HomeMy WebLinkAbout20010310 RESOLUTION
RE: APPROVE WELD COUNTY GOVERNMENT EMPLOYEES' CAFETERIA PLAN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with the Weld County Government
Employees' Cafeteria Plan for the County of Weld, State of Colorado, by and through the Board
of County Commissioners of Weld County, on behalf of the Personnel Department, with terms
and conditions being as stated in said plan, and
WHEREAS, after review, the Board deems it advisable to approve said plan, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Weld County Government Employees' Cafeteria Plan for the
County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the Personnel Department be, and hereby is, approved.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 31st day of January, A.D., 2001.
BOARD OF NTY COMMISSIONERS
WELD CO , COLORADO
ATTEST: wa� QO / ,, �� I_
7reslc� i -' ,• , �� . eile •
., , h
Weld County Clerk to th� ��: � � c1/42.'BY: r r , Glenn Vaad, ro-Tem
Deputy Clerk to the Bo L
m H. Jerke �
APPR ED A O FORM: Ct
avi E. Long
ounty Attorney S
Robert D. Masden
2001-0310
PE0019
WELD COUNTY GOVERNMENT
EMPLOYEES' CAFETERIA PLAN
SUMMARY PLAN DESCRIPTION
TABLE OF CONTENTS
ELIGIBILITY
1. When Can I Become a Participant in the Plan? 1
2. What Are the Eligibility Requirements for Our Plan? 1
3. When Is My Entry Date? 1
4. What Must I Do to Enroll in the Plan? 1
II
OPERATION
1. How Does This Plan Operate? 2
III
CONTRIBUTIONS
1. How Much of My Pay May the Employer Redirect? 2
2. How is My Compensation Measured Under Our Plan? 2
3. What Happens to Contributions Made to the Plan? 2
4. When Must I Decide Which Accounts I Want to Use? 2
5. When Is the "Election Period" for Our Plan? 3
6. May I Change My Elections During the Plan Year? 3
7. May I Make New Elections in Future Plan Years? 4
IV
BENEFITS
1. What Benefits Are Available? 4
V
BENEFIT PAYMENTS
1. When Will I Receive Payments From My Accounts? 6
2. What Happens If I Don't Spend All Plan Contributions? 6
3. Family and Medical Leave Act (FMLA) 7
4. Uniformed Services Employment and Reemployment Rights Act (USERRA) 7
5. What Happens If I Terminate Employment? 7
6. Will My Social Security Benefits Be Affected? 9
VI
HIGHLY COMPENSATED AND KEY EMPLOYEES
1. Do Limitations Apply to Highly Compensated Employees? 9
VII
PLAN ACCOUNTING
1. Periodic Statements 9
VIII
GENERAL INFORMATION ABOUT OUR PLAN
1. General Plan Information 10
2. Employer Information 10
3. Plan Administrator Information 10
4. Service of Legal Process 10
5. Type of Administration 10
Ix
ADDITIONAL PLAN INFORMATION
1. Your Rights Under ERISA 11
2. Claims Process 12
X
SUMMARY
iii
WELD COUNTY GOVERNMENT EMPLOYEES' CAFETERIA PLAN
INTRODUCTION
We have amended the "flexible benefits plan" that we previously established for you and other
eligible employees. Under this program, you will be able to choose among certain benefits that we
make available. The benefits that you may choose are outlined in this summary plan description.
We will also tell you about other important information concerning the amended Plan, such as the
rules you must satisfy before you can join and the laws that protect your rights.
One of the most important features of our Plan is that the benefits being offered are generally ones
that you are already paying for, but normally with money that has first been subject to income and
Social Security taxes. Under our Plan, these same expenses will be paid for with a portion of your
pay before Federal income or Social Security taxes are withheld. This means that you will pay less
tax and have more money to spend and save.
Read this summary plan description carefully so that you understand the provisions of our
amended Plan and the benefits you will receive. You should direct any questions you have to
Personnel Services. There is a plan document on file which you may review if you desire. In the
event there is a conflict between this summary plan description and the plan document, the Plan
will control. Also, if there is a conflict between an insurance contract and either the plan document
or this summary plan description, the insurance contract will control.
ELIGIBILITY
1. When Can I Become a Participant in the Plan?
Before you become a member or a "Participant" in the Plan, there are certain rules which
you must satisfy. First, you must meet the "eligibility requirements." After that, the next
step is to actually join the Plan on the "entry date" that we have established for all
employees. You will also be required to complete certain application forms before you can
enroll in the Health Care Reimbursement Plan or Dependent Care Assistance Account.
2. What Are the Eligibility Requirements for Our Plan?
You will be eligible to join the Plan once you have completed one month of employment.
Of course, if you were already a participant before this amendment, you will remain a
participant. All full-time and part-time employees are eligible.
3. When Is My Entry Date?
Once you have met the eligibility requirements, your entry date will be the first day of the
month coinciding with or following the date you met the eligibility requirements.
4. What Must I Do to Enroll in the Plan?
Before you can join the Plan, you must complete an application to participate in the Plan.
The application includes your personal choices for each of the benefits which are being
offered under the Plan. You must also authorize us to set some of your earnings aside in
order to pay for the benefits you have elected.
1
However, if you are already covered under any of the insured benefits, you will
automatically participate in this Plan to the extent of your premiums unless during the
"election period" you elect not to participate in this Plan.
II
OPERATION
1. How Does This Plan Operate?
Before the start of each Plan Year,you will be able to elect to have some of your upcoming
pay contributed to the Plan. These amounts will be placed in special funds or accounts
which must be set up for you in order to pay for the benefits you have chosen. The portion
of your pay that is paid to the Plan is not subject to Federal income or Social Security taxes.
In other words,this allows you to use tax-free dollars to pay for certain kinds of benefits and
expenses which you normally pay for with out-of-pocket, taxable dollars. However, if you
receive a reimbursement for an expense under the Plan, you cannot claim a Federal
income tax credit or deduction on your return.
III
CONTRIBUTIONS
1. How Much of My Pay May the Employer Redirect?
Each year,for the insured benefits provided under this Plan we will automatically contribute
on your behalf enough of your compensation to pay for the insurance coverage provided.
In addition, you may elect to pay for the benefits that you elect under the Plan. These
amounts will be deducted from your pay over the course of the year.
2. How is My Compensation Measured Under Our Plan?
Compensation under our Plan means the total cash amount that is paid to you each year.
3. What Happens to Contributions Made to the Plan?
Before each Plan year begins, you will select the non-insured benefits you want and how
much of the contributions should go toward each benefit. It is very important that you make
these choices carefully based on what you expect to spend on each covered benefit or
expense during the Plan Year. Later, they will be used to pay for the expenses as they
arise during the Plan Year.
4. When Must I Decide Which Accounts I Want to Use?
You are required by Federal law to decide before the Plan Year begins,during the"election
period." You must decide two things. First, which benefits you want and, second, how
much should go toward each benefit.
If you are already covered by any of the insured benefits offered by this Plan, you will
automatically become a Participant to the extent of the premiums for such insurance unless
you elect, during the "election period," not to participate in the Plan.
2
5. When Is the "Election Period" for Our Plan?
Your election period will start on the date you first meet the "eligibility requirements" and
end 30 days after your "entry date." (You should review Section I on Eligibility to better
understand the terms"eligibility requirements" and "entry date.") Then, for each following
Plan Year, the election period is established by Personnel Services and applied uniformly
to all Participants. It will normally be a period of time prior to the beginning of each Plan
Year. Personnel Services will inform you each year about the election period. (See the
Article entitled "General Information About Our Plan" for the definition of Plan Year.)
6. May I Change My Elections During the Plan Year?
Generally, you cannot change the elections you have made after the beginning of the Plan
Year. However, there are certain limited situations when you can change your elections.
You are permitted to change elections if you have a "change in status" and you make an
election change that is consistent with the "change in status." Currently, Federal law
considers the following events to be "changes in status":
Marriage, divorce, death of a spouse, legal separation or annulment;
Change in the number of dependents, including birth, adoption, placement for adoption, or
death of a dependent;
Any of the following events for you, your spouse or dependent: termination or
commencement of employment, a strike or lockout, commencement or return from an
unpaid leave of absence, a change in work site, or any other change in employment status
that affects eligibility for benefits;
One of your dependents satisfies or ceases to satisfy the requirements for coverage due
to change in age, student status, or any similar circumstance; and
A change in the place of residence of you, your spouse or dependent.
In addition, if you are participating in the Dependent Care Assistance Program, then there
is a "change in status" if your dependent no longer meets the qualifications to be eligible
for dependent care.
There are detailed rules on when a change in election is deemed to be consistent with a
"change in status." In addition, there are laws that give you rights to change accident and
health coverage for you, your spouse, or your dependents. If you change coverage due to
rights you have under the law,then you can make a corresponding change in your elections
under the Plan. If any of these conditions apply to you, you should contact Personnel.
If the cost of a benefit provided under the Plan increases or decreases during a Plan Year,
then we will automatically increase or decrease,as the case may be,your salary redirection
election. If the cost increases significantly, you will be permitted to either make
corresponding changes in your payments or revoke your election and obtain coverage
under another benefit package option with similar coverage.
3
If the coverage under a Benefit is significantly curtailed or ceases during a Plan Year, then
you may revoke your elections and elect to receive on a prospective basis coverage under
another plan with similar coverage. In addition, if we add a new coverage option or
eliminate an existing option, you may elect the newly-added option (or elect another option
if an option has been eliminated) and make corresponding election changes to other
options providing similar coverage. There are also certain situations when you may be able
to change your elections on account of a change under the plan of your spouse's, former
spouse's or dependent's employer.
These rules on change due to cost or coverage do not apply to the Health Care
Reimbursement Plan, and you may not change your election to the Health Care
Reimbursement Plan if you make a change due to cost or coverage for insurance.
You may not change your election under the Dependent Care Assistance Program if the
cost change is imposed by a dependent care provider who is your relative.
7. May I Make New Elections in Future Plan Years?
Yes, you may. For each new Plan Year, you may change the elections that you previously
made. You may also choose not to participate in the Plan for the upcoming Plan Year. If
you do not make new elections during the"election period" before a new Plan Year begins,
you will not be considered a Participant for the non-insured benefit options under the Plan
for the upcoming Plan Year.
IV
BENEFITS
1. What Benefits Are Available?
Under our Plan,you can choose to receive your entire compensation or use a portion to pay
for the following benefits or expenses during the year:
(a) Health Care Reimbursement Plan:
The Health Care Reimbursement Plan enables you to pay for expenses which are
not covered by our insured medical plan and save taxes at the same time. The
account allows you to be reimbursed by the Employer for out-of-pocket medical,
dental and vision expenses incurred by you and your dependents. The expenses
which qualify are those permitted by Section 213 of the Internal Revenue Code. A
list of covered expenses is available from Personnel Services. You may not,
however, be reimbursed for the cost of other health care coverage maintained
outside of the Plan, or for long-term care expenses.
In order to be reimbursed for a health care expense,you must submit to Personnel
Services an itemized bill from the service provider. Amounts reimbursed from the
Plan may not be claimed as a deduction on your personal income tax return.
Reimbursement from the fund shall be paid at least once a month.
4
(b) Dependent Care Assistance Account:
The Dependent Care Assistance Account enables you to pay for out-of-pocket,
work-related dependent day-care cost with pre-tax dollars. If you are married, you
can use the account if you and your spouse both work or, in some situations, if your
spouse goes to school full-time. Single employees can also use the account.
An eligible dependent is any member of your household for whom you can claim
expenses on Federal Income Tax Form 2441 "Credit for Child and Dependent Care
Expenses." Children must be under age 13. Other dependents must be physically
or mentally unable to care for themselves. Dependent Care arrangements which
qualify include:
- - A Dependent (Day) Care Center, provided that if care is provided by the
facility for more than six individuals, the facility complies with applicable
state and local laws.
- - An Educational Institution for pre-school children. For older children, only
expenses for non-school care are eligible.
- - An "Individual" who provides care inside or outside your home. The
"Individual" may not be a child of yours under age 19 or anyone you claim
as a dependent for Federal tax purposes.
You should make sure that the dependent care expenses you are currently paying
for qualify under our Plan. The law places limits on the amount of money that can
be paid to you in a calendar year from your Dependent Care Assistance Account.
Generally,your reimbursements may not exceed the lesser of: (a)$5,000(if you are
married filing a joint return or you are head of a household) or $2,500 (if you are
married filing separate returns); (b)your taxable compensation;or(c)your spouse's
actual or deemed earned income (a spouse who is a full time student or incapable
of caring for himself/herself has a monthly earned income of $200 for one
dependent or $400 for two or more dependents). Also, in order to have the
reimbursements made to you from this account excluded from your income, you
must provide a statement from the service provider including the name, address,
and in most cases, the taxpayer identification number of the service provider on
your tax form for the year, as well as the amount of such expense as proof that the
expense has been incurred. In addition, Federal tax laws permit a tax credit for
certain dependent care expenses you may be paying for even if you are not a
Participant in this Plan. You may save more money if you take advantage of this
tax credit rather than using the Dependent Care Assistance Account under our Plan.
Ask your tax adviser which is better for you.
(c) Premium Expense Account:
A Premium Expense Account allows you to use tax-free dollars to pay for certain
premium expenses under various insurance programs that we offer you. These
premium expenses include:
- - Health care premiums under our insured group medical plan.
5
- - Group term life insurance premiums.
- - Dental and Vision insurance premiums.
Under our Plan, we will establish sub-accounts for you for each different type of
insurance coverage that is available. Also, certain limits on the amount of coverage
may apply.
Personnel Services may terminate or modify Plan benefits at any time, subject to
the provisions of any insurance contracts providing benefits described above. We
will not be liable to you if an insurance company fails to provide any of the benefits
described above. Also, your insurance will end when you leave employment, are
no longer eligible under the terms of any insurance policies, or when insurance
terminates.
Any benefits to be provided by insurance will be provided only after (1) you have
provided Personnel Services the necessary information to apply for insurance, and
(2) the insurance is in effect for you.
V
BENEFIT PAYMENTS
1. When Will I Receive Payments From My Accounts?
During the course of the Plan Year, you may submit requests for reimbursement of
expenses you have incurred. Expenses are considered "incurred" when the service is
performed, not necessarily when it is paid for. Personnel Services will provide you with
acceptable forms for submitting these requests for reimbursement. If the request qualifies
as a benefit or expense that the Plan has agreed to pay, you will receive a reimbursement
payment soon thereafter. Remember, these reimbursements which are made from the
Plan are generally not subject to Federal Income Tax or withholding. Nor are they subject
to Social Security taxes. Requests for payment of insured benefits should be made directly
to the insurer. You will only be reimbursed from the Dependent Care Assistance Account
to the extent that there are sufficient funds in the Account to cover your request.
2. What Happens If I Don't Spend All Plan Contributions?
Any monies left at the end of the Plan Year will be forfeited. Obviously, qualifying expenses
that you incur late in the Plan Year for which you seek reimbursement after the end of such
Plan Year will be paid first before any amount is forfeited. However, you must make your
requests for reimbursement no later than 45 days after the end of the Plan Year. Because
it is possible that you might forfeit amounts in the Plan if you do not fully use the
contributions that have been made, it is important that you decide how much to place in
each account carefully and conservatively. Remember,you must decide which benefits you
want to contribute to and how much to place in each account before the Plan Year begins.
You want to be as certain as you can that the amount you decide to place in each account
will be used up entirely.
6
3. Family and Medical Leave Act (FMLA)
If you take leave under the Family and Medical Leave Act, you may revoke or change your
existing elections for health insurance, group-term life insurance and the Health Care
Reimbursement Plan. If your coverage in these benefits terminates,due to your revocation
of the benefit while on leave or due to your non-payment of contributions, you will be
permitted to reinstate coverage for the remaining part of the Plan Year upon your return.
However, for the Health Care Reimbursement Plan, the expenses you incur during that
lapse in coverage are not reimbursable and your maximum amount will be reduced
proportionately for the time that you were gone. For example, if you elect $1,200 for the
year and are out on leave for 3 months, your amount will be reduced to $900.
If you continue your coverage during your unpaid leave,you may pre-pay for the coverage,
you may pay for your coverage on an after-tax basis while you are on leave, or you and
your Employer may arrange a schedule for you to "catch up" your payments when you
return.
4. Uniformed Services Employment and Reemployment Rights Act (USERRA)
If you are going into or returning from military service,you may have special rights to health
care coverage under your Health Care Reimbursement Plan under the Uniformed Services
Employment and Re-employment Rights Act of 1994. These rights can include extended
health care coverage. If you may be affected by this law, ask Personnel Services for further
details.
5. What Happens If I Terminate Employment?
If you leave our employ during the Plan Year,your right to benefits will be determined in the
following manner:
- - You will remain covered by insurance, but only for the period for which premiums
have been paid prior to your termination of employment.
- - You will still be able to request reimbursement for qualifying dependent care
expenses for the remainder of the Plan Year from the balance remaining in your
dependent care account at the time of termination of employment. However, no
further salary redirection contributions will be made on your behalf after you
terminate.
- - Participation in the Health Care Reimbursement Plan will cease and no further
salary redirection contributions will be contributed on your behalf. You will be able
to submit claims for health care expenses incurred prior to your date of termination,
if you have a remaining balance in your account.
Under Federal law, if you, your spouse, and/or your covered dependents lose coverage
under this Plan, then you, your spouse, and/or your covered dependents may be entitled
to continuation of health care coverage. Personnel Services will inform you of these rights
if you lose coverage for any reason other than divorce, legal separation or a covered
dependent ceasing to be a dependent. Generally, if we (and any related companies)
employed twenty (20) or more employees "on a typical business day" in the preceding
calendar year, health plan continuation must be made available for a period not to exceed
7
eighteen (18) months if a loss of benefits occurs because of your termination of
employment or reduction of hours, or for a period not to exceed three (3) years for any of
the other reasons given in (b) and (c) below. Under certain circumstances, persons who
are disabled at the time of termination of employment or reduction in hours and/or within
the first 60 days of COBRA coverage may be eligible for continuation of coverage for a total
of 29 months (rather than 18). You should check with Personnel Services for more details
regarding this extended coverage. However, in certain circumstances, this continuation
coverage may be terminated for reasons such as failure to pay continuation coverage cost,
coverage under another employer's plan (whether as an employee or otherwise, provided
the other employer's health plan does not contain any exclusion or limitation with respect
to any pre-existing condition of the beneficiary unless the pre-existing condition limit does
not apply to, or is satisfied by, the qualified beneficiary by reason of the group health plan
portability, access and renewability requirements of the Health Insurance Portability and
Accountability Act, ERISA or the Public Health Services Act),termination of our health plan,
a "for cause" termination of coverage for reasons such as fraud, or you (or the person
entitled to continued coverage) become enrolled in Medicare. However, if you become
enrolled in Medicare, your covered dependents may still qualify for continuation coverage.
The cost of continuation coverage must be paid by the individual choosing such coverage;
however, the cost may not exceed 102% of the cost of the same coverage for a "similarly
situated" employee or family member. When the continuation coverage for a disabled
person is extended from 18 months to 29 months, the disabled person may be charged
150% (rather than 102%)of the cost of the coverage after expiration of the initial 18-month
period.
(a) If you would otherwise lose your health plan coverage under this Plan because of
a termination of employment you may continue the health plan coverage provided
under this Plan. However, this will not be a tax-deductible expense to you, absent
unusual circumstances.
(b) Your spouse may choose continuation coverage for himself or herself if he or she
loses group health coverage for any of the following reasons: (1) your death; (2)
your divorce or legal separation; or (3) you become enrolled in Medicare.
(c) Your dependent children, including a child born to or placed for adoption with the
Participant during the period of COBRA coverage, may choose continuation
coverage for themselves if they lose group health coverage for any of the following
reasons: (1)death of a parent; (2)your divorce or legal separation; (3)you become
enrolled in Medicare; or (4) your dependent ceases to be a dependent child under
the Plan.
It is your responsibility to notify Personnel Services of a divorce, legal separation or other
change in marital status, change in a spouse's address, or a child losing dependent status
under the plan, within sixty (60) days of the event. It is our responsibility to notify the Plan
Administrator of your death, termination of employment or reduction in hours, the
Employer's bankruptcy, or Medicare eligibility.
You can elect to continue your participation in the Health Care Reimbursement Plan for the
remainder of the Plan Year, subject to the following conditions. You may only continue to
participate in the Health Care Reimbursement Plan if you have contributed more money
than you have taken out in claims. For example, if you elected to contribute an annual
amount of$500 and, at the time you terminate employment,you have contributed$300 but
8
only claimed $150, you may elect to continue coverage under the Health Care
Reimbursement Plan. If you elect to continue coverage,then you would be able to continue
to receive your health care reimbursements up to the $500. However, you must continue
to pay for the coverage,just as the money has been taken out of your paycheck, but on an
after-tax basis. The Plan can also charge you an extra amount to provide this benefit.
When you terminate employment Personnel Services will provide you with a notice
regarding your right to continue coverage.
6. Will My Social Security Benefits Be Affected?
Your Social Security benefits may be slightly reduced because when you receive tax-free
benefits under our Plan, it reduces the amount of contributions that you make to the Federal
Social Security system as well as our contribution to Social Security on your behalf.
VI
HIGHLY COMPENSATED AND KEY EMPLOYEES
1. Do Limitations Apply to Highly Compensated Employees?
Under the Internal Revenue Code, "highly compensated employees"and "key employees"
generally are Participants who are officers,shareholders or highly paid. You will be notified
by Personnel Services each Plan Year whether you are a "highly compensated employee"
or a "key employee." If you are within these categories, the amount of contributions and
benefits for you may be limited so that the Plan as a whole does not unfairly favor those
who are highly paid, their spouses or their dependents. Federal tax laws state that a plan
will be considered to unfairly favor the key employees if they as a group receive more than
25% of all of the nontaxable benefits provided for under our Plan.
Plan experience will dictate whether contribution limitations on "highly compensated
employees"or"key employees"will apply. You will be notified of these limitations if you are
affected.
VII
PLAN ACCOUNTING
1. Periodic Statements
Accounting will provide you with a statement of your account periodically during the Plan
Year that shows your account balance. It is important to read these statements carefully so
you understand the balance remaining to pay for a benefit. Remember, you want to spend
all the money you have designated for a particular benefit by the end of the Plan Year.
9
VIII
GENERAL INFORMATION ABOUT OUR PLAN
This Section contains certain general information which you may need to know about the Plan.
1. General Plan Information
Weld County Government Employees' Cafeteria Plan is the name of the Plan.
Your Employer has assigned Plan Number 501 to your Plan.
The provisions of your amended Plan become effective on February 1, 2001. Your Plan
was originally effective on January 1, 1987.
Your Plan's records are maintained on a twelve-month period of time. This is known as the
Plan Year. The Plan Year begins on January 1 and ends on December 31.
2. Employer Information
Your Employer's name, address, and identification number are:
Weld County
915 10th Street
Greeley, Colorado 80631
84-8000613
3. Plan Administrator Information
The name, address and business telephone number of your Plan's Administrator are:
Weld County
915 10th Street
Greeley, Colorado 80631
(970) 356-4000, Ext. 4231
Personnel Services keeps the records for the Plan and is responsible for the administration
of the Plan. Personnel Services will also answer any questions you may have about our
Plan. You may contact Personnel Services for any further information about the Plan.
4. Service of Legal Process
The name and address of the Plan's agent for service of legal process are:
Weld County Board of County Commissioners
915 10th Street
Greeley, Colorado 80631
5. Type of Administration
The type of Administration is Employer Administration.
10
IX
ADDITIONAL PLAN INFORMATION
1. Your Rights Under ERISA
Plan Participants, eligible employees and all other employees of the Employer may be
entitled to certain rights and protections under the Employee Retirement Income Security
Act of 1974 (ERISA)and the Internal Revenue Code. These laws provide that Participants,
eligible employees and all other employees are entitled to:
(a) Examine,without charge,at the Personnel Services office, all Plan documents, and
copies of all documents filed by the Plan with the U.S. Department of Labor, such
as detailed annual reports and Plan descriptions; and
(b) Obtain copies of all Plan documents and other Plan information upon request to
Personnel Services. Personnel Services may charge a reasonable fee for the
copies.
In addition to creating rights for Plan Participants, ERISA imposes duties upon the people
who are responsible for the operation of an employee benefit plan. The people who
operate your Plan, called "fiduciaries"of the Plan, have a duty to do so prudently and in the
best interest of you and other Plan Participants.
No one, including your employer or any other person,may fire you or otherwise discriminate
against you in any way to prevent you from obtaining a benefit or exercising your rights
under ERISA.
If your claim for a benefit is denied in whole or in part, you must receive a written
explanation of the reason for the denial. You have the right to have your claim reviewed
and reconsidered.
Under ERISA there are steps you can take to enforce the above rights. For instance, if you
request materials from the Plan and do not receive them within thirty (30) days, you may
file suit in a Federal Court. In such a case, the Court may request Personnel Services to
provide the materials and pay you up to $110 a day until you receive the materials, unless
the materials were not sent because of reasons beyond the control of the Administrator.
If you have a claim for benefits which is denied or ignored, in whole or in part, you may file
suit in a state or Federal Court.
If it should happen that Plan fiduciaries misuse the Plan's money,or if you are discriminated
against for asserting your rights, you may seek assistance from the U.S. Department of
Labor, or you may file suit in a Federal court. The court will decide who should pay court
costs and legal fees. If you are successful, the court may order the person you have sued
to pay these costs and fees. If you lose, the court may order you to pay these costs and
fees; for example, if it finds your claim is frivolous.
11
2. Claims Process
You should submit reimbursement claims during the Plan Year, but in no event later than
45 days after the end of a Plan Year. Any claims submitted after that time will not be
considered. Claims for benefits that are insured will be reviewed in accordance with
procedures contained in the policies. All other general claims or requests should be
directed to Personnel Services of our Plan. If a non-insured claim under the Plan is denied
in whole or in part, you or your beneficiary will receive written notification. The notification
will include the reasons for the denial, with reference to the specific provisions of the Plan
on which the denial was based, a description of any additional information needed to
process the claim and an explanation of the claims review procedure. If we fail to respond
within 90 days, your claim is treated as denied. Within 60 days after denial, you or your
beneficiary may submit a written request for reconsideration of the application to the
Administrator.
Any such request should be accompanied by documents or records in support of your
appeal. You or your beneficiary may review pertinent documents and submit issues and
comments in writing. Personnel Services will review the claim and provide,within 60 days,
a written response to the appeal. (This period may be extended an additional 60 days
under certain circumstances.) In this response, Personnel Services will explain the reason
for the decision, with specific reference to the provisions of the Plan on which the decision
is based. Personnel Services has the exclusive right to interpret the appropriate plan
provisions. Decisions of Personnel Services are conclusive and binding.
X
SUMMARY
The money you earn is important to you and your family. You need it to pay your bills, enjoy
recreational activities and save for the future. Our flexible benefits plan will help you keep more
of the money you earn by lowering the amount of taxes you pay. The Plan is the result of our
continuing efforts to find ways to help you get the most for your earnings.
If you have any questions, please contact Personnel Services.
12
WELD COUNTY GOVERNMENT EMPLOYEES' CAFETERIA PLAN
TABLE OF CONTENTS
ARTICLE I
DEFINITIONS
ARTICLE II
PARTICIPATION
2.1 ELIGIBILITY 3
2.2 EFFECTIVE DATE OF PARTICIPATION 3
2.3 APPLICATION TO PARTICIPATE 3
2.4 TERMINATION OF PARTICIPATION 4
2.5 CHANGE OF EMPLOYMENT STATUS 4
2.6 TERMINATION OF EMPLOYMENT 4
2.7 DEATH 5
ARTICLE III
CONTRIBUTIONS TO THE PLAN
3.1 SALARY REDIRECTION 5
3.2 APPLICATION OF CONTRIBUTIONS 6
3.3 PERIODIC CONTRIBUTIONS 6
ARTICLE IV
BENEFITS
4.1 BENEFIT OPTIONS 6
4.2 HEALTH CARE REIMBURSEMENT PLAN BENEFIT 7
4.3 DEPENDENT CARE ASSISTANCE PROGRAM BENEFIT 7
4.4 HEALTH INSURANCE BENEFIT 7
4.5 DENTAL AND VISION INSURANCE BENEFIT 7
4.6 GROUP - TERM LIFE INSURANCE BENEFIT 7
4.7 NONDISCRIMINATION REQUIREMENTS 8
ARTICLE V
PARTICIPANT ELECTIONS
5.1 INITIAL ELECTIONS 8
5.2 SUBSEQUENT ANNUAL ELECTIONS 9
5.3 FAILURE TO ELECT 9
5.4 CHANGE OF ELECTIONS 9
ARTICLE VI
HEALTH CARE REIMBURSEMENT PLAN
6.1 ESTABLISHMENT OF PLAN 12
6.2 DEFINITIONS 12
6.3 FORFEITURES 13
6.4 NONDISCRIMINATION REQUIREMENTS 13
6.5 COORDINATION WITH CAFETERIA PLAN 14
6.6 HEALTH CARE REIMBURSEMENT PLAN CLAIMS 14
ARTICLE VII
DEPENDENT CARE ASSISTANCE PROGRAM
7.1 ESTABLISHMENT OF PROGRAM 15
7.2 DEFINITIONS 15
7.3 DEPENDENT CARE ASSISTANCE ACCOUNTS 16
7.4 INCREASES IN DEPENDENT CARE ASSISTANCE4 ACCOUNTS 16
7.5 DECREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS 17
7.6 ALLOWABLE DEPENDENT CARE ASSISTANCE REIMBURSEMENT 17
7.7 ANNUAL STATEMENT OF BENEFITS 17
7.8 FORFEITURES 17
7.9 LIMITATIONS ON PAYMENTS 17
7.10 NONDISCRIMINATION REQUIREMENTS 17
7.11 COORDINATION WITH CAFETERIA PLAN 18
7.12 DEPENDENT CARE ASSISTANCE PROGRAM CLAIMS 18
ARTICLE VIII
ERISA PROVISIONS
8.1 CLAIM FOR BENEFITS 19
8.2 APPLICATION OF BENEFIT PLAN SURPLUS 20
8.3 NAMED FIDUCIARY 21
8.4 GENERAL FIDUCIARY RESPONSIBILITIES 21
8.5 NON-ASIGNABILITY OF RIGHTS 21
ARTICLE IX
ADMINISTRATION
9.1 PLAN ADMINISTRATION 21
9.2 EXAMINATION OF RECORDS 22
9.3 PAYMENT OF EXPENSES 22
9.4 INSURANCE CONTROL CLAUSE 22
9.5 INDEMNIFICATION OF ADMINISTRATOR 22
ARTICLE X
AMENDMENT OR TERMINATION OF PLAN
10.1 AMENDMENT 23
10.2 TERMINATION 23
iii
ARTICLE XI
MISCELLANEOUS
11.1 PLAN INTERPRETATION 23
11.2 GENDER AND NUMBER 24
11.3 WRITTEN DOCUMENT 24
11.4 EXCLUSIVE BENEFIT 24
11.5 PARTICIPANT'S RIGHTS 24
11.6 ACTION BY THE EMPLOYER 24
11.7 EMPLOYER'S PROTECTIVE CLAUSES 24
11.8 NO GUARANTEE OF TAX CONSEQUENCES 25
11.9 INDEMNIFICATION OF EMPLOYER BY PARTICIPANTS 25
11.10 FUNDING 25
11.11 GOVERNING LAW 26
11.12 SEVERABILITY 26
11.13 CAPTIONS 26
11.14 CONTINUATION OF COVERAGE 26
11.15 FAMILY AND MEDICAL LEAVE ACT 26
11.16 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT 26
11.17 UNIFORM SERVICES EMPLOYMENT AND RE-EMPLOYMENT RIGHTS ACT 26
iv
WELD COUNTY GOVERNMENT EMPLOYEES' CAFETERIA PLAN
INTRODUCTION
The Employer has amended this Plan effective February 1, 2001, to recognize the contribution
made to the Employer by its Employees. Its purpose is to reward them by providing benefits for
those Employees who shall qualify hereunder and their dependents and beneficiaries. 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 1, 1987. The Plan shall be known as Weld County Government Employees'
Cafeteria 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. 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(o).
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 111, 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 total cash remuneration received by the Participant from the
Employer during a Plan Year prior to any reductions pursuant to a Salary Redirection
Agreement authorized hereunder. Compensation shall include overtime,commissions and
bonuses.
1
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 1, 1987.
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
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.
1.11 "Employee"means any person who is employed by the Employer, but excludes any person
who is employed as an independent contractor. The term Employee shall include leased
employees within the meaning of Code Section 414(n)(2).
1.12 "Employer" means Weld County Government and any successor which shall maintain this
Plan; and any predecessor which has maintained this Plan.
1.13 "ERISA" means the Employee Retirement Income Security Act of 1974, as amended from
time to time.
1.14 "Insurance Contract" means any contract issued by an Insurer underwriting a Benefit.
1.15 "Insurance Premium Payment Plan" means the plan of benefits contained in Section 4.1
of this Plan, which provides for the payment of Premium Expenses.
1.16 "Insurer" means any insurance company that underwrites a Benefit under this Plan.
1.17 "Key Employee"means an Employee described in Code Section 416(1)(1)and the Treasury
regulations thereunder.
1.18 "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.
1.19 "Plan" means this instrument, including all amendments thereto.
1.20 "Plan Year" means the 12-month period beginning January 1 and ending December 31.
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.
1.21 "Premium Expenses"or"Premiums" mean the Participant's cost for the Benefits described
in Section 4.1.
1.22 "Premium Reimbursement Account" means the account established for a Participant
pursuant to this Plan to which part of his Cafeteria Plan Benefit Dollars may be allocated
and from which Premiums of the Participant shall be paid or reimbursed. If more than one
type of insured Benefit is elected, sub-accounts shall be established for each type of
insured Benefit.
2
1.23 "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.
1.24 "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.
1.25 "Spouse" means the legally married husband or wife of a Participant, unless legally
separated by court decree.
ARTICLE II
PARTICIPATION
2.1 ELIGIBILITY
Any Eligible Employee shall be eligible to participate hereunder I month(s) after his initial
date of employment with the Employer. 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 first day of the month
coinciding with or next following the date on which he met the eligibility 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 an application to participate and election of benefits form which the
Administrator shall furnish to the Employee. The election made on such form 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 shall 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 under this Plan shall automatically
3
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.
2.4 TERMINATION OF PARTICIPATION
A Participant shall no longer participate in this Plan upon the occurrence or any of the
following events:
(a) His termination of employment, subject to the provisions of Section 2.6;
(b) The end of the Plan Year during which he became a limited Participant because of
a change in employment status pursuant to Section 2.5;
(c) His death, subject to the provisions of Section 2.7; or
(d) The termination of this Plan, subject to the provisions of Section 10.2.
2.5 CHANGE OF EMPLOYMENT STATUS
If a Participant ceases to be eligible to participate because of a change in employment
status or classification(other than through termination of employment),the Participant shall
become a limited Participant in this Plan for the remainder of the Plan Year in which such
change of employment status occurs. As a limited Participant,no further Salary Redirection
may be made on behalf of the Participant, and, except as otherwise provided herein, all
further Benefit elections shall cease, subject to the limited Participant's right to continue
coverage under any Insurance Contracts. However, any balances in the limited
Participant's Dependent Care Assistance Account may be used during such Plan Year to
reimburse the limited Participant for any allowable Employment-Related Dependent Care
incurred during the Plan Year. Subject to the provisions of Section 2.6, if the limited
Participant later becomes an Eligible Employee, then the limited Participant may again
become a full Participant in this Plan, provided he otherwise satisfies the participation
requirements set forth in this Article 11 as if he were a new Employee and made an election
in accordance with Section 5.1.
2.6 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 Care Assistance Program, 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 Care
Assistance Account as of his date of termination.
4
(c) With regard to the Health Care Reimbursement Plan, the Participant may elect to
continue his participation in the Plan.
(1) If the Participant elects to continue participation in the Health Care
Reimbursement Plan for the remainder of the Plan Year in which such
termination occurs, the Participant may continue to seek reimbursement
from the Health Care Reimbursement Fund. The Participant shall be
required to make contributions to the fund based on the elections made prior
to the beginning of the Plan Year.
(2) If the Participant does not elect to continue participation in the Health Care
Reimbursement Plan for the remainder of the Plan Year in which such
termination occurs,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.
(d) In the event a Participant terminates his participation in the Health Care
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.
2.7 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.
5
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 Health Care Reimbursement Fund or Dependent Care
Assistance Account shall be credited to such fund or account. Amounts designated for the
Participant's Premium Expense Reimbursement Account shall likewise be credited to such
account for the purpose of paying Premium Expenses.
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 Health Care 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 2.6.
ARTICLE IV
BENEFITS
4.1 BENEFIT OPTIONS
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:
6
(a) Health Care Reimbursement Plan
(b) Dependent Care Assistance Program
(c) Health Insurance Benefit
(d) Dental and Vision Insurance Benefit
(e) Group-Term Life Insurance Benefit
4.2 HEALTH CARE REIMBURSEMENT PLAN BENEFIT
Each Participant may elect coverage under the Health Care Reimbursement Plan option,
in which case Article VI shall apply.
4.3 DEPENDENT CARE ASSISTANCE PROGRAM BENEFIT
Each Participant may elect coverage under the Dependent Care Assistance Program
option, in which case Article VII shall apply.
4.4 HEALTH INSURANCE BENEFIT
(a) Each Participant may elect to be covered under a health and hospitalization
Insurance Contract for the Participant, his or her spouse, and his or her
Dependents.
(b) The Employer may select suitable health and hospitalization Insurance Contracts
for use in providing this health insurance benefit,which policies will provide uniform
benefits for all Participants electing this Benefit.
(c) The rights and conditions with respect to the benefits payable from such health and
hospitalization Insurance Contract shall be determined therefrom, and such
Insurance Contract shall be incorporated herein by reference.
4.5 DENTAL AND VISION INSURANCE BENEFIT
(a) Each Participant may elect to be covered under the Employer's dental and vision
Insurance Contract. In addition,the Participant may elect either individual or family
coverage under such Insurance Contract.
(b) The Employer may select suitable dental and vision Insurance Contracts for use in
providing this dental and vision insurance benefit,which policies will provide uniform
benefits for all Participants electing this Benefit.
(c) The rights and conditions with respect to the benefits payable from such dental and
vision Insurance Contract shall be determined therefrom,and such dental and vision
Insurance Contract shall be incorporated herein by reference.
4.6 GROUP-TERM LIFE INSURANCE BENEFIT
(a) Each Participant may elect to be covered under the Employer's group-term life
Insurance Contract. However, the amount of coverage hereunder on behalf of any
Participant may not exceed $50,000.
7
(b) The Employer may select suitable group-term life Insurance Contracts for use in
providing this group-term life insurance benefit, which policies will provide benefits
for all Participants electing this Benefit on a uniform basis.
(c) The rights and conditions with respect to the benefits payable from such group-term
life Insurance Contract shall be determined therefrom, and such group-term life
Insurance Contract shall be incorporated herein by reference.
4.7 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, but shall not be required to, reduce
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. If the Administrator decides to reduce
contributions or non-taxable Benefits, it shall be done in the following manner. First,
the non-taxable Benefits of the affected Participant (either an employee who is
highly compensated or a Key Employee, whichever is applicable) who has the
highest amount of non-taxable Benefits for the Plan Year shall have his non-taxable
benefits reduced until the discrimination tests set forth in this Section are satisfied
or until the amount of his non-taxable Benefits equals the non-taxable Benefits of
the affected Participant who has the second highest amount of non-taxable
Benefits. This process shall continue until the nondiscrimination tests set forth in
this Section are satisfied. With respect to any affected Participant who has had
Benefits reduced pursuant to this Section, the reduction shall be made
proportionately among Health Care Reimbursement Plan Benefits and Dependent
Care Assistance Program Benefits, and once ail these Benefits are expended,
proportionately among insured Benefits. Contributions which are not utilized to
provide Benefits to any Participant by virtue of any administrative act under this
paragraph shall be forfeited and deposited into the benefit plan surplus.
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
8
Section 2.2. However, if such Employee does not complete an application to participate
and benefit election form and deliver it to the Administrator before such date, his Election
Period shall 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 30-day 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 form by the Administrator, 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 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, on an election of benefits form to be provided by the
Administrator, 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;
(b) A Participant may terminate his participation in the Plan by notifying the
Administrator 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, with respect to spending account Benefits.
5.3 FAILURE TO ELECT
Any Participant who fails to complete a new benefit election form pursuant to Section 5.2
by the end of the applicable Election Period shall be treated in the following manner:
(a) With regard to Benefits available under the Plan for which no Premium Expenses
apply, such Participant shall be deemed to have elected not to participate in the
Plan for the upcoming Plan Year. No further Salary Redirections shall therefore be
authorized or made for the subsequent Plan Year for such Benefits.
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
9
under rules and regulations adopted by the Department of the Treasury, the
provisions of which are incorporated by reference. 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 eligibility for
coverage under a family member plan as a result of a change in martial status or
a change in employment status, 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.
If the change in status is a change in status in the Participant's marital status under
(1) below or a change in employment status of the Participant's spouse or covered
dependents under (3) below, an election to increase, or an election to decrease,
group-term life coverage corresponds with that change in status.
Regardless of the consistency requirement,if the individual,the individual's spouse,
or dependent becomes eligible for continuation coverage under the Employer's
group health plan as provided in Code Section 49808 or any similar state law, then
the individual may elect to increase payments under this Plan in order to pay for the
continuation coverage.
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 form 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:
(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
10
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.
For the Dependent Care Assistance Program, 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).
(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:
(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.
(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 and becomes entitled to coverage
(i.e., enrolled) under Part A or Part B of the Title XVIII of the 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).
(e) If 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.
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
11
thereof, elect to receive on a prospective basis coverage under another plan with
similar coverage.
If, during the period of coverage, a new benefit package option or other coverage
option is added (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.
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.
A cost change is allowable in the Dependent Care Assistance Program only if the
cost change is imposed by a dependent care provider who is not related to the
Participant, as defined in Code Section I 52(a)(1) through (8).
A Participant shall not be permitted to change an election to the Health Care
Reimbursement Plan as a result of a cost or coverage change under this
subsection.
ARTICLE VI
HEALTH CARE REIMBURSEMENT PLAN
6.1 ESTABLISHMENT OF PLAN
This Health Care Reimbursement Plan is intended to quality 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 Health Care Reimbursement Plan may submit claims for the
reimbursement of Medical Expenses. All amounts reimbursed under this Health Care
Reimbursement Plan shall be periodically paid from amounts allocated to the Health Care
Reimbursement Fund. Periodic payments reimbursing Participants from the Health Care
Reimbursement 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) "Health Care Reimbursement 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.
12
(b) "Health Care 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 this Article and
determining discrimination under Code Section 105(h), a participant who is:
(1) One of the 5 highest paid officers;
(2) A shareholder who owns (or is considered to own applying the rules of Code
Section 318) more than 10 percent in value of the stock of the Employer; or
(3) Among the highest paid 25 percent of all Employees (other than exclusions
permitted by Code Section 105(h)(3)(B) for those individuals who are not
Participants).
(d) "Medical Expenses"means any expense for medical care within the meaning of the
term "medical care"or"medical expense" as defined in Code Section 213 and the
rulings and Treasury regulations thereunder, and not otherwise used by the
Participant as a deduction in 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 tinder 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 7702B(c).
(e) The definitions of Article I are hereby incorporated by reference to the extent
necessary to interpret and apply the provisions of this Health Care Reimbursement
Plan.
6.3 FORFEITURES
The amount in the Health Care Reimbursement Fund as of the end of any Plan Year(and
after the processing of all claims for such Plan Year pursuant to Section 6.6 hereof) shall
be forfeited and credited to the benefit plan surplus. In such event, the Participant shall
have no further claim to such amount for any reason, subject to Section 8.2.
6.4 NONDISCRIMINATION REQUIREMENTS
(a) It is the intent of this Health Care 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 Health
Care Reimbursement Plan, it may, but shall not be required to, reject any elections
or reduce contributions or 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. If the Administrator decides to reject any
elections or reduce contributions or Benefits, it shall be done in the following
manner. First, the Benefits designated for the Health Care Reimbursement Fund
by the member of the group in whose favor discrimination may not occur pursuant
to Code Section 105 that elected to contribute the highest amount to the fund for
13
the Plan Year shall be reduced until the nondiscrimination tests set forth in this
Section or the Code are satisfied,or until the amount designated for the fund equals
the amount designated for the fund by the next member of the group in whose favor
discrimination may not occur pursuant to Code Section 105 who has elected the
second highest contribution to the Health Care Reimbursement Fund for the Plan
Year. This process shall continue until the nondiscrimination tests set forth in this
Section or the Code are satisfied. Contributions which are not utilized to provide
Benefits to any Participant by virtue of any administrative act under this paragraph
shall be forfeited and credited to the benefit plan surplus.
6.5 COORDINATION WITH CAFETERIA PLAN
All Participants under the Cafeteria Plan are eligible to receive Benefits under this Health
Care Reimbursement Plan. The enrollment under the Cafeteria Plan shall constitute
enrollment under this Health Care Reimbursement Plan. In addition, other matters
concerning contributions,elections and the like shall be governed by the general provisions
of the Cafeteria Plan.
6.6 HEALTH CARE REIMBURSEMENT PLAN CLAIMS
(a) All Medical Expenses incurred by a Participant shall be reimbursed during the Plan
Year subject to Section 2.6, 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 Health Care Reimbursement 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 45 day
period immediately following the end of the Plan Year, 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.
However, in the Administrator's discretion, payments may be made directly to the
service provider. The application for payment or reimbursement shall be made to
the Administrator 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
14
written statement that the Medical Expense has not been reimbursed or is not
reimbursable under any other health plan coverage and, if reimbursed from the
Health Care Reimbursement Fund, such amount will not be claimed as a tax
deduction. The Administrator shall retain a file of all such applications.
ARTICLE VII
DEPENDENT CARE ASSISTANCE PROGRAM
7.1 ESTABLISHMENT OF PROGRAM
This Dependent Care Assistance Program 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 Care Assistance Program shall be paid from amounts
allocated to the Participant's Dependent Care Assistance Account.
7.2 DEFINITIONS
For the purposes of this Article and the Cafeteria Plan the terms below shall have the
following meaning:
(a) "Dependent Care Assistance Account" means 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 Care Assistance Program" 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 or 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:
15
(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 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 Care Assistance Program 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 15.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
2.1.(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 Care Assistance
Program.
7.3 DEPENDENT CARE ASSISTANCE ACCOUNTS
The Administrator shall establish a Dependent Care Assistance Account for each
Participant who elects to apply Cafeteria Plan Benefit Dollars to Dependent Care
Assistance Program benefits.
7.4 INCREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS
A Participant's Dependent Care Assistance Account shall be increased each pay period by
the portion of Cafeteria Plan Benefit Dollars that he has elected to apply toward his
Dependent Care Assistance Account pursuant to elections made under Article V hereof.
16
7.5 DECREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS
A Participant's Dependent Care Assistance 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.
7.6 ALLOWABLE DEPENDENT CARE ASSISTANCE 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 Care Assistance 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 Care Assistance 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 and credited to the benefit plan surplus. 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 Care Assistance 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 ($2,500 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 Care Assistance Program 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 Care Assistance Program 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
17
Code Section 129 it may, but shall not be required to, reject any elections or reduce
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. If the Administrator decides to reject
any elections or reduce contributions or Benefits, it shall be done in the following
manner. First,the Benefits designated for the Dependent Care Assistance Account
by the affected Participant that elected to contribute the highest amount to such
account for the Plan Year shall be reduced until the nondiscrimination tests set forth
in this Section are satisfied, or until the amount designated for the account equals
the amount designated for the account of the affected Participant who has elected
the second highest contribution to the Dependent Care Assistance Account for the
Plan Year, This process shall continue until the nondiscrimination tests set forth in
this Section are satisfied. Contributions which are not utilized to provide Benefits
to any Participant by virtue of any administrative act under this paragraph shall be
forfeited.
7.11 COORDINATION WITH CAFETERIA PLAN
All Participants under the Cafeteria Plan are eligible to receive Benefits under this
Dependent Care Assistance Program. The enrollment and termination of participation
under the Cafeteria Plan shall constitute enrollment and termination of participation under
this Dependent Care Assistance Program. In addition, other matters concerning
contributions, elections and the like shall be governed by the general provisions of the
Cafeteria Plan.
7.12 DEPENDENT CARE ASSISTANCE PROGRAM CLAIMS
The Administrator shall direct the payment of all such Dependent Care Assistance claims
to the Participant upon the presentation to the Administrator of documentation of such
expenses in a form satisfactory to the Administrator. However, in the Administrator's
discretion, payments may be made directly to the service provider. 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;
18
(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:
(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
a) He or she is incapacitated, or
b) 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 45 day period immediately following
the end of the Plan Year, those claims shall not be considered for reimbursement
by the Administrator.
ARTICLE VIII
ERISA PROVISIONS
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;
19
(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 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 Participants' Health Care Reimbursement Fund or
Dependent Care Assistance Account as of the end of each Plan Year shall be
forfeited and deposited in the benefit plan surplus of the Employer pursuant to
Section 6.3 or Section 7.8,whichever is applicable,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 and credited to the benefit plan surplus.
8.2 APPLICATION OF BENEFIT PLAN SURPLUS
Any forfeited amounts credited to the benefit plan surplus 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. Amounts in the
benefit plan surplus shall first be used to defray any administrative costs and experience
losses and thereafter be retained by the Employer.
20
8.3 NAMED FIDUCIARY
The Administrator shall be the named fiduciary pursuant to ERISA Section 402 and shall
be responsible for the management and control of the operation and administration of the
Plan.
8.4 GENERAL FIDUCIARY RESPONSIBILITIES
The Administrator and any other fiduciary under ERISA shall discharge their duties with
respect to this Plan solely in the interest of the Participants and their beneficiaries and
(a) for the exclusive purpose of providing Benefits to Participants and their beneficiaries
and defraying reasonable expenses of administering the Plan;
(b) with the care, skill, prudence and diligence under the circumstances then prevailing
that a prudent man acting in like capacity and familiar with such matters would use
in the conduct of an enterprise of a like character and with like aims; and
(c) in accordance with the documents and instruments governing the Plan insofar as
such documents and instruments are consistent with ERISA.
8.5 NON-ASSIGNABILITY OF RIGHTS
The right of any Participant to receive any reimbursement under the Plan shall not be
alienable by the Participant by assignment or any other method, and shall not be subject
to the rights of creditors, and any attempt to cause such right to be so subjected shall not
be recognized, except to such extent as may be required by law.
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;
21
(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;
(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 home by the Participants under the Plan or
by any Trust Fund which may be established hereunder. 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
22
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.
9.6 The Plan Administrator shall be the Director of Finance and Administration of Weld County.
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 Health Care Reimbursement Fund or Dependent
Care Assistance Account, but all payments from such fund shall continue to be made
according to the elections in effect until the end of the Plan Year in which the Plan
termination occurs (and for a reasonable period of time thereafter, if required for the filing
of claims). Any amounts remaining in any such fund or account as of the end of the Plan
Year in which Plan termination occurs shall be forfeited and deposited in the benefit plan
surplus 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.
23
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.
11.4 EXCLUSIVE BENEFIT
This Plan shall be maintained for the exclusive benefit of the Employees who participate in
the Plan.
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
24
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 nor the Employer 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 or state income tax purposes, or that any other
federal or state 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 and state income 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.
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 or state income tax or
Social Security tax from such payments or reimbursements. However,such indemnification
and reimbursement shall not exceed the amount of additional federal and state 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 tax that would have been paid on such
compensation, less any such additional income and Social Security 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.
25
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 Colorado.
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 4980B.
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 Proposed
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 RE-EMPLOYMENT 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.
26
Hello