be deemed to have made the same Benefit option
elections as are then in effect for the current Plan Year, unless otherwise directed by the Plan
Administrator. The Participant shall also be deemed to have elected Salary Redirection in an
amount necessary to purchase such Benefit options .
5 . 4 CHANGE OF ELECTIONS
( a ) Any Participant may change a Benefit election after the Plan Year
(to which such election relates ) has commenced and make new elections with
respect to the remainder of such Plan Year if, under the facts and circumstances ,
the changes are necessitated by and are consistent with a change in status which
is acceptable under rules and regulations adopted by the Department of the
Treasury, the provisions of which are incorporated by reference and permitted by
the Administrator during the Plan Year pursuant to any temporary, proposed , or
final regulation or ruling of the Internal Revenue Service . Notwithstanding anything
herein to the contrary, if the rules and regulations conflict , then such rules and
regulations shall control .
In general , a change in election is not consistent if the change in status is
the Participant's divorce , annulment or legal separation from a spouse , the death
of a spouse or dependent, or a dependent ceasing to satisfy the eligibility
requirements for coverage , and the Participant' s election under the Plan is to
cancel accident or health insurance coverage for any individual other than the one
involved in such event. In addition , if the Participant , spouse or dependent gains or
loses eligibility for coverage , then a Participant's election under the Plan to cease
or decrease coverage for that individual under the Plan corresponds with that
change in status only if coverage for that individual becomes applicable or is
increased under the family member plan .
Regardless of the consistency requirement, if the individual , the individual ' s
spouse , or dependent becomes eligible for continuation coverage under any
available Employer's group health plan as provided in Code Section 4980B or any
similar state law, then the individual may elect to increase payments under this
Plan in order to pay for the continuation coverage . However, this does not apply for
COBRA eligibility due to divorce , annulment or legal separation .
Any new election shall be effective at such time as the Administrator shall
prescribe , but not earlier than the first pay period beginning after the election is
completed and returned to the Administrator. For the purposes of this subsection , a
change in status shall only include the following events or other events permitted
by Treasury regulations :
8
( 1 ) Legal Marital Status : Events that change a Participant' s legal
marital status , including marriage , divorce , death of a spouse , legal
separation or annulment;
( 2 ) Number of Dependents : Events that change a Participant's number
of dependents , including birth , adoption , placement for adoption , or death
of a dependent ;
( 3 ) Employment Status : Any of the following events that change the
employment status of the Participant , spouse , or dependent: termination or
commencement of employment, a strike or lockout, commencement or
return from an unpaid leave of absence , or a change in worksite . In
addition , if the eligibility conditions of this Plan or other employee benefit
plan of the Employer of the Participant, spouse , or dependent depend on
the employment status of that individual and there is a change in that
individual 's employment status with the consequence that the individual
becomes ( or ceases to be ) eligible under the plan , then that change
constitutes a change in employment under this subsection ;
( 4) Dependent satisfies or ceases to satisfy the eligibility requirements :
An event that causes the Participant's dependent to satisfy or cease to
satisfy the requirements for coverage due to attainment of age , student
status , or any similar circumstance ; and
( 5 ) Residency: A change in the place of residence of the Participant ,
spouse or dependent that directly affects eligibility for Benefit coverage .
For the Dependent Day Care Reimbursement Plan , a dependent becoming
or ceasing to be a "Qualifying Dependent" as defined under Code Section 21 ( b )
shall also qualify as a change in status .
( b ) Notwithstanding subsection (a ) , the Participants may change an
election for accident or health coverage during a Plan Year and make a new
election that corresponds with the special enrollment rights provided in Code
Section 9801 (f) . Such change shall take place on a prospective basis .
( c) Notwithstanding subsection (a ) , in the event of a judgment , decree ,
or order ( "order" ) resulting from a divorce , legal separation , annulment , or change
in legal custody ( including a qualified medical child support order defined in ERISA
Section 609 ) which requires accident or health coverage for a Participant's child
( including a foster child who is a dependent of the Participant) :
( 1 ) The Plan may change an election to provide coverage for the child
if the order requires coverage under the Participant's plan ; or
(2 ) The Participant shall be permitted to change an election to cancel
coverage for the child if the order requires the former spouse to provide
coverage for such child , under that individual's plan and such coverage is
actually provided .
( d ) Notwithstanding subsection ( a ) , a Participant may change elections
to cancel accident or health coverage for the Participant or the Participant's spouse
or dependent if the Participant or the Participant's spouse or dependent is enrolled
in the accident or health coverage of the Employer ( if available ) and becomes
entitled to coverage ( i . e . , enrolled ) under Part A or Part B of the Title XVIII of the
9
Social Security Act ( Medicare ) or Title XIX of the Social Security Act ( Medicaid ) ,
other than coverage consisting solely of benefits under Section 1928 of the Social
Security Act (the program for distribution of pediatric vaccines ). If the Participant or
the Participant's spouse or dependent who has been entitled to Medicaid or
Medicare coverage loses eligibility, that individual may prospectively elect
coverage under the Plan if a benefit package option under the Plan provides
similar coverage .
( e ) If an Employer Sponsored Benefit is offered , and the cost of a
benefit provided under the Plan increases or decreases during a Plan Year, then
the Plan shall automatically increase or decrease , as the case may be , the
Salary Redirections of all affected Participants for such Benefit. Alternatively, if
the cost of a benefit package option increases significantly, the Administrator
shall permit the affected Participants to either make corresponding changes in
their payments or revoke their elections and , in lieu thereof, receive on a
prospective basis coverage under another benefit package option with similar
coverage , or drop coverage prospectively if there is no benefit package option
with similar coverage .
A cost increase or decrease refers to an increase or decrease in the
amount of elective contributions under the Plan , whether resulting from an action
taken by the Participants or an action taken by the Employer.
If the coverage under a Benefit is significantly curtailed or ceases during a
Plan Year, affected Participants may revoke their elections of such Benefit and ,
in lieu thereof, elect to receive on a prospective basis coverage under another
plan with similar coverage , or drop coverage prospectively if no similar coverage
is offered .
If, during the period of coverage , a new benefit package option or other
coverage option is added , an existing benefit package option is significantly
improved , or an existing benefit package option or other coverage option is
eliminated , then the affected Participants may elect the newly-added option , or
elect another option if an option has been eliminated prospectively and make
corresponding election changes with respect to other benefit package options
providing similar coverage . In addition , those Eligible Employees who are not
participating in the Plan may opt to become Participants and elect the new or
newly improved benefit package option .
A Participant may make a prospective election change to add group
health coverage for the Participant , the Participant's spouse or dependent if such
individual loses group health coverage sponsored by a governmental or
educational institution , including a state children ' s health insurance program
under the Social Security Act , the Indian Health Service or a health program
offered by an Indian tribal government , a state health benefits risk pool , or a
foreign government group health plan .
A Participant may make a prospective election change that is on account
of and corresponds with a change made under the plan of a spouse's , former
spouse' s or dependent' s employer if ( 1 ) the cafeteria plan or other benefits plan
of the spouse' s , former spouse's or dependent' s employer permits its participants
to make a change ; or (2 ) the cafeteria plan permits participants to make an
election for a period of coverage that is different from the period of coverage
under the cafeteria plan of a spouse's , former spouse 's or dependent' s employer .
10
A Participant may make a prospective election change that is on account
of and corresponds with a change by the Participant in the dependent care
provider. The availability of dependent care services from a new childcare
provider is similar to a new benefit package option becoming available . A cost
change is allowable in the Dependent Day Care Reimbursement Plan only if the
cost change is imposed by a dependent care provider who is not related to the
Participant , as defined in Code Section 152(a )( 1 ) through ( 8 ) .
A Participant shall not be permitted to change an election to the Medical
Expense Reimbursement Plan as a result of a cost or coverage change under
this subsection .
ARTICLE VI
MEDICAL EXPENSE REIMBURSEMENT PLAN
6 . 1 ESTABLISHMENT OF PLAN
This Medical Expense Reimbursement Plan is intended to qualify as a medical
reimbursement plan under Code Section 105 and shall be interpreted in a manner consistent
with such Code Section and the Treasury regulations thereunder. Participants who elect to
participate in this Medical Expense Reimbursement Plan may submit claims for the
reimbursement of Medical Expenses . All amounts reimbursed under this Medical Expense
Reimbursement Plan shall be periodically paid from amounts allocated to the Medical Expense
Reimbursement Plan Fund . Periodic payments reimbursing Participants from the Medical
Expense Reimbursement Plan Fund shall in no event occur less frequently than monthly.
6 . 2 DEFINITIONS
For the purposes of this Article and the Cafeteria Plan , the terms below have the
following meaning :
( a ) " Medical Expense Reimbursement Plan Fund " means the fund
established for Participants pursuant to this Plan to which part of their Cafeteria
Plan Benefit Dollars may be allocated and from which all allowable Medical
Expenses may be reimbursed .
( b ) " Medical Expense Reimbursement Plan " means the plan of
benefits contained in this Article , which provides for the reimbursement of eligible
Medical Expenses incurred by a Participant or his Dependents .
( c ) " Highly Compensated Participant" means , for the purposes of
determining nondiscrimination , an employee who is described in :
( 1 ) Code Section 105( h ) ; or
( 2 ) Code Section 416( 1 )( 1 ) ; or
( 3 ) any other Code Section as defined in the Treasury regulations or
by the Internal Revenue Service .
( d ) " Medical Expenses " means any expense for medical care within
the meaning of the term " medical care" as defined in Code Section 213( d ) and as
allowed under Code Section 105 and the rulings and Treasury regulations
thereunder , and not otherwise used by the Participant as a deduction in
11
determining his tax liability under the Code . However, a Participant may not be
reimbursed for the cost of other health coverage such as premiums paid under
plans maintained by the employer of the Participant' s spouse or individual
policies maintained by the Participant or his spouse or Dependent . Furthermore ,
a Participant may not be reimbursed for "qualified long -term care services" as
defined in Code Section 770213( c ) .
( e ) The definitions of Article I are hereby incorporated by reference to
the extent necessary to interpret and apply the provisions of this Medical
Expense Reimbursement Plan .
6 . 3 FORFEITURES
The amount in the Medical Expense Reimbursement Plan Fund as of the end of
any Plan Year ( and after the processing of all claims for such Plan Year pursuant to Section 6 . 7
hereof) shall be forfeited . In such event , the Participant shall have no further claim to such
amount for any reason , subject to Section 8 . 2 .
6A LIMITATION ON ALLOCATIONS
Notwithstanding any provision contained in this Medical Expense
Reimbursement Plan to the contrary , no more than the amount stated in the Adoption
Information may be allocated to the Medical Expense Reimbursement Plan Fund by a
Participant in or on account of any Plan Year.
6 . 5 NONDISCRIMINATION REQUIREMENTS
( a ) It is the intent of this Medical Expense Reimbursement Plan not to
discriminate in violation of the Code and the Treasury regulations thereunder.
( b ) If the Administrator deems it necessary to avoid discrimination
under this Medical Expense Reimbursement Plan , it may require reduced
contributions or non-taxable Benefits in order to assure compliance with this
Section . Any act taken by the Administrator under this Section shall be carried
out in a uniform and nondiscriminatory manner.
6 . 6 COORDINATION WITH CAFETERIA PLAN
All Participants under the Cafeteria Plan are eligible to receive Benefits under
this Medical Expense Reimbursement Plan . The enrollment under the Cafeteria Plan shall
constitute enrollment under this Medical Expense Reimbursement Plan . In addition , other
matters concerning contributions , elections and the like shall be governed by the general
provisions of the Cafeteria Plan .
12
6 . 7 MEDICAL EXPENSE REIMBURSEMENT PLAN CLAIMS
( a ) All Medical Expenses incurred by a Participant shall be
reimbursed during the Plan Year subject to Section 2 . 5 , even though the
submission of such a claim occurs after his participation hereunder ceases ; but
provided that the Medical Expenses were incurred during the applicable Plan
Year, Medical Expenses are treated as having been incurred when the
Participant is provided with the medical care that gives rise to the medical
expenses , not when the Participant is formally billed or charged for, or pays for
the medical care .
( b ) The Administrator shall direct the reimbursement to each eligible
Participant for all allowable Medical Expenses , up to a maximum of the amount
designated by the Participant for the Medical Expense Reimbursement Plan
Fund for the Plan Year. Reimbursements shall be made available to the
Participant throughout the year without regard to the level of Cafeteria Plan
Benefit Dollars which have been allocated to the fund at any given point in time .
Furthermore , a Participant shall be entitled to reimbursements only for amounts
in excess of any payments or other reimbursements under any health care plan
covering the Participant and/or his Spouse or Dependents .
( c ) Claims for the reimbursement of Medical Expenses incurred in
any Plan Year shall be paid as soon after a claim has been filed as is
administratively practicable ; provided however, that if a Participant fails to submit
a claim within the number of days listed in the Adoption Information immediately
following the end of the Plan Year, or the number of days listed in the Adoption
Information after termination of employment, those Medical Expense claims shall
not be considered for reimbursement by the Administrator.
( d ) Reimbursement payments under this Plan shall be made directly
to the Participant . The application for payment or reimbursement shall be made
to the Administrator or Plan Service Provider on an acceptable form within a
reasonable time of incurring the debt or paying for the service . The application
shall include a written statement from an independent third party stating that the
Medical Expense has been incurred and the amount of such expense .
Furthermore , the Participant shall provide a written statement that the Medical
Expense has not been reimbursed or is not reimbursable under any other source
and , if reimbursed from the Medical Expense Reimbursement Plan Fund , such
amount will not be claimed as a tax deduction . The Administrator shall retain a
file of all such applications .
6 . 8 DEBIT AND CREDIT CARDS
( a ) If the Debit Card is offered , Participants may, subject to a
procedure established by the Administrator and applied in a uniform
nondiscriminatory manner, use debit and/or credit (stored value ) cards ( " cards" )
provided by the Administrator and the Plan for payment of allowable expenses ,
subject to the following terms :
( 1 ) Each Participant issued a card shall certify that such card shall
only be used for allowable expenses . The Participant shall also certify
that any allowable expense paid with the card has not already been
13
reimbursed by any other plan covering benefits and that the Participant
will not seek reimbursement from any other plan covering benefits .
( 2 ) Such card will be issued in a manner determined by the Plan
Administrator and reissued on a periodic basis providing the Participant
remains a Participant . Such card shall be automatically cancelled upon
the Participant' s death or termination of employment , or if such Participant
has a change in status that results in the Participant's withdrawal from the
Plan .
( 3 ) The dollar amount of coverage on the card shall be the amount
elected by the Participant for the Plan Year.
(4) The cards shall only be accepted by such merchants and service
providers as have been approved by the Administrator.
( 5 ) The cards shall only be used for eligible purchases at accepted
providers .
( 6 ) Such purchases by the cards shall be subject to substantiation by
the Administrator or Plan Service Provider, usually by submission of a
receipt from a merchant or service provider describing the service or
product, the date of the purchase and the amount. Some charges shall be
considered substantiated at the time of charge by the nature of the
charge , such as co-payments . Some charges shall be considered
substantiated due to their " recurring " nature , in which the expenses match
expenses previously approved as to amount, provider, and time period . At
point of sale , the service provider or merchant can provide information to
the Administrator or Plan Service Provider to substantiate the charge . All
charges shall be conditional pending confirmation and substantiation .
( 7 ) If such purchase is later determined by the Administrator or Plan
Service Provider to not qualify as an eligible expense , the Administrator
or Plan Service Provider, in its discretion , shall use one of the following
correction methods to make the Plan whole . Until the amount is repaid ,
the Administrator or Plan Service Provider shall take further action to
ensure that further violations of the terms of the card do not occur, up to
and including denial of access to the card .
( i ) Repayment of the improper amount by the Participant ;
( ii ) Claims substitution or offset of future claims until the
amount is repaid ;
( iii ) Withholding the improper payment from the
Participant's wages or other compensation to the extent consistent
with applicable federal or state law .
14
ARTICLE VII
DEPENDENT DAY CARE REIMBURSEMENT PLAN
7 . 1 ESTABLISHMENT OF PROGRAM
This Dependent Day Care Reimbursement Plan is intended to qualify as a
program under Code Section 129 and shall be interpreted in a manner consistent with such
Code Section . Participants who elect to participate in this program may submit claims for the
reimbursement of Employment- Related Dependent Care Expenses . All amounts reimbursed
under this Dependent Day Care Reimbursement Plan shall be paid from amounts allocated to
the Participant's Dependent Day Care Reimbursement Plan Account.
7 . 2 DEFINITIONS
For the purposes of this Article and the Cafeteria Plan the terms below shall have
the following meaning :
( a ) " Dependent Day Care Reimbursement Plan Account itmeans the
account established for a Participant pursuant to this Article to which part of his
Cafeteria Plan Benefit Dollars may be allocated and from which
Employment- Related Dependent Care Expenses of the Participant may be
reimbursed .
( b ) " Dependent Day Care Reimbursement Plan " means the program
of benefits contained in this Article , which provides for the reimbursement of
eligible expenses for the care of the Qualifying Dependents of Participants .
( c ) " Earned Income" means earned income as defined under Code
Section 32 ( c)( 2 ) , but excluding such amounts paid or incurred by the Employer
for dependent care assistance to the Participant .
( d ) " Employment- Related Dependent Care Expenses" means the
amounts paid for expenses of a Participant for those services which if paid by the
Participant would be considered employment related expenses under Code
Section 21 ( b )( 2 ) . Generally, they shall include expenses for household services
and for the care of a Qualifying Dependent , to the extent that such expenses are
incurred to enable the Participant to be gainfully employed for any period for
which there are one or more Qualifying Dependents with respect to such
Participant. Employment- Related Dependent Care Expenses are treated as
having been incurred when the Participant's Qualifying Dependents are provided
with the dependent care that gives rise to the Employment- Related Dependent
Care Expenses , not when the Participant is formally billed or charged for, or pays
for the dependent care . The determination of whether an amount qualifies as an
Employment- Related Dependent Care Expense shall be made subject to the
following rules :
( 1 ) If such amounts are paid for expenses incurred outside the
Participant's household , they shall constitute Employment- Related
Dependent Care Expenses only if incurred for a Qualifying Dependent as
defined in Section 7 . 2 ( e )( 1 ) ( or deemed to be , as described in Section
7 . 2( e )( 1 ) pursuant to Section 7 . 2 ( e )( 3 )) , or for a Qualifying Dependent as
15
defined in Section 7 . 2( e )(2 ) ( or deemed to be , as described in Section
7 . 2(e )(2 ) pursuant to Section 7 . 2 ( e )( 3) ) who regularly spends at least 8
hours per day in the Participant' s household ;
( 2 ) If the expense is incurred outside the Participant' s home at a
facility that provides care for a fee , payment , or grant for more than 6
individuals who do not regularly reside at the facility , the facility must
comply with all applicable state and local laws and regulations , including
licensing requirements , if any; and
( 3 ) Employment- Related Dependent Care Expenses of a Participant
shall not include amounts paid or incurred to a child of such Participant
who is under the age of 19 or to an individual who is a dependent of such
Participant or such Participant's Spouse .
(e ) " Qualifying Dependent" means , for Dependent Day Care
Reimbursement Plan purposes ,
( 1 ) a Dependent of a Participant who is under the age of 13 , with
respect to whom the Participant is entitled to an exemption under Code
Section 151 ( c);
( 2 ) a Dependent or the Spouse of a Participant who is physically or
mentally incapable of caring for himself or herself; or
( 3 ) a child that is deemed to be a Qualifying Dependent described in
paragraph ( 1 ) or ( 2 ) above , whichever is appropriate , pursuant to Code
Section 21 ( e )( 5 ) .
(f) The definitions of Article I are hereby incorporated by reference to
the extent necessary to interpret and apply the provisions of this Dependent Day
Care Reimbursement Plan .
7 . 3 DEPENDENT DAY CARE REIMBURSEMENT PLAN ACCOUNTS
The Administrator shall establish a Dependent Day Care Reimbursement Plan
Account for each Participant who elects to apply Cafeteria Plan Benefit Dollars to Dependent
Day Care Reimbursement Plan benefits .
7 . 4 INCREASES IN DEPENDENT DAY CARE REIMBURSEMENT PLAN ACCOUNTS
A Participant's Dependent Day Care Reimbursement Plan Account shall be
increased each pay period by the portion of Cafeteria Plan Benefit Dollars that he has elected to
apply toward his Dependent Day Care Reimbursement Plan Account pursuant to elections
made under Article V hereof.
7 . 5 DECREASES IN DEPENDENT DAY CARE REIMBURSEMENT PLAN ACCOUNTS
A Participant' s Dependent Day Care Reimbursement Plan Account shall be
reduced by the amount of any Employment- Related Dependent Care Expense reimbursements
paid or incurred on behalf of a Participant pursuant to Section 7 . 12 hereof.
16
7 . 6 ALLOWABLE DEPENDENT DAY CARE REIMBURSEMENT PLAN REIMBURSEMENT
Subject to limitations contained in Section 7 . 9 of this Program , and to the extent
of the amount contained in the Participant's Dependent Day Care Reimbursement Plan
Account, a Participant who incurs Employment- Related Dependent Care Expenses shall be
entitled to receive from the Employer full reimbursement for the entire amount of such expenses
incurred during the Plan Year or portion thereof during which he is a Participant .
7 . 7 ANNUAL STATEMENT OF BENEFITS
On or before January 31st of each calendar year, the Employer shall furnish to
each Employee who was a Participant and received benefits under Section 7 . 6 during the prior
calendar year , a statement of all such benefits paid to or on behalf of such Participant during the
prior calendar year .
7 . 8 FORFEITURES
The amount in a Participant' s Dependent Day Care Reimbursement Plan
Account as of the end of any Plan Year ( and after the processing of all claims for such Plan
Year pursuant to Section 7 . 12 hereof) shall be forfeited . In such event , the Participant shall have
no further claim to such amount for any reason .
7 . 9 LIMITATION ON PAYMENTS
Notwithstanding any provision contained in this Article to the contrary , amounts
paid from a Participant's Dependent Day Care Reimbursement Plan Account in or on account of
any taxable year of the Participant shall not exceed the lesser of the Earned Income limitation
described in Code Section 129( b ) or $ 5 , 000 ( $21500 if a separate tax return is filed by
a
Participant who is married as determined under the rules of paragraphs ( 3 ) and ( 4) of Code
Section 21 ( e ) ) .
7 . 10 NONDISCRIMINATION REQUIREMENTS
( a ) It is the intent of this Dependent Day Care Reimbursement Plan
that contributions or benefits not discriminate in favor of the group of employees
in whose favor discrimination may not occur under Code Section 129( d ) .
( b ) It is the intent of this Dependent Day Care Reimbursement Plan
that not more than 25 percent of the amounts paid by the Employer for
dependent care assistance during the Plan Year will be provided for the class of
individuals who are shareholders or owners ( or their Spouses or Dependents ) ,
each of whom ( on any day of the Plan Year) owns more than 5 percent of the
stock or of the capital or profits interest in the Employer .
( c) If the Administrator deems it necessary to avoid discrimination or
possible taxation to a group of employees in whose favor discrimination may not
occur in violation of Code Section 129 , it may require reduced contributions or
non -taxable Benefits in order to assure compliance with this Section . Any act
taken by the Administrator under this Section shall be carried out in a uniform
and nondiscriminatory manner .
17
7 . 11 COORDINATION WITH CAFETERIA PLAN
All Participants under the Cafeteria Plan are eligible to receive Benefits under
this Dependent Day Care Reimbursement Plan . The enrollment and termination of participation
under the Cafeteria Plan shall constitute enrollment and termination of participation under this
Dependent Day Care Reimbursement Plan . In addition , other matters concerning contributions ,
elections and the like shall be governed by the general provisions of the Cafeteria Plan .
7 . 12 DEPENDENT DAY CARE REIMBURSEMENT PLAN CLAIMS
The Administrator shall direct the payment of all such Dependent Day Care
Reimbursement Plan claims to the Participant upon the presentation to the Administrator or
Plan Service Provider of documentation of such expenses in a form satisfactory to the
Administrator. In its discretion in administering the Plan , the Administrator may utilize forms and
require documentation of costs as may be necessary to verify the claims submitted . At a
minimum , the form shall include a statement from an independent third party as proof that the
expense has been incurred and the amount of such expense . In addition , the Administrator may
require that each Participant who desires to receive reimbursement under this Program for
Employment- Related Dependent Care Expenses submit a statement which may contain some
or all of the following information :
( a ) The Dependent or Dependents for whom the services were
performed ;
( b ) The nature of the services performed for the Participant , the cost
of which he wishes reimbursement ;
( c ) The relationship , if any, of the person performing the services to
the Participant ;
( d ) If the services are being performed by a child of the Participant ,
the age of the child ;
( e ) A statement as to where the services were performed ;
(f) If any of the services were performed outside the home , a
statement as to whether the Dependent for whom such services were performed
spends at least 8 hours a day in the Participant' s household ;
( g ) If the services were being performed in a day care center, a
statement containing the following :
( 1 ) that the day care center complies with all applicable laws and
regulations of the state of residence ,
( 2 ) that the day care center provides care for more than 6 individuals
( other than individuals residing at the center) , and
( 3 ) of the amount of fee paid to the provider.
( h ) If the Participant is married , a statement containing the following :
( 1 ) the Spouse's salary or wages if he or she is employed , or
( 2 ) if the Participant' s Spouse is not employed , that
18
( i ) he or she is incapacitated , or
he or she is a full-time student attending an educational
institution and the months during the year which he or she
attended such institution .
( i ) If a Participant fails to submit a claim within the number of days
listed in the Adoption Information immediately following the end of the Plan Year
or within the number of days listed in the Adoption Information immediately
following termination of employment, those claims shall not be considered for
reimbursement by the Administrator.
ARTICLE VIII
BENEFITS AND RIGHTS
8 . 1 CLAIM FOR BENEFITS
( a ) Any claim for Benefits underwritten by an Insurance Contract shall
be made to the Insurer. If the Insurer denies any claim , the Participant or
beneficiary shall follow the Insurer's claims review procedure . Any other claim for
Benefits shall be made to the Administrator. If the Administrator denies a claim ,
the Administrator may provide notice to the Participant or beneficiary , in writing ,
within 90 days after the claim is filed unless special circumstances require an
extension of time for processing the claim . If the Administrator does not notify the
Participant of the denial of the claim within the 90 day period specified above ,
then the claim shall be deemed denied . The notice of a denial of a claim shall be
written in a manner calculated to be understood by the claimant and shall set
forth :
( 1 ) specific references to the pertinent Plan provisions on which the
denial is based ;
( 2 ) a description of any additional material or information necessary
for the claimant to perfect the claim and an explanation as to why such
information is necessary; and
( 3 ) an explanation of the Plan ' s claim procedure .
( b ) Within 60 days after receipt of the above material , the claimant
shall have a reasonable opportunity to appeal the claim denial to the
Administrator for a full and fair review . The claimant or his duly authorized
representative may:
( 1 ) request a review upon written notice to the Administrator ;
( 2 ) review pertinent documents ; and
( 3 ) submit issues and comments in writing .
( c ) A decision on the review by the Administrator will be made not
later than 60 days after receipt of a request for review , unless special
circumstances require an extension of time for processing ( such as the need to
hold a hearing ) , in which event a decision should be rendered as soon as
19
possible , but in no event later than 120 days after such receipt . The decision of
the Administrator shall be written and shall include specific reasons for the
decision , written in a manner calculated to be understood by the claimant , with
specific references to the pertinent Plan provisions on which the decision is
based .
(d ) Any balance remaining in the Participant' s Dependent Day Care
Reimbursement Plan or Medical Expense Reimbursement Plan Account as of
the end of each Plan Year shall be forfeited , unless the Participant had made a
claim for such Plan Year, in writing , which has been denied or is pending ; in
which event the amount of the claim shall be held in his account until the claim
appeal procedures set forth above have been satisfied or the claim is paid . If any
such claim is denied on appeal , the amount held beyond the end of the Plan
Year shall be forfeited .
8 . 2 APPLICATION OF FORFEITURES
Any forfeited amounts by virtue of the failure of a Participant to incur a qualified
expense or seek reimbursement in a timely manner may, but need not be , separately accounted
for after the close of the Plan Year (or after such further time specified herein for the filing of
claims ) in which such forfeitures arose . In no event shall such amounts be carried over to
reimburse a Participant for expenses incurred during a subsequent Plan Year for the same or
any other Benefit available under the Plan ; nor shall amounts forfeited by a particular Participant
be made available to such Participant in any other form or manner, except as permitted by
Treasury regulations . Forfeited amounts shall first be used to defray any administrative costs
and experience losses and thereafter be retained by the Employer.
ARTICLE IX
ADMINISTRATION
9 . 1 PLAN ADMINISTRATION
The operation of the Plan shall be under the supervision of the Administrator. It
shall be a principal duty of the Administrator to see that the Plan is carried out in accordance
with its terms , and for the exclusive benefit of Employees entitled to participate in the Plan . The
Administrator shall have full power to administer the Plan in all of its details , subject , however , to
the pertinent provisions of the Code . The Administrator' s powers shall include , but shall not be
limited to the following authority, in addition to all other powers provided by this Plan :
( a ) To make and enforce such rules and regulations as the
Administrator deems necessary or proper for the efficient administration of the
Plan ;
( b ) To interpret the Plan , the Administrator' s interpretations thereof in
good faith to be final and conclusive on all persons claiming benefits by operation
of the Plan ;
(c) To decide all questions concerning the Plan and the eligibility of
any person to participate in the Plan and to receive benefits provided by
operation of the Plan ;
(d ) To reject elections or to limit contributions or Benefits for certain
highly compensated participants if it deems such to be desirable in order to avoid
discrimination under the Plan in violation of applicable provisions of the Code ;
20
( e ) To provide Employees with a reasonable notification of their
benefits available by operation of the Plan ;
(f) To approve reimbursement requests and to authorize the payment
of benefits ; and
( g ) To appoint such agents , counsel , accountants , consultants , and
actuaries as may be required to assist in administering the Plan .
Any procedure , discretionary act , interpretation or construction taken by the
Administrator shall be done in a nondiscriminatory manner based upon uniform principles
consistently applied and shall be consistent with the intent that the Plan shall continue to comply
with the terms of Code Section 125 and the Treasury regulations thereunder.
9 . 2 EXAMINATION OF RECORDS
The Administrator shall make available to each Participant, Eligible Employee
and any other Employee of the Employer such records as pertain to their interest under the Plan
for examination at reasonable times during normal business hours .
9 . 3 PAYMENT OF EXPENSES
Any reasonable administrative expenses shall be paid by the Employer unless
the Employer determines that administrative costs shall be borne by the Participants under the
Plan . The Administrator may impose reasonable conditions for payments , provided that such
conditions shall not discriminate in favor of highly compensated employees .
9 . 4 INSURANCE CONTROL CLAUSE
In the event of a conflict between the terms of this Plan and the terms of an
Insurance Contract of an independent third party Insurer whose product is then being used in
conjunction with this Plan , the terms of the Insurance Contract shall control as to those
Participants receiving coverage under such Insurance Contract . For this purpose , the Insurance
Contract shall control in defining the persons eligible for insurance , the dates of their eligibility ,
the conditions which must be satisfied to become insured , if any, the benefits Participants are
entitled to and the circumstances under which insurance terminates .
9 . 5 INDEMNIFICATION OF ADMINISTRATOR
The Employer agrees to indemnify and to defend to the fullest extent permitted
by law any Employee serving as the Administrator or as a member of a committee designated
as Administrator ( including any Employee or former Employee who previously served as
Administrator or as a member of such committee ) against all liabilities , damages , costs and
expenses ( including attorney's fees and amounts paid in settlement of any claims approved by
the Employer) occasioned by any act or omission to act in connection with the Plan , if such act
or omission is in good faith .
21
ARTICLE X
AMENDMENT OR TERMINATION OF PLAN
10 . 1 AMENDMENT
The Employer, at any time or from time to time , may amend any or all of the
provisions of the Plan without the consent of any Employee or Participant . No amendment shall
have the effect of modifying any benefit election of any Participant in effect at the time of such
amendment , unless such amendment is made to comply with Federal , state or local laws ,
statutes or regulations .
10 . 2 TERMINATION
The Employer is establishing this Plan with the intent that it will be maintained for
an indefinite period of time . Notwithstanding the foregoing , the Employer reserves the right to
terminate this Plan , in whole or in part , at any time . In the event the Plan is terminated
, no
further contributions shall be made . Benefits under any Insurance Contract shall be paid in
accordance with the terms of the Contract.
No further additions shall be made to the Medical Expense Reimbursement Plan
Fund or Dependent Day Care Reimbursement Plan Account, but all payments from such fund or
account shall continue to be made for a reasonable period of time as specified by the
Administrator. Any amounts remaining in any such fund or account as of the end of such period
shall be forfeited after the expiration of the filing period .
ARTICLE XI
MISCELLANEOUS
11 . 1 PLAN INTERPRETATION
All provisions of this Plan shall be interpreted and applied in a uniform ,
nondiscriminatory manner . This Plan shall be read in its entirety and not severed except as
provided in Section 11 . 12 .
11 . 2 GENDER AND NUMBER
Wherever any words are used herein in the masculine , feminine or neuter
gender, they shall be construed as though they were also used in another gender in all cases
where they would so apply , and whenever any words are used herein in the singular or plural
form , they shall be construed as though they were also used in the other form in all cases where
they would so apply .
11 . 3 WRITTEN DOCUMENT
This Plan , in conjunction with any separate written document which may be
required by law , is intended to satisfy the written Plan requirement of Code Section 125 and any
Treasury regulations thereunder relating to cafeteria plans .
11A EXCLUSIVE BENEFIT
This Plan shall be maintained for the exclusive benefit of the Employees who
participate in the Plan .
22
11 . 5 PARTICIPANT' S RIGHTS
This Plan shall not be deemed to constitute an employment contract between the
Employer and any Participant 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 which such discharge shall have upon him as a Participant of this Plan .
11 . 6 ACTION BY THE EMPLOYER
Whenever the Employer under the terms of the Plan is permitted or required to
do or perform any act or matter or thing , it shall be done and performed by a person duly
authorized by its legally constituted authority.
11 . 7 EMPLOYER' S PROTECTIVE CLAUSES
( a ) Upon the failure of either the Participant or the Employer to obtain
the insurance contemplated by this Plan (whether as a result of negligence ,
gross neglect or otherwise ) , the Participant's Benefits shall be limited to the
insurance premium (s ) , if any, that remained unpaid for the period in question and
the actual insurance proceeds , if any, received by the Employer or the Participant
as a result of the Participant' s claim .
( b ) The Employer' s liability to the Participant shall only extend to and
shall be limited to any payment actually received by the Employer from the
Insurer . In the event that the full insurance Benefit contemplated is not promptly
received by the Employer within a reasonable time after submission of a claim ,
then the Employer shall notify the Participant of such facts and the Employer
shall no longer have any legal obligation whatsoever ( except to execute any
document called for by a settlement reached by the Participant) . The Participant
shall be free to settle , compromise or refuse to pursue the claim as the
Participant , in his sole discretion , shall see fit.
( c) The Employer shall not be responsible for the validity of any
Insurance Contract issued hereunder or for the failure on the part of the Insurer
to make payments provided for under any Insurance Contract. Once insurance is
applied for or obtained , the Employer shall not be liable for any loss which may
result from the failure to pay Premiums to the extent Premium notices are not
received by the Employer.
11 . 8 NO GUARANTEE OF TAX CONSEQUENCES
Neither the Administrator , the Employer, nor the Plan Service Provider makes
any commitment or guarantee that any amounts paid to or for the benefit of a Participant under
the Plan will be excludable from the Participant's gross income for federal , state or local ( if
applicable ) income tax purposes , Social Security or Medicare taxes , or that any other federal ,
state or local ( if applicable ) income tax , Social Security or Medicare tax treatment will apply to or
be available to any Participant . It shall be the obligation of each Participant to determine
whether each payment under the Plan is excludable from the Participant' s gross income for
federal , state or local ( if applicable ) income tax , Social Security or Medicare tax purposes , and
to notify the Employer if the Participant has reason to believe that any such payment is not so
excludable . Notwithstanding the foregoing , the rights of Participants under this Plan shall be
legally enforceable .
23
11 . 9 INDEMNIFICATION OF EMPLOYER BY PARTICIPANTS
If any Participant receives one or more payments or reimbursements under the
Plan that are not for a permitted Benefit , such Participant shall indemnify and reimburse the
Employer for any liability it may incur for failure to withhold federal , state , or local ( if applicable )
income tax or Social Security and Medicare tax from such payments or reimbursements .
However, such indemnification and reimbursement shall not exceed the amount of additional
federal , state , or local ( if applicable ) income tax ( plus any penalties ) that the Participant would
have owed if the payments or reimbursements had been made to the Participant as regular
cash compensation , plus the Participant's share of any Social Security and Medicare tax that
would have been paid on such compensation , less any such additional income and Social
Security and Medicare tax actually paid by the Participant.
11 . 10 FUNDING
Unless otherwise required by law, contributions to the Plan need not be placed in
trust or dedicated to a specific Benefit, but may instead be considered general assets of the
Employer. Furthermore , and unless otherwise required by law , nothing herein shall be
construed to require the Employer or the Administrator to maintain any fund or segregate any
amount for the benefit of any Participant, and no Participant or other person shall have any
claim against , right to , or security or other interest in , any fund , account or asset of the Employer
from which any payment under the Plan may be made .
11 . 11 GOVERNING LAW
This Plan is governed by the Code and the Treasury regulations issued
thereunder ( as they might be amended from time to time ) . In no event shall the Employer
guarantee the favorable tax treatment sought by this Plan . To the extent not preempted by
Federal law, the provisions of this Plan shall be construed , enforced and administered according
to the laws of the State of Florida .
11 . 12 SEVERABILITY
If any provision of the Plan is held invalid or unenforceable , its invalidity or
unenforceability shall not affect any other provisions of the Plan , and the Plan shall be
construed and enforced as if such provision had not been included herein .
11 . 13 CAPTIONS
The captions contained herein are inserted only as a matter of convenience and
for reference , and in no way define , limit , enlarge or describe the scope or intent of the Plan , nor
in any way shall affect the Plan or the construction of any provision thereof.
11 . 14 CONTINUATION OF COVERAGE
Notwithstanding anything in the Plan to the contrary , in the event any benefit
under this Plan subject to the continuation coverage requirement of Code Section 4980B
becomes unavailable , each Participant will be entitled to continuation coverage as prescribed in
Code Section 49808 .
24
11 . 15 FAMILY AND MEDICAL LEAVE ACT
Notwithstanding anything in the Plan to the contrary, in the event any benefit
under this Plan becomes subject to the requirements of the Family and Medical Leave Act and
regulations thereunder, this Plan shall be operated in accordance with Regulation 1 . 125-3 .
11 . 16 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
Notwithstanding anything in this Plan to the contrary, this Plan shall be operated in
accordance with HIPAA and regulations thereunder.
11 . 17 UNIFORM SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT
Notwithstanding any provision of this Plan to the contrary, contributions , benefits
and service credit with respect to qualified military service shall be provided in accordance with
USERRA and the regulations thereunder.
11 . 18 COMPLIANCE WITH HIPAA PRIVACY STANDARDS
( a ) If the Medical Expense Reimbursement Plan under this Cafeteria
Plan is subject to the Standards for Privacy of Individually Identifiable Health
Information ( 45 CFR Part 164 , the " Privacy Standards" ) , then this Section shall
apply.
( b ) The Plan shall not disclose Protected Health Information to any
member of the Employer' s workforce unless each of the conditions set out in this
Section are met . " Protected Health Information" shall have the same definition as
set forth in the Privacy Standards but generally shall mean individually
identifiable information about the past, present or future physical or mental health
or condition of an individual , including information about treatment or payment for
treatment .
( c ) Protected Health Information disclosed to members of the
Employer' s workforce shall be used or disclosed by them only for purposes of
Plan administrative functions . The Plan's administrative functions shall include
all Plan payment functions and health care operations . The terms " payment" and
" health care operations" shall have the same definitions as set out in the Privacy
Standards , but the term " payment" generally shall mean activities taken to
determine or fulfill Plan responsibilities with respect to eligibility , coverage ,
provision of benefits , or reimbursement for health care .
( d ) The Plan shall disclose Protected Health Information only to
members of the Employer's workforce who are authorized to receive such
Protected Health Information , and only to the extent and in the minimum amount
necessary for that person to perform his or her duties with respect to the Plan .
" Members of the Employer' s workforce" shall refer to all employees and other
persons under the control of the Employer. The Employer shall keep an updated
list of those authorized to receive Protected Health Information .
( 1 ) An authorized member of the Employer's workforce who receives
Protected Health Information shall use or disclose the Protected Health
Information only to the extent necessary to perform his or her duties with
respect to the Plan .
25
( 2 ) In the event that any member of the Employer's workforce uses or
discloses Protected Health Information other than as permitted by this
Section and the Privacy Standards , the incident shall be reported to the
Plan ' s privacy officer. The privacy officer shall take appropriate action ,
including :
( i ) investigation of the incident to determine whether the
breach occurred inadvertently, through negligence or deliberately;
whether there is a pattern of breaches ; and the degree of harm
caused by the breach ;
( ii ) appropriate sanctions against the persons causing the
breach which , depending upon the nature of the breach , may
include oral or written reprimand , additional training , or termination
of employment;
( iii ) mitigation of any harm caused by the breach , to the
extent practicable ; and
( iv) documentation of the incident and all actions taken to
resolve the issue and mitigate any damages .
(e ) The Employer must provide certification to the Plan that it agrees
to :
( 1 ) Not use or further disclose the information other than as permitted
or required by the Plan documents or as required by law ;
( 2 ) Ensure that any agent or subcontractor, to whom it provides
Protected Health Information received from the Plan , agrees to the same
restrictions and conditions that apply to the Employer with respect to such
information ;
( 3 ) Not use or disclose Protected Health Information for employment-
related actions and decisions or in connection with any other benefit or
employee benefit plan of the Employer;
( 4 ) Report to the Plan any use or disclosure of the Protected Health
Information of which it becomes aware that is inconsistent with the uses
or disclosures permitted by this Section , or required by law;
( 5 ) Make available Protected Health Information to individual Plan
members in accordance with Section 164 . 524 of the Privacy Standards ;
( 6 ) Make available Protected Health Information for amendment by
individual Plan members and incorporate any amendments to Protected
Health Information in accordance with Section 164 . 526 of the Privacy
Standards ;
( 7 ) Make available the Protected Health Information required to
provide an accounting of disclosures to individual Plan members in
accordance with Section 164 . 528 of the Privacy Standards ;
( 8 ) Make its internal practices , books and records relating to the use
and disclosure of Protected Health Information received from the Plan
26
available to the Department of Health and Human Services for purposes
of determining compliance by the Plan with the Privacy Standards ;
( 9 ) If feasible , return or destroy all Protected Health Information
received from the Plan that the Employer still maintains in any form , and
retain no copies of such information when no longer needed for the
purpose for which disclosure was made , except that, if such return or
destruction is not feasible , limit further uses and disclosures to those
purposes that make the return or destruction of the information infeasible ;
and
( 10 ) Ensure the adequate separation between the Plan and members
of the Employer's workforce , as required by Section 164 . 504(f)( 2 )( iii ) of
the Privacy Standards and set out in (d ) above .
27
IN WITNESS WHEREOF , this Plan document is hereby executed this
1 nth day of FphriL V 2nQ ;
Clerk of the Circuit Court of Indian River
County
BOmON
qE i8 ER
Indian River County Property Appraiser
By �
EMPLOY6R
Indian River my T ollector
By
E OYER
Indian River County Supervisor of Elections
By t*� &tA4k
EM OYI R
qa . .
Indian Ri144%104.
e,WrW' ftarbty Board of County
Commis } ieiii
0 4A
By .
E k R Thor J. Lowther , Chairman
i; 3
4 ` . .
Any oth 'l rp�q ( k sQecified by Clerk of
the Circuit G` i oa ihdan River County
By
EMPLOYER
APPROV D AS TO FORM
AN L S ICIEN
B
WILLIAM K . DEBRAAL
ASSISTANT COUNTY ATTORNEY
28
ADOPTION RESOLUTION
The undersigned of Clerk of the Circuit Court of Indian River County (the
Employer) hereby certifies that the following resolutions were duly adopted , and that such
resolutions have not been modified or rescinded :
RESOLVED , that the form of amended Cafeteria Plan effective October 01 ,
2004 , is hereby approved and adopted and that the proper duly appointed agent( s ) of the
Employer are hereby authorized and directed to execute the Plan .
RESOLVED , that the Administrator shall be instructed to take such actions that
are deemed necessary and proper in order to implement the Plan , and to set up adequate
accounting and administrative procedures to provide benefits under the Plan .
RESOLVED , that the proper duly appointed agent(s ) of the Employer shall act as
soon as possible to notify the employees of the adoption of the Cafeteria Plan by delivering to
each employee a copy of the summary of the Plan in the form of the Summary Plan Description .
The undersigned further certifies that Clerk of the Circuit Court of Indian River
County Flexible Benefit Plan as amended and restated is hereby approved and adopted .
Signature
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