HomeMy WebLinkAboutRes 35-04 05/18/2004
Kad
5/12/04
PJS
5/13/04
RESOLUTION NO 35-04
A RESOLUTION AUTHORIZING THE AMENDMENT OF THE VILLAGE OF MOUNT
PROSPECT FLEXIBLE COMPENSATION PLAN
WHEREAS, the Village of Mount Prospect is a Home Rule Municipality exercising its Home
Rule Powers pursuant to the Illinois Constituent of 1970; and
WHEREAS, the Corporate Authorities have previously adopted a Village of Mount Prospect
Flexible Compensation Plan for its employees; and
WHEREAS, the Corporate Authorities have determined that the Plan should be amended to
become compliant with the Family Medical Leave Act (FMLA)
WHEREAS, the Corporate Authorities have determined that the Plan should be amended to
improve the administration of the plan.
SECTION ONE: That the Mayor of the Village of Mount Prospect is hereby authorized to
execute the amended Village of Mount Prospect Flexible Compensation Plan, attached hereto
ad Exhibit A, the same being hereby approved and adopted to be effective as of January 1,
2004.
SECTION TWO: That the Plan Administrator of the Village of Mount Prospect be instructed
to take any and all such steps as may be required for the implementation of the Amended Plan.
SECTION THREE: That this Resolution shall be in full force and effect from and after its
adoption and passage in the manner provided by law.
AYES:
Corcoran, Hoefert, Lohrstorfer, Skowron, Wilks, Zadel
NAYS:
None
ABSENT:
None
Passed and approved on this 18th day of May, 2004.
&:~m~ {l~
Deputy Village Clerk
H:\ClKO\files\WIN\RES\flexible compensation amendment 2004.doc
VILLAGE OF MOUNT PROSPECT
FLEXIBLE CO MPENSA TI 0 N PLAN
Restated Effective January 1,2004
T ABLE OF CONTENTS
ARTICLE I DEFINITIONS .............................,.............................................................................1
1.1 Code .................................................................................................................................1
1.2 Dependent.. ........... ............ ............... .... ...... ""'" ............,..,........ """"""""'" ..................., 1
1.3 Dependent Care Reimbursement .Account...........................................,..........................l
1.4 Dependent Care Expenses................................................................................................1
1.5 Dependent Care Service Provider..................,.......,.........................................................1
1.6 Employee... ..... .............. ............ ............................... .... ............... ........................ .............1
1.7 Employer. .,..... .... ..,....... ................ ... ...............,... .... ........ ...,............ ..................... .............1
1.8 Eligible Medical or Dental Expenses....................................................................,..........2
1.9 FMLA Leave... ........ """""""""""""'" ................... ............ ......... .....,. ... ......... ...... ......... ..2
1.10 Health Reimbursement Account. ....,..............................................................................2
1.11 Highly Compensated Employee ....................................................................................2
1.12 Key Employee........ ...... ...... ........... .............. ......... ......... """"" """"" ........ .....................2
1.13 Participant ......................... ...................................... ............ ...... ................... ............. .....2
1.14 Plan .........................................................................................................,......................2
1.15 Plan Administrator... ..... ....... ... ..............,.................. ................. ..................... ... ..... ........2
1.16 Plan Y ear....... """""""" """""'" ............................. ..... """"""'" ............... ....... .............2
1.17 Premium Program ................................,....................................................................,....2
1.18 Spouse ........... ..... .................. """"" ................... ................ """"""""'" ........ ........ ..........2
1.19 Unifonned Services ..........................................................,............................................2
ARTICLE II PARTICIPATION... ,.. """""""""""""" ........................... ............ .... ........................3
2.1 Conditions of Participation ..............................................................................................3
2.2 Tennination of Participation......................................... ...................................................3
2.3 Participation During Leave. .............................................................................................3
2.4 Reinstatement of Fonner Participant ...............................................................................5
ARTICLE III BENEFITS..... """"""" ........ .... """""""""""""""" ............ ...... .................. ............6
3.1 Coverage Options - General Rule ...................................................................................6
3.2 Election Procedure - General Rule................................."...............................................6
3.3 New Participants - General Rule..".................................................................................7
3.4 FaJIure to Return Election Form ......................................................................................7
3.5 Periods to Which Election Form Applies ........................................................................7
3.6 Changes by Plan Administrator .......................................................................................8
3.7 Irrevocable Elections .................... .................... ............... """""'" ... """"""""'" .............8
3.8 Limit on Reimbursement Account Elections .................................................................11
3.9 Limit on Group-Term Life Insurance ............................................................................11
3.10 When Expenses Incurred .............................................................................................12
ARTICLE IV HEALTH REIMBURSEMENT ............................................................................13
Benefits Provided by the Health Reimbursement Account ...........................................13
Determination of Status as a Spouse or a Dependent ....................................................13
Total Health Reimbursement Account Available ................................... ............. ..........13
4.1
4.2
4.3
4.4
4.5
Claims for Benefits ........................................................................................................13
Excess Reimbursement or Failure to Use Amounts Available......................................14
ARTICLE V DEPENDENT CARE REIMBURSEMENT ACCOUNT ......................................15
5.1 Benefits Provided by the Dependent Care Reimbursement Account............................15
5.2 Crediting of Accounts ....................................................................................................15
5.3 Payment of Dependent Care Expense Reimbursements. ...............................................15
5.4 Excess Reimbursements or Failure to Use Amount Available ......................................16
ARTICLE VI CONTINUATION COVERAGE UNDER HEALTH
REIMBURSEMENT ACCOUNT .....................................................................................17
6.1 Continuation Coverage After Tennination ofNonnal Participation .............................17
6.2 Qualified Beneficiary..... ... """"""""""""""""" """" ........... ............... .... """"""'" ..... .17
6.3 Qualifying Event.. """"""'" """"""""""""""""'" ............... .................... ............... ......17
6.4 Benefit Available Under Continuation Coverage..... ..... .... ................. .... ................ .......18
6.5 Notice Requirements. .... ........ ............ ...................... ............ ...... """"'" ""'" ......... .... ..... .18
6.6 Election Period................ ........... ....... ..................... .... """"""'" ................ ... ................. .18
6.7 Duration of Continuation Coverage..... .... ...... ............. ............. ............... ....... .......... ""00 19
6.8 Birth or Adoption ofa Child..........................................................................................19
6.9 Automatic Termination of Continuation Coverage .......................................................19
6.10 Required Monthly Premium ........................................................................................19
6.11 Continuation Coverage for Employees in the Uniformed Services.............................19
ARTICLE VII PLAN ADMINISTRATION ................................................................................21
7.1 Allocation of Authority..................................................................................................21
7.2 Provision for Third-Party Plan Service Providers .........................................................21
7.3 Limitation of Liability........... ......... ............. ............. ................ ............ ....... .........,.. .......21
7.4 Compensation of the Plan Administrator............. ...... .............. .................. .......... ..........22
7.5 Bonding..........................................................................................................................22
7.6 Payment of Administrative Expenses ........................................................"..................22
7.7 Disbursement Reports ................. ............. """""'" """" ................ ...... """"""""" ........ .22
ARTICLE VIII CLAIMS PROCEDURE.................................................".................... ..............23
8.1 Procedure if Benefits are Denied Under the Plan ..........................................................23
8.2 Requirement for Written Notice of Claim DeniaL.........................................................23
8.3 Right to Request Hearing on Benefit Denial..."............................................................23
8.4 Disposition of Disputed Claims """"""""" .......... ........... ..... ........... ..... .... ........... .... ......23
ARTICLE IX AMENDMENT OR TERMINATION OF PLAN.................................................24
9.1 PeTIllanency......... ................. """"" .......... ............ ....... ............. ................................... ...24
9.2 Employer's Right to Amend ..........................................................................................24
9.3 Employer's Right to Terminate .....................................................................................24
ARTICLE X GENERAL PROVISIONS..................................................................... .................25
10.1 No Employment Rights Conferred ........................................................................"....25
10.2 Payments Upon Death ofParticipant............ """"""" ..... ................... ................ ... ......25
10.3 Nonalienation of Benefits ... .................... ......... .................. ................. .............. ..... ..... .25
11
lOA
10.5
10.6
10.7
10.8
10.9
10.10
10.11
10.12
10.13
Mental or Physical Incompetence .............. ....... .............. .......... """"""""""" ........... ..25
Benefits ........................................................................................................................25
Benefits Solely From General Assets ..........................................................................25
Tax Effects """"""""""""""""""""""""""""...........................................................25
Multiple Function.........................................................................................................26
Gender and Number .....................................................................................................26
Headings ......................................................................................................................26
Applicable Laws ..........................................................................................................26
Severability """"""""""""""""""""""""""'"...........................................................26
Premium Program Control Clause .......... ............ .......,....... """"""" .... ..................... ...26
APPENDIX A """"""""""""""""""""""""""".........................................................................26
111
INTRODUCTION
The Village of Mount Prospect established this plan, known as the Village of Mount Prospect
Flexible Compensation Plan (the "Plan"), effective July 1, 1985. The Plan is a cafeteria, medical
spending account, and dependent care assistance plan within the meanings of Sections 105, 125
and 129 of the Internal Revenue Code of 1986, as amended (the "Code"). The Plan was restated
effective January 1, 2001, and again effective January 1, 2002, in response to the issuance of
final Treasury Regulations governing cafeteria plans and to incorporate certain other changes to
the Plan. This restatement of the Plan is effective January 1, 2004.
The purpose of the Plan is to provide eligible employees the opportunity to choose benefits from
among those benefits made available to them under the Plan. This Plan is intended to qualify as
a cafeteria plan within the meaning of Code section 125 and to qualify as a dependent care
assistance program within the meaning of Code section 129. Furthennore, to the maximum
extent possible, benefits paid under the Plan are intended to be eligible for exclusion from gross
income under Code sections 105, 106, and 129. This Preamble and the following Articles, as
amended from time to time, comprise the restated Plan.
IV
ARTICLE I
DEFINITIONS
The following words and phrases, as used in this Plan, shall have the following meanings, unless
a different meaning is plainly required by the context.
1.1 Code. The tenn "Code" means the Internal Revenue Code of 1986, as amended.
1.2 Dependent. With regard to "Eligible Medical or Dental Expenses," the tem1
"Dependent" means any individual who is a dependent of the Participant, as defined in
Code section 152, as amended.
\\lith regard to "Dependent Care Expenses," the tenn "Dependent" means any individual
who is:
1.3
A dependent of the Participant who is under the age of 13 and with respect to
whom the Participant is entitled to an exemption under Code section 151 (c); or
A dependent (as defined in Code section 152) or spouse of the Participant who is
physically or mentally incapable of caring for himself/herself.
Dependent Care Reimbursement Account. The tenn "Dependent Care Reimbursement
Account" means the bookkeeping account maintained by the Employer to detem1ine the
amount available to reimburse the Participant, in accordance with the tenus of the Plan,
for eligible dependent care expenses the Participant incurs.
Dependent Care Expenses. The tem1 "Dependent Care Expenses" means expenses
incurred by a Participant that:
(a) Are incurred for the care of a Dependent of the Participant or for related
household services;
(b)
(a)
1.4
1.5
Are paid or payable to a Dependent Care Service Provider; and
Are incurred to enable the Participant to be gainfully employed for any period for
which there are one or more Dependents with respect to the Participant.
Dependent Care Expenses shall not include expenses incurred for services outside the
Participant's household for the care of a Dependent unless such Dependent is described
in Section 1 .2(a) 0 r regularly spends a t I east eight hours each day in the Participant's
household.
Dependent Care Service Provider. The term "Dependent Care Service Provider" means a
person who provides care or other services described in Section 1.4 above, but shall not
include (a) a dependent care center (as defined in Code section 21(b)(2)(D), unless the
requirements of Code section 21(b)(2)(C) are satisfied, or (b) a related individual
described in Code section 129( c).
(b)
(c)
1.6
Employee. The term "Employee" means any individual who is identified as an employee
on the payroll records of the Employer. The tenn "Employee" does not include any
person who is an independent contractor.
Employer. The term "Employer" means the Village of Mount Prospect, a municipality
organized and existing under the laws of the State ofIlJinois.
1.7
1
1.8
1.9
1.10
1.11
1.12
1.13
1.14
1.15
1.16
1.17
1.18
1.19
Eligible Medical or Dental Expenses. The phrase "Eligible Medical or Dental Expenses"
means any expense for "medical care" as defined in Code section 213(d), as amended.
The term "Eligible Medical or Dental Expenses" does not include premium payments for
health plan coverage, such as premiums paid for health coverage under a plan maintained
by an employer ofthe Participant's Spouse or Dependents.
FMLA Leave. The term "FMLA Leave" means a leave described under the Family and
Medical Leave Act of 1993.
Health Reimbursement Account. The term "Health Reimbursement Account" means the
bookkeeping account maintained by the Employer to determine the amount available to
reimburse the Participant, in accordance with the terms of the Plan, for Eligible Medical
and Dental Expenses the Participant incurs.
Hi~hly Compensated Employee. The term "Highly Compensated Employee" means an
Employee described in Code section 414(q), Code section 125(e) or Code section
1 05(h)( 5), as applicable.
Key Employee. The term "Key Employee" means an Employee described in Code
section 416(i)(1), as amended.
Participant. The term "Participant" means an Employee who is eligible to participate in
this Plan pursuant to Article III.
Plan. The term "Plan" means the Village of Mount Prospect Flexible Compensation
Plan, as set forth herein and amended from time to time.
Plan Administrator. The term "Plan Administrator" means the person or committee
appointed by the Employer to manage and direct the operation and the administration of
the Plan. If the Employer does not appoint such a person or committee, the Employer
shaH be the Plan Administrator.
Plan Year. The term "Plan Year" means the calendar year.
Premium Program.
Appendix A.
Spouse. The term "Spouse" means an individual who is legally married to a Participant,
but shaH not include an individual separated from the Participant under a legal separation
decree.
Uniformed Services, The term "Uniformed Services" means the Armed Forces, the
Army National Guard and the Air National Guard (when engaged in active duty for
training, inactive training, or full-time National Guard duty), the commissioned corps of
the Public Health Service or any other category of persons designated by the President of
the United States in time of war or emergency.
The term "Premium Program" means a program specified in
2
2.1
2.2
2.3
ARTICLE II
PARTICIPATION
Conditions of Participation. An Employee shall be eligible to participate in this Plan as
of the date he or she satisfies the eligibility requirements of the Employer's group health
plan. An Employee need not participate in the Employer's health plan to participate in
this Plan.
The foregoing notwithstanding, any Employee who is a "part-time" Employee shall not
be eligible to participate in the Plan. A "part-time" Employee is any Employee who is
designated as a part-time Employee pursuant to the Employer's employment policy.
Termination of Participation. Except as provided in Article VI, an Employee shall cease
tò be eligible to participate in the Plan as of the date the Employee tem1inates
employment with the Employer or becomes ineligible to participate in the Plan pursuant
to Section 2.1 above (i.e., becomes a part-time Employee). For purposes of this Section,
a Participant on FMLA Leave shall be deemed an Employee eligible for participation in
this Plan until the earlier of:
The end of the FMLA Leave; or
The date the Participant gives notice to the Employer of an intent not to return to
active employment.
A Participant a bsent from employment due to a period 0 f service with the U nifonned
Services shaH be deemed an Employee eligible for participation in this Plan until the
Participant is absent from employment of at least thirty hours per week for more than
thirty-one days due to such period of duty.
If the Plan Administrator, in its sole discretion, detennines that an Employee has filed, or
assisted in the filing of, a dishonest or fraudulent claim for benefits under a Health
Reimbursement Account or a Dependent Care Reimbursement Account, the Employee's
participation in the Health Reimbursement Account and the Dependent Care
Reimbursement Account features of the Plan shall tenninate immediately. In addition,
that Employee will not be eligible to participate in either the Health Reimbursement
Account feature of the Plan or the Dependent Care Reimbursement Account feature of
the Plan for any future period.
(a)
(b)
Participation During Leave.
(a)
FMLA Leave.
(1)
Health Benefits. Notwithstanding any provision to the contrary in this
Plan, if a Participant goes on FMLA Leave, then to the extent required by
the FMLA, the Employer will continue to maintain the Participant's health
insurance benefits and Health Reimbursement Account benefits on the
same tenns and conditions as if the Participant were still an active
Employee. That is, if the Participant elects to continue his or her coverage
while on leave, the Employer will continue to pay its share of the
contribution.
3
An Employer may elect to continue all coverage for Participants while
they are on paid FMLA Leave (provided Participants on non-FMLA
Leave are required to continue coverage). If so, the Participant's share of
the contribution shall be paid by the method normally used during any
paid leave (e.g. on a pre-tax, compensation reduction basis if that was the
method used before FMLA Leave.)
In the event of unpaid FMLA Leave (Q! paid FMLA Leave where
coverage is not required to be continued), a Participant may elect to
continue his or her coverage under the Premium Program and/or Health
Reimbursement Account components during the FMLA Leave. If the
Participant elects to continue coverage while on leave, then the Participant
shall pay his or her share of the contribution in one of the following ways
(as agreed upon by the Plan Administrator):
(A) With after-tax payments, by sending monthly payments to the
Employer by the due date established by the Employer;
With pre-tax, compensation reduction contributjons, by having
such amounts withheld from his or her ongoing compensation (if
any) or pre-paying all or a portion of the contribution for the
expected duration of the leave with pre-tax compensation reduction
contributions [To pre-pay the contribution with pre-tax
compensation reduction amounts, the Participant must make a
special election to that effect prior to the date that such
compensation would normally be made available (pre-tax
compensation reduction contributions may not be used to fund
coverage during the next Plan Year).]; or
Under another aITangement agreed upon between the Participant
and the Plan Administrator (e.g" the Plan Administrator may
choose to fund coverage during the FMLA Leave and withhold
"catch-up" amounts upon the Participant's return with pre-tax,
compensation reduction contributions or after-tax contributions).
If the Employer requires aU Participants to continue coverage during the
leave, the Participant may elect to discontinue the Participant's required
contributions until the Participant returns from FMLA Leave. Upon return
from leave, the Participant will be required to repay the contribution not
paid by the Participant during the FMLA Leave. Payment shall be
withheld fÌom the Participant's compensation either on a pre-tax or after-
tax basis, as may be agreed upon by the Plan Administrator and the
Participant.
If a Participant's coverage ceases while on FMLA Leave (e.g., for non-
payment of required contributions), the Participant will be pennitted to rc-
enter the Plan upon return fÌom such FMLA Leave on the same basis as
the Participant was participating in the Plan prior to the leave, or otherwise
required by the FMLA, Employees whose coverage tenninated during the
leave may be automatically reinstated provided that coverage for
(B)
(C)
4
(b)
Employees on non-FMLA L eave is a utomaticaUy reinstated upon return
from leave. Notwithstanding the preceding sentence, with regard to Health
Reimbursement Account benefits, a Participant whose coverage ceased
will be entitled to elect whether to be reinstated in the Health
Reimbursement Account at the same coverage level as in effect before the
FMLA Leave (with increased contributions for the remaining period of
coverage) 0 rat a Health Reimbursement Account c overage level that is
reduced pro-rata for the period of FMLA Leave during which the
Participant did not make contributions.
Non-Health Benefits. If a Participant goes on FMLA Leave, entitlement to
non-health benefits, such as the Dependent Care Reimbursement Account,
is to be determined by the Employer's policy for providing such benefits
when the Participant is on non-FMLA Leave, as described in subsection
(b) below. If the Employer continues a Participant's non-health benefits
during a qualifying FMLA Leave, the Participant will, upon returning
from leave, be required to repay the contributions due from, but not paid
by, the Participant during the FMLA Leave.
Non-FMLA Leave. If a Participant goes on an unpaid leave of absence that does
not affect eligibility, then the Participant will continue to participate and the
contributions due for the Participant will be paid by pre-payment before going on
leave, by after-tax contributions while on leave, or with catch-up contributions
after the leave ends, as may be determined by the Plan Administrator. If a
Participant goes on an unpaid leave that affects eligibility, the election change
rules in Section 3.7 will apply. If the Employer continues the Participant's
benefits while on leave, the Participant will upon returning from leave be required
to repay the contributions due from, but not paid by, the Participant during the
leave.
(2)
2.4
Reinstatement of Former Participant. An Employee who is a forn1er Participant becomes
a Participant again if and when such Employee satisfies the requirements of Section 2.1.
If, during the same Plan Year, the fonner Participant satisfies the requirements of
Section 2.1 within 30 days of the date his coverage under the Plan was tenninated
pursuant to section 22, the Participant's prior elections under the Plan shall be
automatically reinstated. If, during the same Plan Year, the former Participant satisfies
the requirements of Section 2.1 more than 30 days after the date his coverage under the
Plan was terminated pursuant to Section 22, the Participant shall be entitled to make new
elections under the Plan as provided in Section 3.3.
5
3.1
ARTICLE III
BENEFITS
Coverage Options - General Rule. Each Employee who i saP articipant may choose,
under this Plan, to receive such Participant's compensation from the Employer for any
Plan Year in cash or to:
(a)
(b)
(c)
Receive coverage under one or more Premium Program(s) (i.e., subject to the
tenns of any such Premium Program);
Have an amount credited to the Participant's Health Reimbursement Account;
and/or
Have an amount credited to the Participant's Dependent Care Reimbursement
Account.
If a Participant elects to receive coverage under a Premium Progran1, then the
Participant's compensation from the Employer will be automatically reduced by the
Participant's share of the applicable premium for the Premium Program for the Plan
Year, as determined by the Employer. If a Participant elects to have an amount credited
to the Participant's Health Reimbursement Account and/or Dependent Care
Reimbursement Account for a Plan Year, then the Participant's compensation from the
Employer for the Plan Year will be reduced by an equal amount.
Election Procedure - General Rule. Prior to the first day of each Plan Year, the Plan
Administrator, or the Plan Administrator's delegate, shall provide a written election form
(including a compensation reduction agreement) to each Participant and to each
Employee who is expected to become a Participant as of the beginning of that Plan Year.
To elect coverage under a Premium Program, the Health Reimbursement Account and/or
the Dependent Care Reimbursement Account for that Plan Year, a Participant shall:
3.2
(a)
(b)
(c)
Complete the election form, specifying which, if any, Premium Programs the
Participant desires coverage under (subject to the limits of Section 3.9) and/or the
amount ( subj ect tot he limits 0 f Section 3 .8) to be credited tot he Participant's
Health Reimbursement Account and to the Participant's Dependent Care
Reimbursement Account for that Plan Year;
Execute an agreement directing the Employer to reduce the Participant's
compensation from the Employer for that Plan Year by an amount equal to the
total amount of the Participant's share of the premiums for the Premium Programs
selected a nd the total amount that the Participant elects to have credited to the
Health Reimbursement Account and the Dependent Care Reimbursement Account
pursuant to (a) above; and,
Return the election form and the compensation reduction agreement to the Plan
Administrator, or the Plan Administrator's delegate, prior to the beginning of that
Plan Year.
A Participant's election to enroll in the Employer's group health plan shall be deemed an
election to enroll in this Plan with respect to that Premium Program that satisfies the
requirements of subsections (a), (b) and (c) above.
6
3.3
The election form and compensation reduction agreement shall be effective as of the first
day of that Plan Year.
New Participants - General Rule. If an Employee first becomes eligible to participate
under Section 2.1 or Section 2.4 on a date other than the first day of a Plan Year, the Plan
Administrator shall provide the Employee with the written election described in Section
3.2 before, 0 r as soon asp ossible after, the Employee becomes eligible top articipate.
The Employee may then elect coverage under a Premium Program (subject to the terms
of the Premium Program), Health Reimbursement Account and/or the Dependent Care
Reimbursement Account for the remainder of the Plan Year.
To elect coverage under a Premium Program, Health Reimbursement Account or
Dependent Care Reimbursement Account, the Employee shall:
3.4
Complete the election fonn, specifying which, if any, Premium Programs the
Participant desires coverage under (subject to the limits of Section 3.9) and/or the
amount (subject tot he 1 imits 0 f Section 3 .8) to be credited tot he Participant's
Health Reimbursement Account and to the Participant's Dependent Care
Reimbursement Account for the remainder of that Plan Year;
Execute an agreement directing the Employer to reduce the Participant's
compensation from the Employer for the remainder of that Plan Year by an
amount equal to the total amount of the Participant's share of the premiums for
the Premium Programs selected and the total amount that the Participant elects to
have credited to the Health Reimbursement Account and/or the Dependent Care
Reimbursement Account pursuant to (a) above; and,
Return the election form to the Plan Administrator, or the Plan Administrator's
delegate, on or before such date as the Plan Administrator, or the Plan
Administrator's delegate, shall specify. (The date specified by the Plan
Administrator shall be no later than the beginning ofthe first pay period for which
the Employee's election form and compensation reduction agreement take effect.)
A Participant's election to enroll in the Employer's group health plan shall be deemed an
election to enroll in this Plan with respect to that Premium Program that satisfies the
requirements of subsections (a), (b) and (c) above.
The Employee's election form and compensation reduction agreement shall not take
effect before the date the Employee becomes a Participant.
Failure to Return Election Form. Except as provided in Section 3.5, if a Participant fails
to timely submit a completed election to the Plan Administrator (or the Plan
Administrator's delegate) pursuant to Sections 3.2 or 3.3, the Participant shall be deemed
to have elected to receive cash compensation in lieu of coverage under a Premium
Program, the Health Reimbursement Account or the Dependent Care Reimbursement
Account.
(b)
(a)
(c)
3.5
Periods to Which Election Fonn Applies. If a Participant submits a completed election to
the Plan Administrator pursuant to Sections 3.2 or 3.3, the Participant's elections shall
remain in effect until the time described below.
7
(a)
Premium Program Elections. A Participant's Premium Program election wiJl
remain in effect until:
The effective date of a new election that the Participant submits for a
subsequent Plan Year, pursuant to Section 3.2;
The date the Participant revokes such Participant's election to the extent
pennitted pursuant to Section 3.7;
The date the Participant ceases to be a Participant as described in Section
2.2;
The date the Plan or the Premium Program is terminated; or
The date the Plan Administrator modifies the Participant's election
pursuant to Section 3.6.
Health Reimbursement Account and Dependent Care Reimbursement Account
Elections. A Participant's election with respect to the HeaHh Reimbursement
Account or Dependent Care Reimbursement Account will remain in effect until:
(1) The last day of the Plan Year for which the election was made;
(2) The date the Participant revokes such Participant's election, to the extent
pennitted pursuant to Section 3.7;
The date the Participant ceases to be a Participant as described in Section
2.2;
The date the Plan is terminated or amended to eliminate the benefit to
which the election applies; or
The date the Plan Administrator modifies the Participant's election
pursuant to Section 3.6.
The foregoing notwithstanding, the amount of the reduction of a Participant's
compensation shall be adjusted by the Plan Administrator to correspond to any change in
the Participant's share of the cost, as detennined by the Employer, of elected Premium
Program coverage.
(1)
(2)
(3)
(4)
(5)
(b)
(3)
(4)
(5)
3.6
Changes by Plan Administrator. If the Plan Administrator (or the Plan Administrator's
delegate) detem1Ìnes that the Plan may fail to satisfy any nondiscrimination requirement
or any limit upon Key Employee benefits imposed by the Code, the Plan Administrator
shall take such action as the Plan Administrator deems appropriate, under rules uniformly
applicable to similarly situated Participants to comply with such requirement or limit.
Such action may include, without limitation, modifying the elections of Highly
Compensated Employees and/or Key Employees without the consent of such Employees.
Irrevocable Elections. Except asp rovided inS ections 2.3, 3 .5 and this Section 3 .7, a
Participant's Plan coverage election pursuant to Section 3.2 or 3.3 or deemed election of
cash compensation pursuant to Section 3.4 shall be irrevocable during any Plan Year that
begins while such election remains in effect. All election changes shall conform with
applicable regulations issued by the Department of the Treasury, under Code section 125.
3.7
8
(a)
(b)
Election Change Events that Apply to All Plan Elections. To the extent permitted
by applicable Treasury Regulations, a Participant may enroll for coverage under
this Plan or may change an election under this Plan on account of, and consistellt
with, one of the following events:
(1) A change in the Participant's marital status. A change in marital status
includes a change that results from marriage, death of Spouse, divorce,
legal separation or annulment.
A change in the number of the Participant's Dependents. A change in the
number of the Participant's Dependents includes a change resulting from
birth, death, adoption, or placement for adoption.
A change in the Participant's employment status, 0 r in the employment
status of the Participant's Spouse or Dependent. A change in employment
status includes, for example, a termination or commencement of
employment, a strike or lockout, a commencement of or return from an
unpaid leave of absence, a change in work site, or a change in employment
status affecting eligibility for coverage under a coverage option set forth in
Section 3.1 (e.g., from full-time to part-time status).
The Participant's Dependent satisfying or ceasing to satisfy the eligibility
requirements for coverage under a coverage option on account of
attainment of age, student status, or any similar circumstance.
A change in the Participant's residence or the residence of the
Participant's Spouse or Dependent.
Election Changes That Only Apply to Dependent Care Reimbursement Account
and Premium Program Elections. The events described in this subsection (b)
permit a Participant to change his or her Plan elections only with respect to the
Dependent Care Reimbursement Account and the Premium Programs.
(1) Significant Cost Changes. To the extent permitted by applicable Treasury
Regulations, if the Participant's cost of coverage significantly increases or
decreases during a Plan Year, the Plan Administrator may permit an
affected Participant to make a corresponding prospective change to the
Participant's elections under the Plan. A Participant may only change his
or her Dependent Care Reimbursement Account elections due to a cost
change if the cost change is imposed by a Dependent Care Service
Provider who is not a relative ofthe Participant.
Change in Coverage. To the extent permitted by applicable Treasury
Regulations, the Plan Sponsor may allow a Participant to change his or her
elections under the P Ian i f there is a change in coverage. A change in
coverage occurs if there is a significant curtailment of a benefit option
without a loss 0 f coverage ( e.g., a significant increase in the deductible
under the Employer's group health plan), a significant curtailment of a
benefit option with a loss of coverage (e.g., the elimination of a benefit
option) or the addition or improvement of a benefit option. Also, a
Participant may make a prospective change to his or her Dependent Care
(2)
(3)
(4)
(5)
(2)
9
(d)
(e)
(c)
Reimbursement Plan elections as a result of a change in coverage if the
Participant changes his or her Dependent Care Provider. Finally, a
Participant may make a prospective change in his or her Plan elections if
there is a change in coverage of a Spouse or Dependent under another
employer's cafeteria plan.
Election Changes that Only Ap?ly to the Group Health Plan Premium Program.
The events described in this subsection I pennit a change to a Participant's Plan
elections only with respect to the group health plan Premium Program (i.e.,
change the amount of compensation withheld for group health plan premium
payments).
(l) Judgment, Decree or Order. To the extent pennitted by applicable
Treasury Regulations, if a Participant's enroHment under the Employer's
group health plan is modified to comply with a judgment, decree or order
resulting from a divorce, legal separation, annulment, or change in legal
custody that requires coverage under that plan for the Participant's
Dependent child or Dependent foster child, the Plan will make a
corresponding change to the Participant's group health plan Premium
Program elections.
Entitlement to Medicare or Medicaid. To the extent pennitted by
applicable Treasury Regulations, if a Participant's enrollment under the
Employer's group health plan is modified due to coverage or loss of
coverage under Medicare or Medicaid, the Plan will make a corresponding
change to the Participant's group health plan Premium Program elections.
Loss of Coverage Under Other Group Health Coverage. To the extent
pennitted by applicable Treasury Regulations, if a Participant, a
Participant's Spouse or Participant's Dependent is enrolled in the
Employer's group health plan due to a loss of coverage under a group
health plan sponsored by a governmental or educational institution, the
Plan will make a corresponding change to the Participant's group health
plan Premium Program elections.
Election Changes that Only Apply to the Health Reimbursement Account and the
Group Health Plan Premium Program. To the extent pennitted by applicable
Treasury Regulations, if a Participant, Participant's Spouse, or Participant's
Dependent is entitled to s pedal enrollment rights under a group health plan in
accordance with 42 U.SoC.A. section 300gg(f), the Participant may enroll for
coverage under this Plan with respect to the Health Reimbursement Account or
the Group Health Plan Premium Program or otherwise modify such Participant's
elections under this Plan.
(2)
(3)
Special Rule for Changes in Health Reimbursement Account Elections. Except as
described in this subsection, this Section 3.7 does not pennit a Participant to
reduce the amount to be credited to the Participant's Health Reimbursement
Account for the Plan Year or the amount by which his compensation will be
reduced for Health Reimbursement Account coverage for the Plan Year. If
otherwise pennitted under this Section 3.7, a Participant may reduce the amount
10
3.8
to be credited to the Participant's Health Reimbursement Account for the
remainder of the Plan Year only if, as of the date of the change, the amount by
which the Participant's compensation for the Plan Year has actually been reduced
for Health Reimbursement Account coverage exceeds the Eligible Medical or
Dental Expenses reimbursed from the Participant's Health Reimbursement
Account for that Plan Year. If a Participant described in the preceding sentence
changes the amount to be credited to the Participant's Health Reimbursement
Account during the Plan Year, the amount credited to the Participant's Health
Reimbursement Account immediately after such change shall equal the excess, if
any, detennined pursuant to the preceding sentence plus the amount the
Participant directs the Employer to credit to the Health Reimbursement Account
for the remainder of the Plan Year.
Limit on Reimbursement Account Elections. The amount that a Participant may elect to
have credited for any Plan Year to the Dependent Care Reimbursement Account or to the
Health Reimbursement Account shall be limited as described in this Section 3.8.
(a)
Limit on Dependent Care Reimbursement Account. The amount that a Participant
may elect to have credited tot he Dependent Care Reimbursement Account for
any Plan Year may not exceed the least of:
(1) The Participant's earned income (as defined in Code section 129(e)(2» for
the Plan Year (after all compensation withholdings, including reductions
related to this Plan);
(2)
The actual or deemed earned income of the Participant's spouse for the
Plan Year; or
$5,000 ($2,500 in the case of a separate return by a married individual).
(3)
3.9
In the case of a spouse who is a full-time student at an educational institution or is
physically or mentally incapable of caring for himself/herself, such spouse shall
be deemed to have earned income of not less than $200 per month if the
Participant has one Dependent and $400 per month if the Participant has two or
more Dependents.
Limit on Health Reimbursement Account. The total amount that a Participant
may elect to have credited to the Participant's Health Reimbursement Account for
a Plan Year may not exceed $5,000,00. If an Employee first becomes a
Participant during a Plan Year, as described in Section 3.3, the applicable limit
described in the preceding sentence shall be reduced by multiplying it by a
fraction. The numerator of that fraction shall be the number of calendar months
during the Plan Year that the Employee will be a Participant and the denominator
of which is the total number of months in the Plan Year. F or purposes of the
foregoing calculation, the Employee shall be considered a Participant for a
calendar month only if the Employee is a Participant on the fifteenth day of that
calendar month.
Limit on Group-Term Life Insurance. For Participants who elect coverage under the
Employer's Group-Tenn Life Insurance Plan Premium Program, the amount of such
(b)
11
3.10
coverage must be in increments of $10,000 up to an aggregate coverage amount, in
conjunction with coverage provided directly by the Employer, equal to $50,000.
When Expenses Incurred. For purposes of this Plan, Eligible Medical or Dental
Expenses and Dependent Care Expenses shall be deemed to have been incurred on the
day the service or treatment is rendered or furnished, not the day the Participant is
formally billed, charged or pays for such service or treatment.
12
Benefits Provided by the Health Reimbursement Account. Amounts credited to a
Participant's Health Reimbursement Account for a Plan Year shall be available to
reimburse the Participant for Eligible Medical or Dental Expenses incurred by the
Participant during the Plan Year for the care of the Participant, the Participant's Spouse,
or the Participant's Dependents, provided such expenses are submitted properly in
accordance with the provisions of this Article IV. The balance of the Participant's Health
Reimbursement Account shall be reduced by reimbursements the Participant receives for
such Eligible Medical or Dental Expenses. Expenses incurred before an Employee
becomes a Participant or after an Employee ceases to be a Participant shall not be eligible
for reimbursement under this Plan. The foregoing notwithstanding, if a Participant
becomes ineligible to participate in the Plan during a Plan Year due to a change from full-
time to part-time employment status, reimbursable expenses include Eligible Medical or
Dental Expenses incurred during the Plan Year but after the Employee ceases to b e a
Participant.
Determination of Status as a Spouse or a Dependent. The Plan Administrator shaH
determine whether an individual is a Spouse (within the meaning of Section 1.18) or a
Dependent (with respect to Eligible Medical or Dental Expenses within the meaning of
Section 1.2) of the Participant whose Eligible Medical or Dental Expenses are eligible for
reimbursement under the Health Reimbursement Account. The Plan Administrator shall
make that determination at the time those expenses are incurred by the Participant.
Eligible Medical or Dental Expenses incurred with respect to an individual who ceases to
be a Participant's Spouse (within the meaning of Section 1.18) or Dependent (within the
meaning of Section 1.2), which are otherwise eligible for reimbursement pursuant to the
tenDS of this Plan, shall be reimbursed only if such expenses are incurred prior to the date
such individual ceases to be the Participant's Spouse or Dependent.
Total Health Reimbursement Account A vaìlable. The total amount to be credited to a
Participant's Health Reimbursement Account for the Plan Year (reduced by prior
reimbursements made for that Plan Year and modified to the extent required by
Section 3.7) shall be available at aU times that the Participant is eligible to participate
during that Plan Year.
Claims for Benefits. A Participant applying for reimbursement of Eligible Medical or
Dental Expenses must submit the following to the Plan Administrator no later than the
March 3151 after the end of the Plan Year in which such expenses are incurred:
(a) A written claim for benefits on a foml approved by the Plan Administrator that
contains the following information:
(1) The name of the person, or the names of the persons, on whose behalf the
Participant incurred the Eligible Medical or Dental Expenses and their
relationship to the Participant;
A description of the nature of the expenses incurred;
The amount of the requested reimbursements; and
4.1
4.2
4.3
4.4
(2)
(3)
ARTICLE IV
HEAL TH REIMBURSEMENT
13
(4)
4.5
A statement that such expenses have not otherwise been paid through
insurance or reímbursed from any other source.
All receipts (or photocopies of all receipts) for such Eligible Medical or Dental
Expenses.
Proof of the dates such Eligible Medical or Dental Expenses were incurred.
Proof of the Participant's payment of such Eligible Medical or Dental Expenses
(identifying the person, organization or company to which such Eligible Medical
or Dental Expenses were paid).
Any claim for reimbursement submitted to the Plan Administrator by the Participant later
than the March 3151 after the close of the Plan Year in which the expense to which such
claim relates was incurred will not be eligible for reimbursement under this Plan.
Excess Reimbursement or Failure to Use Amounts Available. If the reimbursement
provided by the Employer pursuant tot he Plan for the Plan Year exceeds t he a mount
credited to the Participant's Health Reimbursement Account for the Plan Year, the
Participant shaH repay such excess amount to the Employer. If a Participant's incurred
and properly submitted Eligible Medical or Dental Expenses for a Plan Year are less than
the amount credited to the Participant's Health Reimbursement Account for that Plan
Year, the excess of the amount credited to the Participant's Health Reimbursement
Account over the Eligible Medical or Dental Expenses incurred and properly submitted
with respect to such Plan Year shall be forfeited and may not b e utilized for Eligible
Medical or Dental Expenses incurred in any subsequent Plan Year.
(b)
(c)
Cd)
14
5.1
5.2
53
ARTICLE V
DEPENDENT CARE REIMBURSEMENT ACCOUNT
Benefits Provided by the Dependent Care Reimbursement Account. Subject to the
provisions of this Article Y, amounts credited to a Participant's Dependent Care
Reimbursement Account for each Plan Year shaH be available to reimburse the
Participant for Dependent Care Expenses incuaed during the Plan Year. Dependent Care
Expenses incurred before an Employee becomes a Participant or after an Employee
ceases to be a Participant shall not be eligible for reimbursement under this Plan. The
foregoing notwithstanding, if a Participant becomes ineligible to participate in the Plan
during a Plan Year due to a change from full-time to part-time employment status,
reimbursable expenses include Dependent Care Expenses incurred during the Plan Year
but after the Employee ceases to be a Participant.
Crediting 0 f Accounts. T he a mount that the Participant elects to h aye credited tot he
Participant's Dependent Care Reimbursement Account for the Plan Year shall be credited
to the Participant's Dependent Care Reimbursement Account over the course of such
Plan Year. As of a given date within the Plan Year, the amount credited to a Participant's
Dependent Care Assistance Account shall equal:
(1) The amount by which the Participant's compensation from the Employer
for the Plan Year has been reduced as of that date for amounts to be
credited to the Dependent Care Assistance Account for that Plan Year;
mInUS
(2)
Amounts debited to the Participant's Dependent Care Assistance Account
for that Plan Year pursuant to (b) below.
Debiting of Accounts. A Participant's Dependent Care Reimbursement Account
for each Plan Year shall be debited from time to time by the amount of any
payment under this Article V to or for the benefit of the Participant for Dependent
Care Expenses incurred during such Plan Year. Amounts debited to a
Participant's Dependent Care Reimbursement Account shall be treated as
payments of the earliest amounts credited to that Account and not yet treated as
paid under this sentence, under a "first-in/first-out" approach.
Payment of Dependent Care Expense Reimbursements.
(a) Claims for Reimbursement. A Participant applying for reimbursement of
Dependent Care Expenses must submit the following to the Plan Administrator,
on a form approved by the Plan Administrator no later than the March 31 5t after
the end of the Plan Year in which such expenses are incurred:
(1) The amount, date, and nature of the expense with respect to which a
benefit is requested;
The nan1e, address, and taxpayer identification number of the person,
organization, or entity to which the expense was or is to be paid;
(b)
(2)
(3)
The name of the Dependent for whom the expense was incurred and the
relationship of such Dependent to the Participant; and
15
(b)
5.4
(4) Such other infonnation that the Plan Administrator may require.
Such application shall be accompanied by biBs, invoices, receipts, cancelled
checks or other statements showing the amounts of such expenses, together with
any additional documentation which the Plan Administrator may request.
Any claim for reimbursement submitted to the Plan Administrator by the
Participant later than the March 31 st after the close of the Plan Year in which the
expense to which such claim relates was inculTed will not be eligible for
reimbursement under this Plan.
Reimbursement or Payment of Expenses. The Employer shall reimburse the
Participant from the Participant's Dependent Care Reimbursement Account for
Dependent Care Expenses inculTed during the Plan Year, for which the
Participant submits a written application and documentation in accordance with
(a) above. The Employer may, at its option, pay any such Dependent Care
Expenses directly to the Dependent Care service provider in lieu of reimbursing
the Participant. No reimbursement or payment to a Participant under this Article
V of expenses inculTed during a Plan Year shall at any time exceed the balance of
the Participant's Dependent Care Reimbursement Account at the time of the
reimbursement or payment. The amount of any Dependent Care Expenses
incuITed in a Plan Year that are not reimbursed or paid as a result of the preceding
sentence shall be reimbursed or paid only if and when the balance in the
Participant's Account for such Plan Year is sufficient to permit such
reimbursement or payment.
Excess Reimbursements or Failure to Use Amount Available. If the reimbursement
provided by the Employer pursuant tot he P Ian for the Plan Year exceeds t he a mount
credited to the Participant's Dependent Care Reimbursement Account for the Plan Year,
the Participant shall repay such excess amount to the Employer. If a Participant's
inculTed and properly submitted Dependent Care Expenses for a Plan Year are less than
the amount credited to the Participant's Dependent Care Reimbursement Account for that
Plan Year, the excess of the amount credited to the Particípant's Dependent Care
Reimbursement Account over the Dependent Care Expenses incUlTed and properly
submitted with respect to such Plan Year shall be forfeited and may not be utilized for
Dependent Care Expenses inculTed in any subsequent Plan Year.
16
6.1
6.2
6.3
ARTICLE VI
CONTINUATION COVERAGE UNDER
HEALTH REIl\IBURSEMENT ACCOUNT
Continuation Coverage After Termination of Normal Participation. During any Plan
Year during which the Employer has more than 20 employees and notwithstanding any
other provision of this Plan to the contrary, each person who is a Qualified Beneficiary
described under Section 6.2 shall have the right to elect continued coverage for the
remainder of the Plan Year under the Health Reimbursement Account upon the
occurrence of a Qualifying Event. Such extended coverage under the Plan is known as
"Continuation Coverage."
Continuation Coverage, however, shall not be available if, as of the Qualifying Event, the
sum of the premiums the Qualified Beneficiary must pay to obtain Continuation
Coverage for the remainder of the Plan Year pursuant to Section 6.10, equals or exceeds
the Qualified Beneficiary's remaining benefit for the Plan Year. The Qualified
Beneficiary's remaining benefit for the Plan Year shall be determined by subtracting the
Participant's previously reimbursed Eligible Medical and Dental Expenses for the Plan
Year from the amount the Participant elected to have credited to the Health
Reimbursement Account for that Plan Year.
Qualified Beneficiary. A "Qualified Beneficiary" for purposes of this Article VI is any
person who, as of the day before a Qualifying Event, is:
(a) A Participant in a Health Reimbursement Account under the Plan;
(b) The Spouse of such a Participant; or
(c) The Dependent child of such a Participant.
A Participant can be a Qualified Beneficiary only if the Qualifying Event is described in
subsection (b) of Section 6.3. A retiree or other former employee actively participating in
the Plan by reason of a previous period of employment will be treated as a "Qualified
Beneficiary." A person is not a "Qualified Beneficiary" if, as of the date of the
Qualifying Event, the individual is covered under a Health Reimbursement Account
under the Plan by virtue of an election of Continuation Coverage by another person and is
not already a Qualified Beneficiary by reason of a prior Qualifying Event. Furthermore,
an individual who fails to elect Continuation Coverage within the election period
provided in Section 6.6, below, shall not be considered to be a Qualified Beneficiary.
Qualifying Event. Any of the following shall be considered a "Qualifying Event" if, but
for the Continuation Coverage available under this Article VI, such event would result in
a loss of coverage under the Health Reimbursement Account under this Plan:
(a) Death of a Participant.
(b) Tennination (other than by reason of gross misconduct) of the Participant's
emplo)lment or a reduction of hours of employment below any minimum level of
hours required for participation in this Plan. In the case of a Participant who:
(1) Does not return to covered employment at the end of an FMLA Leave, the
Qualifying Event of termination occurs on the earlier of the last day of the
17
FMLA Leave or the date the Participant notifies the Employer of the
intention not to return to active employment; or
Is absent more than 31 days due to a period of duty with the Uniformed
Services, the Qualifying Event occurs on the first day of such absence.
Divorce or legal separation of a Participant from the Participant's Spouse.
A Participant becoming eligible to receive Medicare Benefits under Title XVIII of
the Social Security Act.
( e) A Dependent child of a Participant ceasing to be a Dependent.
Benefit Available Under Continuation Coverage. A Participant who is eligible to elect to
continue coverage under this Article VI shall have the right to continue the level of
coverage in effect for the Participant on the day before the Qualifying Event. If a
Participant has a Spouse and/or Dependent child(ren) at the time of a Qualifying Event
and does not or cannot elect Continuation Coverage, the Spouse and Dependent
child(ren) shall have the right to elect Continuation Coverage.
(c)
(d)
6.4
(2)
(a)
Notice Requirements.
6.5
(b)
(c)
When an Employee becomes covered under a Health Reimbursement Account
under this Plan, the Plan Administrator must inform the Participant (and Spouse,
if any) in writing of the rights to continued coverage, as described in this Article
VI.
The Employer shall give the P Ian Administrator w riUen notice 0 f a Qualifying
Event described in Sections 6.3(a), (b), or (d) within 30 days of the OCCUITence
thereof.
Within 14 days of receipt of the Employer's notice, the Plan Administrator shall
furnish each Qualified Beneficiary with written notification of the termination of
regular coverage under the Health Reimbursement Account under this Plan and
the rights 0 f any such Qualified Beneficiary toe leet Continuation C overage as
required by 42 U.S.c.A. sections 300bb-l through 8, in accordance with the terms
of this Plan.
In the case of a Qualifying Event described in Section 6.3(c) or (e), a Participant
or Qualified Beneficiary who is a Spouse or Dependent child of such Participant
must notify the Plan Administrator within 60 days of the occurrence thereof. The
Plan Administrator shaH give written notification of Continuation Coverage rights
to any other affected Qualified Beneficiary within 14 days of its receipt of the
notice described in this Section 6.5(d). Notwithstanding any of the foregoing,
notification to a Qualified Beneficiary who is a Spouse of a Covered Employee is
treated as notification to all other Qualified Beneficiaries residing with that person
at the time notification is made.
Election Period. Any Qualified Beneficiary entitled to Continuation Coverage shall have
60 days from the later of the date coverage would otherwise end or the date of the notice
required by Section 6.5 in which to return a signed election to the Plan Administrator
indicating the choice to continue benefits under this Plan.
(d)
6.6
18
6.7
6.8
6.9
6.10
6.11
Duration of Continuation Coverage. Unless otherwise tenninated pursuant to
Section 6.9, Continuation C overage shall extend until the last day 0 fthe Plan Year in
which the Qualifying Event occurred.
Birth or Adoption of a Child. If a child is born to or placed for adoption with a fonner
Participant during a period of Continuation Coverage and such child is a Dependent, then
such child shall be treated as a Qualified Beneficiary eligible to elect Continuation
Coverage for the remainder of the Continuation Coverage period to which that child
would have been entitled had the child been a Dependent child at the time of the
Qualifying Event.
Automatic Tennination of Continuation Coverage.
automatically cease if:
Continuation Coverage shall
The Employer no longer offers group health coverage to any of its Employees;
The Required Monthly Premium, as defined under Section 6.10, for Continuation
Coverage is not timely paid within the period prescribed under Section 6.10;
An electing Qualified Beneficiary becomes covered under another group health
plan after making that election; or
An electing Qualified Beneficiary becomes eligible to receive benefits under
Medicare after making that election.
Required Monthly Premium. To obtain Continuation Coverage, a Qualified Beneficiary
must pay the Required Monthly Premium to the Plan Administrator. The amount of the
Required Monthly Premium shall be determined by the Plan Administrator based upon
the amount the Participant elected to contribute to the Health Reimbursement Account for
the Plan Year and as provided in 42 US.CA. section 300bb-4. The Required Monthly
Premium is due as of the first day of each calendar month during which coverage is
continued under this Article VI. A Required Monthly Premium payment shall be
considered timely if it is made within 30 days after the date such payment is due.
The initial Required Monthly Premium for Continuation Coverage shall be considered
timely if paid by the later of the date which is 45 days after the date the Qualified
Beneficiary tìmely elects Continuation Coverage pursuant to Section 6.6 or which is 30
days after the first day of the first calendar month of Continuation Coverage. If the initial
Required Monthly Premium is timely, as described in the preceding sentence, but is paid
more than 30 days after the due date of a Required Monthly Premium for a month of
Continuation Coverage, the initial Required Monthly Premium shall include the Required
Monthly Premium for that month.
Continuation Coverage for Employees in the Unifonned Services. For purposes of this
Article V I, a Participant absent from work for more than 3 1 days in 0 rder to fulfill a
period of duty in the Unifonned Services has a Qualifying Event as of the first day of the
Participant's absence for such duty. Such individual shall be treated as any other
Qualified Beneficiary for all purposes of COBRA and this Article VI. The Plan
Administrator shall furnish the Participant a notice of the right to elect Continuation
Coverage as provided in this Article VI and the Plan Administrator shall afford the
Participant the opportunity to elect such Continuation Coverage. The maximum period
(a)
(b)
(c)
(d)
19
of coverage available to the Participant and the Participant's Spouse and Dependent
child(ren) under this Section 6.11, however, shall be the Jesser of:
(a) The period ending on the last day of the Plan Year during which the Participant's
absence began; or
The period beginning on the date of the Participant's absence and ending the day
after the date on which the Participant fails to apply for or return to active
employment with the Employer.
Continuation Coverage provided pursuant to this Section 6.11 shall tenninate as
described inS ection 6.9 (i.e., before the end 0 f t he maximum period described in the
preceding sentence) if an event described in Section 6.9 occurs.
(b)
20
7.2
7.3
Allocation 0 f A uthoritv, Except as tot hose functions reserved within the Plan tot he
Employer, the Plan Administrator shall control and manage the operation and
Administration of the Plan. The Plan Administrator shall have the exclusive right to
interpret the Plan and to decide all matters arising thereunder, including the right to
remedy possible ambiguities, inconsistencies, or omissions. All detenninations of the
Plan Administrator or the Employer 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 such reasonable infonnation as the Plan
Administrator may request for the purpose of the proper administration of the
Plan as a condition to receiving any benefits under the Plan;
To make and enforce such rules and regulations and prescribe the use of such
fonus as the Plan Administrator shall deem necessary for the efficient
administration of the Plan;
To decide any question concerning the Plan and/or the eligibility of any Employee
to participate in the Plan;
To detennine the amount of benefits which shall be payable to any person; to
infonn the Employer, as appropriate, of the amount of such benefits; and to
provide a full and fair review to any Participant whose claim for benefits has been
denied in whole or in part; and
To designate other persons to catTy out any duty or power which would otherwise
be a responsibility of the Plan Administrator, under the tenns ofthe Plan.
Provision for Third-Party Plan Service Providers. The Plan Administrator may employ
the services of such persons as it may deem necessary or desirable in connection with the
operation of the Plan. The Plan Administrator, the Employer (and any person to whom it
may delegate any duty or power in connection with the administration of the Plan), and
all persons connected therewith may rely upon all tables, valuations, certificates, reports
and opinions furnished by any duly appointed actuary, accountant, (including employees
who are actuaries or accountants), consultant, third-party administrative service provider,
legal counsel (including employees who are attorneys), or other specialist, and they shall
be fully protected in respect to any action taken or pennitted in good faith in reliance
thereon. All actions so taken or pennitted shall be conclusive and binding as to all
persons.
7.1
(b)
(c)
(d)
(e)
ARTICLE VII
PLAN ADMINISTRATION
Limitation of Liability. No officer or Employee of the Employer shaH incur any personal
liability for any act done or omitted to be done in good faith in connection with duties
imposed in connection with the Plan. Each officer and Employee shall be indemnified
and saved hanDless by the Employer from and against any liability to which any such
officer or Employee may be subjected by reason of any good faith act or omission
perfonned in their 0 fficial 0 r fiduciary capacity with respect tot he Plan, i neluding a 11
expenses reasonably incuaed in their defense to the extent pennitted by law.
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7.4
7.5
7.6
7.7
Compensation of the Plan Administrator. The Plan Administrator shall serve without
compensation for services rendered in such capacity, but all reasonable expenses incurred
in the performance of the Plan Administrator's duties shall be paid by the Plan unless
paid by the Employer.
Bonding. Unless required by applicable federal or state law, the Plan Administrator shall
not be required to give any bond or other security in any jurisdiction in connection with
the administration of this Plan.
Payment of Administrative Expenses. All reasonable expenses incurred in administering
the Plan, including but not limited to administrative fees and expenses owing to any third
party administrative service provider, actuary, consultant, accountant, attorney, specialist,
or other person or organization that may be employed by the Plan Administrator in
connection with the administration thereof, shall be paid by the Employer.
Disbursement Reports. T he P Ian A dministrator shall issue directions to the Employer
concerning all benefits that are to be paid from the Employer's general assets pursuant to
the provisions of the Plan.
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8.1
8.2
8.3
8.4 .
ARTICLE VIII
CLAIMS PROCEDURE
Procedure if Benefits are Denied Under the Plan. Any Participant, Spouse or Dependent,
or such individual's duly authorized representative may file a claim for a Plan benefit to
which the claimant is entitled. Such a claim must be made in writing as described in
Article IV and Article V and delivered to the Plan Administrator, in person or by mail,
postage paid. Within 90 days after receipt of such claim, the Plan Administrator shall
send to the claimant, by mail, postage prepaid, notice ofthe granting or denying, in whole
or in part, of such claim, unless special circumstances require an extension of time for
processing the claim. In no event may the extension exceed 90 days from the end of the
initial period. If such extension is necessary, the claimant will be given a written notice
to this effect prior to the expiration of the initial 90-day period. The Plan Administrator
shall have full discretion to deny or grant a claim in whole or in part. If notice of the
denial and of claim is not furnished in accordance with this Section 8.1, the claim shaH be
deemed denied and the claimant shall be pennitted to exercise his right to review
pursuant to Sections 8.3 and 8.4.
Requirement for Written Notice of Claim Denial. The Plan Administrator shall provide,
to every claimant who is denied a claim for benefits, written notice setting forth in a
manner designed to be understood by the claimant:
(a) The specific reason or reasons for the denial;
(b) Specific reference to pertinent Plan provisions on which the denial is based;
(c) A description of any additional material or infonnation necessary for the claimant
to perfect the claim and an explanation of why such material is necessary; and
(d) An explanation of the Plan's claim review procedure.
Right to ReQuest Hearing on Benefit Denial. Within 60 days after the receipt by the
claimant of written notification of the denial (in whole or in part) of the claim, the
claimant, or the claimant's duly authorized representative, upon written application to the
Plan Administrator, in person or by certified mail, postage prepaid, may request a review
of such denial, may review pertinent documents, and may submit issues and comments in
writing.
Disposition of Disputed Claims. Upon its receipt of notice of a request for review, the
Plan Administrator shall make a prompt decision on the review. The decision on review
shall be written in a manner calculated to be understood by the claimant and shall include
specific reasons for the decision and specific references to the pertinent Plan provisions
on which the decision is based. The decision on review shall be made not later than 60
days after the Plan Administrator's receipt of a request for a review, unless special
circumstances require an extension of time for processing, in which case a decision shall
be rendered not later than 120 days after receipt of a request for review. If an extension
is necessary, the claimant shall be given written notice fort the extension prior to the
expiration of the initial 60-day period. After exhaustion of the claims procedures
provided under this Plan, nothing shall prevent any person from pursuing any other legal
or equitable remedy otherwise available.
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9.1
9.2
9.3
ARTICLE IX
MIENDMENT OR TERl\lINA TION OF PLAN
Permanency. While the Employer fully expects that this Plan will continue indefinitely,
permanency of the Plan will be subject to the Employer's right to amend or tenninate the
Plan, as provided in Sections 9.2 and 9.3 below.
Employer's Right to Amend. The Employer reserves the right at any time or times to
amend the provisions of the Plan to any extent and in any manner that it may deem
advisable.
Employer's Right to Terminate. The Employer reserves the right to discontinue or
terminate the Plan at any time without liability. Notwithstanding any other provision of
the Plan, the Employer, upon termination of the Plan, shall only be obligated to reimburse
a Participant for Eligible Medical or Dental Expenses incurred and properly submitted
pursuant to Article IV or for Dependent Care Expenses incurred and properly submitted
pursuant to Article V prior to the date of termination (which would otherwise be
reimbursed pursuant to the terms of this Plan).
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10.1
10.2
10.3
10.4
10.5
10.6
10.7
ARTICLE X
GENERAL PROVISIONS
No EmploYment Rights Conferred. Neither this Plan nor any action taken with respect to
it shall confer upon any person the right to be continued in the employment of the
Employer.
Payments Upon Death of Participant. Notwithstanding Article VI, in the event of the
death of a Participant, the Participant's Spouse and/or estate may, pursuant to
Sections 4.4 and 5.3, request the reimbursement of any Eligible Medical or Dental
Expenses or Dependent Care Expenses incUlTed prior to the date of the Participant's
death. Any benefits payable to a Participant following the date of death of such
Participant shall be paid to the Participant's Spouse, or, ifthere is no surviving Spouse, to
the Participant's estate. To the extent any amounts remain in a deceased Participant's
account, those amounts will be forfeited in accordance with Section 3.10.
Nonalienation of Benefits. No benefit under the Plan shall be subject in any manner to
anticipation, alienation, s ale, transfer, assignment, pledge, encumbrance 0 r 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.
If any person entitled to benefits under the Plan becomes bankrupt or attempts to
anticipate, alienate, sell, transfer, assign, pledge, encumber or charge any benefit under
the Plan, or if any attempt is made to subject any such benefit to the debt, contracts,
liabilities, engagements or torts of the person entitled to any such benefit, except as
specifically provided in the Plan, then such benefit shall be forfeited. Alternatively, the
Plan Administrator, in its sole direction, may hold or apply the same or any part thereof
for the benefit of any Spouse, Dependent or beneficiary of such person, in such manner
and proportion, as the Plan Administrator may deem proper.
Mental or Physical Incompetence. If the Plan Administrator detelTIlines that any person
entitled to payments under the Plan is incompetent by reason of physical or mental
disability, the Plan Administrator may cause all payments thereafter becoming due to
such person to be made to any other person for his or her benefit, without responsibility
to follow the application of amounts so paido Payments made pursuant to this Section
10.4 shall completely discharge the Plan Administrator and the Employer.
Benefits. All contributions made pursuant to the Plan and all benefits of the Plan shall
inure to the exclusive benefit ofthe Participants and their beneficiaries.
Benefits Solely From General Assets. The benefits provided hereunder will be paid
solely from the general assets of the Employer. Nothing herein will be construed to
require the Employer to maintain any fund or segregate any amount for the benefit of any
Participant, Participant's Spouse or Participant's Dependent and no Participant or other
person shall have any claim against, right to or security or other interest in any specific
fund, account or asset of the Employer from which any payment under the Plan may be
made. Any claim of a Participant or any other person to benefits under this Plan shall be
the claim of an unsecured creditor of the Employer.
Tax Effects. Neither the Employer nor the Plan Administrator makes any warranty or
other representation as to whether or not any payments received by a Participant
25
hereunder will be treated as includible in gross income for federal or state income tax
purposes.
Multiple Function. Any person or group of persons may serve in more than one fiduciary
capacity with respect to the Plan.
Gender and Number, Masculine pronouns include the feminine, feminine pronouns
include the masculine, and the singular shall include the plural unless the context
indicates otherwise.
10.10 Headings. The Article and Section headings contained herein are for convenience of
reference 0 nly and shall not be construed as d efming 0 r 1 imiting the matter contained
thereunder.
10.8
10.9
10.11 Applicable Laws. The provisions of the Plan shall be construed, administered and
enforced according to applicable federal law and the applicable laws of the State of
Illinois.
10.12 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.
10.13 Premium Program Control Clause. A Premium Program may be either self-funded by the
Employer or insured. In the event of a conflict between the Premium Program's plan
document or insurance contract and this Plan, the tenns of the Premium Program's plan
document or insurance contract shall control as to those participants receiving coverage
under such Premium Program. For this purpose, the Premium Prograrn's plan document
or insurance contract shall control in defining the persons eligible for coverage under the
Premium Program, the dates of their eligibility, the conditions that must be satisfied to
become covered under the Premium Program, if any, the benefits Participants are entitled
to and the circumstances under which coverage terminates.
The VILLAGE OF MOUNT PROSPECT has caused this instrument to be executed by its duly
authorized officer this - day of , 2004.
VILLAGE OF MOUNT PROSPECT
By
26
APPENDIX A
Premium Programs
1.
Village of Mount Prospect Group Health Plan
2.
Village of Mount Prospect Group - Tenn Life Insurance Plan
VILLAGE OF MT. PROSPECT FLEX COMPo PLAN-RESTATED 1_1_04
27