HomeMy WebLinkAboutAgr 1997-05-08 (Cafeteria Plan Corporate Reso)CERTIFICATE OF CORPORATE RESOLUTION
The undersigned Secretary of Town of Tiburon (the
Corporation) hereby certifies that the following resolutions were(No 3072)
duly adopted by the board of directors of the Corporation on
January 4, 1995 , and that such resolutions have not been
modified or rescinded as of the date hereof:
RESOLVED, that the updated form of Cafeteria Plan
including a Dependent Care Assistance Program and Health Care
Reimbursement Plan effective January 1, 1995, is hereby approved
and adopted and that the proper officers of the Corporation are
hereby authorized and directed to execute and deliver to the
Administrator of the Plan one or more counterparts of the Plan.
RESOLVED, that the Administrator shall be instructed to
take such actions that are deemed necessary and proper in order to
implement the updated Plan, and to set up adequate accounting and
administrative procedures to provide benefits under the Plan.
RESOLVED, that the proper officers of the Corporation
shall act as soon as possible to notify the employees of the
Corporation of the adoption of the updated Cafeteria Plan by
delivering to each employee a copy of the summary description of
the Plan in the form of the Summary Plan Description presented to
this meeting, which form is hereby approved.
The undersigned further certifies that attached hereto as
Exhibits A and B, respectively, are true copies of Town of Tiburon
Cafeteria Plan and the Summary Plan Description approved and
adopted in the foregoing resolutions.
Secretary
Date: S'~?" ~ 7-
TOWN OF TIBURON
CAFETERIA PLAN
INTRODUCTION
We are pleased to announce that we have established a
"flexible benefit plan" 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 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 Plan and the benefits you will
receive. You should direct any questions you have to the
Administrator. 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.
TABLE OF CONTENTS
I
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? ..............................1
I I I
CONTRIBUTIONS
1.
How
Much of
My Pay May the Employer Redirect?
2
2.
What
Happens
to Contributions Made to the Plan?
2
3.
When
Must I
Decide Which Accounts I Want to Use?.........
2
4.
When
Is the
"Election Period" for Our Plan?
2
5.
May
I Change
My Elections During the Plan Year?..........
2
6.
May
I Make N
ew Elections in Future Plan Years?
3
IV
BENEFITS
1. What Benefits Are Available? .............................4
V
BENEFIT PAYMENTS
1.
When
Will I Receive Payments From My Accounts?
5
2.
What
Happens If I Don't Spend All Plan Contributions?
6
3.
What
Happens If I Terminate Employment?
6
4.
Will
My Social Security Benefits Be Affected?
8
VI
HIGHLY COMPENSATED AND KEY EMPLOYEES
1. Do Limitations Apply to Highly Compensated Employees? 8
VII
PLAN ACCOUNTING
1. Periodic Statements ......................................8
VIII
GENERAL INFORMATION ABOUT OUR PLAN
1. General Plan Information .................................9
2. Employer Information .....................................9
3. Plan Administrator Information ..............:............9
4. Service of Legal Process .................................9
5. Type of Administration ...................................9
IX
ADDITIONAL PLAN INFORMATION
1. Your Rights Under ERISA .................................10
2. Claims Process ..........................................12
X
SUMMMARY
I
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 election 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 satisfied
the conditions for coverage under our group medical plan.
3. When Is My Entry Date?
You can join the Plan on the same day you can enter our group
medical plan.
4. What Must I Do to Enroll in the Plan?
Before you can join the Plan, you must complete an election
form to participate in the Plan. The election form 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.
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 can be placed in special funds or accounts which will 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
1
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, you may elect to pay for the benefits that you
choose under the Plan. These amounts will be deducted from your
pay each pay period on a pro-rata basis over the course of the
year. If there are insured benefits provided under this Plan,
we will automatically contribute on your behalf the employer
portion for the insurance coverage provided.
2. What Happens to Contributions Made to the Plan?
Before each Plan Year begins, you wi 1 1 select the benef its you
want for the eligible categories of Health Expense Reimbursement
and Dependent Care Assistance. It is very important to make these
choices carefully based on what you expect to spend on each covered
benefit or expenses during the Plan Year. Later, they will be used
to pay for the expenses as they arise during the Plan Year.
3. 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 upon two
things: first, which benefits you want and second, how much should
go toward each benefit.
If you are already covered by any insured benefits offered by
this Plan, you automatically become a Participant to the extent of
any premiums for such insurance unless you elect, during the
"election period," not to participate in the Plan.
4. 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 will be the 60
day period prior to the beginning of each Plan Year. (See the
Article entitled "General Information About Our Plan" for the
definition of Plan Year.)
5. May I Change My Elections During the Plan Year?
Generally, no. You cannot change the elections you have made
after the beginning of the Plan Year. However, there are certain
2
limited situations when you can change your elections. You are
permitted to change if there is a change in your family status.
Currently, Federal law considers the following events to be
examples of a change in family status:
You get married or divorced.
You have a child or adopt one.
Your spouse and/or child(ren) die(s).
Your spouse commences or terminates employment.
Your or your spouse's employment status changes from
full-time to part-time or from part-time to full-time.
You or your spouse take an unpaid leave of absence.
Your spouse has a significant change in health coverage
directly attributable to your spouse's employment.
There may be other events which are considered to a change in
family status. Also, any election change must be consistant with
the reason that such change was permitted. However, with respect
to the Health Care Reimbursement Plan, you may not make a change in
your benefit election as the result of a change in family status.
If you have a change in family status, you should contact the
Administrator, who will provide you with the required forms for
changing your benefit elections. In addition, should there be any
health insurance premiums being contributed to the Plan, we will
adjust the salary redirection election you have made for the
remainder of the Plan Year if there is a change in the premium
expense. If the increase in premium expense is significant, we
will let you either change the salary redirection election or
revoke you election entirely and, in lieu thereof, elect to receive
on a prospective basis, coverage under another health plan with
similar coverage.
6. 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 to be continuing as a
participant (for the non-insured benefit options - health expense,
dependent care, ind. premiums accounts) under the Plan for the
upcoming Plan Year.
3
IV
BENEFITS
1. What Benefits Are Available?
Under our Plan, you can choose
compensation in cash (wages) or use
following benefits or expenses pre-tax
Health Care Reimbursement Plan:
to receive your entire
a portion to pay for the
during the Plan Year:
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, vision and other
health 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 the
Administrator.
The most that you can contribute
Plan each Plan Year is $10,000.
health care expense, you must
itemized bill from the service r
the Plan may not be claimed as a
tax return. Reimbursement from
once a month.
to your Health Care Reimbursement
In order to be reimbursed for a
submit to the Administrator an
~rovider. Amounts reimbursed from
deduction on your personal income
the fund shall be paid at least
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 fo
Child and Dependent Care Expenses." Children must be under the age
of 13. Disabled Dependents qualify regardless of age when they are
unable to physically or mentally 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.
4
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 household) or
$2,500 (if you are married filing separate returns); (b) your
taxable compensation; (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 be excludable
from your income, you must provide a statement from the service
provider including the name, address and the taxpayer identifica-
tion number of the service provider on your tax form for the year,
as we 1 1 as the amount of such expense as proof that the expense has
been incurred. Federal Tax laws also permit a tax credit for
certain dependent care expenses you may be paying for even if you
are not a participant in this Plan. Certain employees may save
more if they take advantage of this tax credit rather than using
the Dependent Care Assistance Account. Contact your tax advisor
for information on which choice may be better for you.
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 can include:
Health care premiums under our insured group medical
program as well as other eligible programs.
The Administrator 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 coverage terminates.
Any benefits to be provided by insurance wi 1 1 be provided only
after (1) you have provided the Administrator 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. The Administrator will provide
5
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 60 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.
3. 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 employmenet.
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 account at
the time of termination of employment. However, no further salary
redirection contributions will be made on your behalf after you
terminate.
Your participation in the Health Care Reimbursement Plan
will continue for the remainder of the Plan Year. You must
continue to pay the required contribution even though you are no
longer employed. You will also be entitled to reimbursements for
the remainder of the Plan Year.
Under Federal Law, you, your spouse, and your dependents may
be entitled to continuation of health care coverage. The
Administrator will inform you of these rights if you terminate
employment. Generally, if we (and any related companies) employed
6
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 (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 may be eligible
for continuation of coverage for a total of 29 months (rather than
18). You should check with the Administrator 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), termination of our health plan, or you (or the
person entitled t.o continued coverage) become entitled to Medicare
benefits. However, if you become entitled to Medicare benefits,
your 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 termination of
employment or reduction in hours, 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
eligible for Medicare.
(c) Your dependent children 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 eligible for Medicare; or (4) your dependent
ceases to be a dependent child under the Plan.
It is your responsibility to notify the Plan Administrator 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,
7
termination of employement or reduction in hours, or Medicare
eligibility.
4. 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 Limitationsss 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 the
Administrator 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 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
The Administrator 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.
8
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
Town of Tiburon Cafeteria Plan is the name of the Plan. Your
Employer has assigned Plan Number 510 to your Plan.
The Provisions of the Plan become effective on January 1,
1995, which is called the Effective Date of the Plan.
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 1st and ends on December 31st.
2. Employer Information
Your Employer's name, address, and identification number are:
Town of Tiburon I.D.Number 94-1576861
1155 Tiburon Blvd.
Tiburon, CA 94920
3. Plan Administrator Information
The name, address and business telephone number of your
Plan's Administrator are:
Town of Tiburon Phone Number (415) 435-7379
1155 Tiburon Blvd.
Tiburon, CA 94920
The Administrator keeps the records for the Plan and is
responsible for the administration of the Plan. The Administrator
will also answer any questions you may have about our Plan. You
may contact the Administrator 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:
Town of Tiburon
1155 Tiburon Blvd.
Tiburon, CA 94920
5. Type of Administration
The type of Administration is Employer Administration
9
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 Administrator's
office, all Plan documents, and copies of all documents
f i led 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 the Administrator. The
Administrator may charge a reasonable fee for the copies.
In addition to creating rights for Plan part-icipants, ERISA
imposes duties upon the people who are responsible for the
operationof 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
yhou from obtaining a benefit or exercising your rights under
ERISA.
If your claim for a benef it 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 the
Administrator to provide the materials and pay you up to $100 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
10
fees; for example, if it finds your claim is frivolous.
2. Your Rights under Family and Medical Leave Act of 1993 (FMLA)
To be eligible for FMLA benefits, an employee must have worked
for a covered employer for a total of at least 12 months, have
worked at least 1250 hours over the previous 12 months and work at
a location (or locations within a 75 mile area) where at least 50
employees are employed by the employer.
The Family and Medical Leave Act or 1993 generally requires
covered employers to permit eligible employees to take up to 12
weeks of unpaid, job-protected leave each year:
upon the birth of an employee's child,
upon placement of a child with the employee for adoption or
foster care,
to care for a child, spouse or parent who has a serious
health condition, or
when the employee is unable to perform the functions of his
or her position because of a serious health condition.
Subject to certain conditions, instead of taking an unpaid
leave, employees or employers may choose to use accrued paid leave
(such as sick or vacation leave) to cover some or all of the FMLA
leave.
Maintenance of Group Health Plan Benefits is provided under
FMLA. Employers are required to "maintain coverage under any group
health plan for the duration of such leave at the level and under
the conditions coverage would have been provided if the employee
had continued in employment continuously for the duration of such
leave."
Employee's Share of the Premium can be paid by arrangement
with the employer. If the leave is unpaid, the employer has a
number of options for obtaining payment from the employee. All of
the following options assume the employee elects to continue his
group health coverage:
(a) Payment would be due at the same time as it
would have been made if by payroll deduction;
(b) Payment would be due on the same schedule as
as payments are made under COBRA;
(c) Payment (during the same plan year) would be
prepaid pursuant to a cafeteria plan at the employee's
option;
11
(d) Another system voluntarily agreed upon by the
employer and employee, which may include prepayment of
premiums.
The Employer must provide the employee with advance written
notice of the selected option's terms and conditions under which
these payments must be made.
If a FMLA leave is substituted paid leave, the employee's
share must be paid by the method normally used during any paid
leave (e.g. through a payroll deduction).
Continuation of a Health Care Reimbusement Account is
permitted under FMLA. All of the following options
assume the employee elects to continue their Health Expense
Reimbursement Account while on FMLA leave:
(a) Payment (during the same Plan Year) would be
made in a lump sum payroll reduction upon the employee's
return to work;
(b) Payment (during the same Plan Year) would be
made in pro-rata amounts for the period of time from
return to work to the end of the Plan Year;
Revocation of a Health Care Reimbursement Account is permitted
under FMLA. If an employee's coverage under the Health Care FSA
terminates while the employee is on FMLA leave, the employee is not
entitled to receive reimbursements for claims incurred during the
period when the coverage is terminated. The employee can elect to
reinstate the Health Care FSA upon return from FMLA leave for the
remainder of the Plan Year, the employee may not retroactively
elect Health Care FSA coverage for claims incurred during the
period when coverage was terminated.
3. Claims Process
You should submit reimbursement claims during the Plan Year
but in no event later than 60 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 the Administrator 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
12
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.
The Administrator will review the claim and provide, within 60
days, a written response to the appeal. (This period may be
extended in additional 60 days under certain circumstances.) In
this response, the Administrator will explain the reason for the
decision, with specific reference to the provisions of the Plan
on which the decision is based. The Administrator has the
exclusive right to interpet the appropriate plan provisions.
Decisions of the Administrator 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 f lexible benef its plan wi 1 1 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 the Administrator.
TOWN OF TIBURON
CAFETERIA PLAN
TABLE OF CONTENTS
ARTICLE I
DEFINITIONS
ARTICLE II
PARTICIPATION
2.1 ELIGIBILITY
2.2 EFFECTIVE DATE OF PARTICIPATION
2.3 APPLICATION TO PARTICIPATE
2.4 TERMINATION OF PARTICIPATION
2.5 TERMINATION OF EMPLOYMENT
2.6 DEATH
ARTICLE III
CONTRIBUTIONS TO THE PLAN
3
4
4
4
5
5
3.1 SALARY REDIRECTION 6
3.2 APPLICATION OF CONTRIBUTIONS 6
7
3.3 PERIODIC CONTRIBUTIONS
ARTICLE IV
BENEFITS
4.1 BENEFIT OPTIONS 7
4.2 HEALTH CARE REIMBURSEMENT PLAN BENEFIT 7
4.3 DEPENDENT CARE ASSISTANCE PROGRAM BENEFIT 7
4.4 HEALTH INSURANCE BENEFIT 7
4.5 CASH BENEFIT 8
4.6 NON-DISCRIMINATION REQUIREMENTS 8
ARTICLE V
PARTICIPANT ELECTIONS
5.1 INITIAL ELECTIONS
5.2 SUBSEQUENT ANNUAL ELECTIONS 9
5.3 FAILURE TO ELECT 10
5.4 CHANGE OF ELECTIONS 10
ARTICLE VI
HEALTH CARE REIMBURSEMENT PLAN
6.1 ESTABLISHMENT OF PLAN 12
6.2 DEFINITIONS 12
6.3 FORFEITURES 12
6.4 LIMITATION ON ALLOCATIONS 12
6.5 NONDISCRIMINATION REQUIREMENTS 13
6.6 COORDINATION WITH CAFETERIA PLAN 13
6.7 HEALTH CARE REIMBURSEMENT PLAN CLAIMS 13
ARTICLE VII
DEPENDENT CARE ASSISTANCE PROGRAM
7.
1
ESTABLISHMENT OF PROGRAM
14
7.
2
DEFINITIONS
15
7.
3
DEPENDENT CARE ASSISTANCE ACCOUNTS
16
7.
4
INCREASES IN DEPENDENT CARE ASSISTANCE ACCOUNTS
16
7.
5
DECREASES IN DEPENDENT CAR ASSISTANCE ACCOUNTS
17
7.
6
ALLOWABLE DEPENDENT CARE ASSISTANCE REIMBURSEMENT
17
7.
7
ANNUAL STATEMENT OF BENEFITS
17
9
7.8 FORFEITURES 17
7.9 LIMITATION ON PAYMENTS 17
7.10 NONDISCRIMINATION REQUIREMENTS 17
7.11 COORDINATION WITH CAFETERIA PLAN........................ 18
7.12 DEPENDENT CARE ASSISTANCE PROGRAM CLAIMS 19
ARTICLE VIII
INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT PLAN
8.1 INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT ACCOUNTS..... 20
8.2 INCREASES IN INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT. 20
8.3 DECREASES IN INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT. 20
8.4 INDIVIDUAL INSURANCE PREMIUM BENEFITS 20
8.5 FORFEITURES 21
ARTICLE IX
ERISA PROVISIONS
9.1 CLAIM FOR BENEFITS 21
9.2 APPLICATION OF BENEFIT PLAN SURPLUS 23
9.3 NAMED FIDUCIARY 23
9.4 GENERAL FIDUCIARY RESPONSIBILITIES 23
9.5 NONASSIGNABILITY OF RIGHTS 23
ARTICLE X
ADMINISTRATION
10.1 PLAN ADMINISTRATION 24
10.2 EXAMINATION OF RECORDS 25
10.3 PAYMENT OF EXPENSES 25
10.4 INSURANCE CONTROL CLAUSE 25
10.5 INDEMNIFICATION OF ADMINISTRATOR 25
ARTICLE XI
AMENDMENT OR TERMINATION OF PLAN
11.1 AMENDMENT PROCESS 25
11.2 TERMINATION OF PLAN 26
ARTICLE XII
MISCELLANEOUS
12.
1
PLAN INTERPRETATION
26
12.
2
GENDER AND NUMBER
26
12.
3
WRITTEN DOCUMENT
26
12.
4
EXCLUSIVE BENEFIT
27
12.
5
PARTICIPANT'S RIGHTS
27
12.
6
ACTION BY THE EMPLOYER
27
12.
7
EMPLOYER'S PROTECTIVE CLAUSES
27
12.
8
NO GUARANTEE OF TAX CONSEQUENCES
28
12.
9
INDEMNIFICATION OF EMPLOYER BY PARTICIPANTS
28
12.
10
FUNDING
28
12.
11
GOVERNING
29
12.
12
SEVERABILITY
29
12.
13
CAPTIONS
29
12.
14
CONTINUATION OF COVERAGE
29
12.
15
FAMILY MEDICAL LEAVE ACT PROVISIONS
30
12.
16
FAMILY MEDICAL LEAVE CAFETERIA OPTIONS
32
12.
17
NON-ELECTION OF PREMIUM REIMBURSEMENT ACCOUNT BY SPECIFIED
EMPLOYEE CLASSIFICATION
34
TOWN OF TIBURON
CAFETERIA PLAN
INTRODUCTION
The Employer has adopted this Plan effective January 1,
1995 to recognize the contributions 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 their beneficiaries. The concept of this Plan is to allow
Employees to choose among different types of benefits based upon
their own particular goals, desires and needs. The Plan shall
be known as Town of Tiburon 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 includable 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 individuals 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 agreement, 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 III, to purchase
Benefits. Each dollar contributed to this Plan shall be converted
into one Cafetertia Plan Benefit Dollar.
1.5 "Code" means the Internal Revenue Code of 1986, as
amended or replaced from time to time.
1
1.6 "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)).
1.7 "Effective Date" means January 1, 1995
1.8 "Election Period" means the 60 days period immediately
preceding the beginning of each Plan Year. However, an Employee's
intitial Election Period shall be determined pursuant to Section
5.1.
1.9 "Eligible Employees" means any Employee who has satisfied
the provisions of Section 2.1.
1.10 "Employee" means any person who is employed by the
Employer, but excludes any person who is employed as an independent
contractor. The term Employee can include leased and/or part-time
employees within the meaning of Code Section 414(n)(2) if indicated
by amendment to this Plan.
1.11 "Employer" means Town of Tiburon and any Affiliated
Employer (as defined in Section 1.2) which shall adopt this Plan;
any successor which shall maintain this Plan; and any predecessor
which has maintained this Plan.
1.12 "ERISA" means the Employee Retirement Income Security Act
of 1974, as amended from time to time.
1.13 "Highly Compensated Employee" means an Employee described
in Code Section 414(q) and the Treasury regulations thereunder.
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(i)(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
1st and ending December 31st. 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 Benef it Dol Lars may be al located 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.
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 as of the date he satisfies the eligibility conditions
for the Employer's group medical plan, the provisions of which are
specifically incorporated herein by reference.
3
If a former Participant is rehired during the same Plan
Year in which termination of employment occurs, and such former
Participant had revoked existing Benefit elections and terminated
the receipt of Benefits at the time of termination of employment,
then such rehired former Participant shall be prohibited from
making new Benefit elections for the remaining portion of the Plan
Year.
2.2 EFFECTIVE DATE OF PARTICIPATION
An Eligible Employee shall become a Participant effective
as of the entry date under the Employer's group medical plan, the
provisions of which are specifically incorporated herein by
reference.
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 from 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
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 of any of the following events:
(a) His termination of employment, subject to the
provisions of Section 2.5;
(b) His death, subject to the provisions of Section
2.6; or
(c) The termination of this Plan, subject to
the provisions of Section 10.2.
4
2.5 TERMINATION OF EMPLOYMENT
If a Participant terminates employment with the Employer
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.
(c) With regard to the Health Care Reimbursement
Plan, the Participant's participation in the Plan shall
continue 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 and
shall be required to make contributions to the fund based
on the elections made prior to the beginning of the Plan
Year. However, such contributions after termination of
employment shall be with after-tax dollars instead of
Salary Redirections.
(d) 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 12.14 of the Plan.
2.6 DEATH
If a Participant dies, his participation in the Plan
shall cease. However, such Participant's beneficiaries, or the
representative of his estate, may submit claims for expenses or
benefits for the remainder of the Plan Year or until the Cafeteria
Plan Benefit Dollars allocated to each specific benefit are
exhausted. A Participant may designate a specific beneficiary for
this purpose. If no such beneficiary is specified, the
Administrator may designate the Participant's Spouse, one of his
Dependents or a representative of his estate.
5
ARTICLE III
CONTRIBUTIONS TO THE PLAN
3.1 SALARY REDIRECTION
Benefits under the Plan shall be financed by Salary
Redirections sufficient to support Benefits that a Participant has
elected hereunder and to pay the Participant's Premium Expenses.
The salary administration program of the Employer shall be revised
to allow each Participant to agree to reduce his pay during a Plan
Year by an amount determined necessary to purchase the elected
Benefit. The amount of such Salary Redirection shall be specified
in the Salary Redirection Agreement and shall be applicable for a
Plan Year. Notwithstanding the above, for new Participants, the
Salary Redirection Agreement shall only be applicable from the
first day of the pay period following the Employee's entry date up
to and including the last day of the Plan Year. These
contributions shall be converted to Cafeteria Plan Benefit Dollars
and allocated to the funds or accounts established under the Plan
pursuant to the Participants' elections made under Article V.
Any Salary Redirection shall be determined prior to the
beginning of a Plan Year (subject to initial elections pursuant to
Section 5. 1 ) and prior to the end of the Election Period and shall
be irrevocable for such Plan Year. However, a Participant may
revoke a Benefit election or a Salary Redirection Agreement after
the Plan Year has commenced and make a new election with respect to
the remainder of the Plan Year, if both the'revocation and the new
election are on account of and consistent with a change in family
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
contributions made or withheld for the Health Care Reimbursement
Fund, Dependent Care Assistance Account or Premium Expense
Reimbursement Account shall be credited to such fund or account.
6
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
Redirect ions 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.
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:
(1) Health Care Reimbursement Plan
(2) Dependent Care Assistance Program
(3) Individual Health Premium Reimbursement Plan
(4) Cash Benefit
In addition, each Participant shall have a sufficient
portion of his Cafeteria Plan Benefit Dollars applied to the
following insured benefits unless the Participant elects not to
receive such benefits:
(5) Health 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 INDIVIDUAL HEALTH PREMIUM REIMBURSEMENT PLAN
Each Participant may elect coverage under the Individual
Health Premium Reimbursement Plan option, in which case Article
VIII shall apply.
7
4.5 CASH BENEFIT
If a Participant elects not to participate in the Plan,
such Participant shall be deemed to have chosen the Cash
Benefit as his sole Benefit option.
4.6 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/or Dependent(s).
(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.
4.7 NONDISCRIMINATION REQUIREMENTS
(a) It is the intent of this plan to provide
benefits to a classification of employees which the
Secretary of 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 which (without regard to this
paragraph) are includable 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
8
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 the 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 non-
insured Benefits, and once all non-insured 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 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
9
an election of benefits form to be provided by the Administrator,
which non-insured 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 non-insured
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 that are non-insured and 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 non-insured 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 the changes are
necessitated by and are consistent with a change in
family status which is acceptable under rules and
regulations adopted by the Department of the Treasury.
Benefit election changes are consistent with family
status changes only if the election changes are necessary
or appropriate as a result of the family status change.
Any new election under this Section 5.4 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
10
paragraph, the following events shall be considered
examples of a change in family status:
(1) the marriage or divorce of the Participant;
(2) the birth or adoption of a child by the
Participant;
(3) the death of the Participant's spouse or a
Dependent;
(4) the termination or commencement of employment
of the Participant's spouse;
(5) the switching from part-time to full-time
employment status or from full-time to part-time
status) by the Participant or the Participant's
spouse;
(6) the taking of an unpaid leave of absence by the
Participant or the Participant's spouse; or
(7) a significant change in health coverage
attributable to the spouse's employment.
(b) A Participant may not make changes to his
Benefit elections under the Health Care Reimbursement
Fund in the event of a change in family status.
(c) If the Premium Expenses under a health
insurance Benefit provided by an independent, third-party
provider 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 health insurance
Benefit. Alternatively, if the Premium Expense increases
significantly, the Administrator shall permit the
affected Participants to either make corresponding
changes in their Premium payments or revoke their
elections and, in lieu thereof, receive on a prospective
basis coverage under another health plan with similar
coverage. In addition, if the coverage under a health
insurance Benefit provided by an independent, third-party
provider is significantly curtailed or ceases during a
Plan Year, affected Participants may revoke their
elections of such health insurance Benefit and, in lieu
thereof, elect to receive on a prospective basis coverage
under another plan with similar coverage.
(d) Generally, the termination of employment by a
Participant shall not be considered a change in family
status. Therefore, upon termination, such Participant
shall not be entitled to change existing Benefit
11
elections. Rather, such termination shall constitute a
revocation of all existing benefit elections, except with
regard to the Health Care Reimbursement Plan, in which
case the Participant's election prior to termination
shall continue in force and may not be modified.
ARTICLE VI
HEALTH CARE REIMBURSEMENT PLAN
6.1 ESTABLISHMENT OF PLAN
This Health Care Reimbursement Plan is intended to
qualify as a medical reimbursement plan under Code Section 105 and
shall be interpreted in a manner consistent with such Code Section
and the Treasury regulations thereunder. Participants who elect to
participate in this 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
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.
(b) "Health Care Reimbursement Plan" means the plan
of benefits contained in the 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
12
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 under
the Health Care Reimbursement Fund for the cost of other
health coverage maintained by the employer of the
Participant's spouse or individual policies maintained by
the Participant or his spouse or Dependent.
(e) The definitions of Article I are hereby
incorporated by reference to the extent necessary to
interpet and apply the provisions of this Health Care
Reimbursement Plan.
6.3 FORFEITURES
(a) The amount in the Health Care Reimbursement
Account as of the end of the Plan Year (and after the processing of
all claims for such Plan Year pursuant to Section 6.7 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 9.2.
6.4 LIMITATION ON ALLOCATIONS
(a) Nonwithstanding any provision contained in this
Health Care Reimbursement Plan to the contrary, no more than
$10,000 may be allocated to the Health Plan Reimbursement fund by
a Participant in or on account of any Plan Year.
6.5 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
13
Health Care Reimbursement Fund by the member of the group
in whose favor discrimination may not occur pursuant to
Code Section 105 or 125 that elected to contribute the
highest amount to the fund for 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 Sections 105 or 125 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.
6.6 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.
6.7 HEALTH CARE REIMBURSEMENT PLAN CLAIMS
(a) All Medical Expenses incurred by a Participant
shall be reimbursed during the Plan Year subject to
Section 2.5, even though the submission of such a claim
occurs after his participation hereunder ceases; but
provided that the Medical Expenses were incurred during
the applicable Plan Year.
(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 the 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
14
after a claim has been filed as is administratively
practicable; provided however, that if a Participant
fails to submit a claim within the 60 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 written statement that the
Medical Expenses 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.
15
(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. The
determination of whether an amount qualifies as an
Employment-Related Dependent Care Expense shall be made
subject to the following rules:
(1) If such amounts are paid for expenses incurred
outside the Participant's household, they shall
constitute Employment-Related Dependent Care
Expenses only if incurred fora Qualifying Dependent
as defined in Section 7.2 (f) ( 1 ) (or deemed to be,
as described in Section 7.2 (f) (1) pursuant to
Section 7.2 (f) (3) or for a Qualifying
Dependent defined in Section 7.2 (f) (2) (or
deemed to be, as described in Section 7.2 (f) (2)
pursuant to Section 7.2 (f) (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) "Highly Compensated Employee" means an Employee
who is a highly compensated employee within the meaning
16
of Code Section 414(q) and the Treasury regulations
if, during the plan year or the preceding plan year:
( 1 ) the employee was at any time a 5% owner of the
Employer;
(2) the employee received compensation from the
Employer in excess of $100,000(as indexed for 1996);
(3) the employee received compensation from the
Employer in excess of $66,000 (as indexed for 1996)
and was in the "top paid" group (generally
consitituting the highest paid 20% of all employees
during the year"; or
(4) the employee was an any time an officer and
received compensation in excess of $60,000 (as
indexed for 1996).
( f ) "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
ent it 1 ed to an exempt ion under Code Sect ion 151 (c) ;
(2) a Dependent or the Spouse of a Participant who
is physically or mentally incapable of caring
for himself or herself; or
(3) a child that is deemed to be a Qualifying
Dependent described in paragraph (1) or (2) above,
whichever is appropriate, pursuant to Code Section
21 (e) (5).
(g) The definitions of Article I are hereby
incorporated by reference to the extent necessary to
interpret and apply the provisions of the 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.
17
7.5 DECREASES IN INDEPENDENT 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 Highly Compensated Employees or
their Dependents, as prohibited by Code Section 129(d).
18
(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 Highly Compensated
Employees defined under Section 7.2(e) or to principal
shareholders or owners as set forth in this Section, it
may, but shall not be required to, reject any elections
or reduce contributions or 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 Highly
Compensated Employee 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 Highly Compensated Employee 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, or until
the amount designated for the account of the Highly
Compensated Employee 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
A11 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.
19
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;
(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
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:
20
(1) the Spouse's salary or wages if he or she is
employed, or
(2) if the Participant's Spouse is not employed,
that
(i) he or she is incapacitated, or
(ii) 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 60 day period immediately following the end of the
Plan Year, those claims shall not be considered for
reimbursement by the Administrator.
ARTICLE VIII
INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT PLAN
8.1 INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT ACCOUNTS
The Employer shall establish for each Participant an
Individual Insurance Premium Reimbursement Account for each Plan
Year. Each Individual Insurance Premium Reimbursement Account
shall initially contain Zero Dollars (0.00).
8.2 INCREASES IN INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT
ACCOUNTS
A Participant's Individual Insurance Premium
Reimbursement Account for a Plan Year shall be increased by the
portion of the Participant's Salary Redirection Contributions for
the Plan Year that he has elected to apply toward his Individual
Insurance Premium Reimbursement Account pursuant to Section 3.1.
8.3 DECREASES IN INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT
ACCOUNTS
A Participant's Individual Insurance Premium
Reimbursement Account for a Plan Year shall be reduced by the
amount of any benefits paid to or on behalf of a Participant
pursuant to Section 8.4.
8.4 INDIVIDUAL INSURANCE PREMIUM BENEFITS
Subject to limitations contained in other provisions of
this Plan, a Participant who pays premiums for individual medical,
dental, vision and disability insurance coverage which is effective
during his Period of Coverage for a Plan Year shall be entitled to
receive from the Employer full reimbursement for the entire amount
21
of such premiums to the extent of the amount contained in the
Participant's Individual Insurance Premium Reimbursement Account
for that Plan Year. The Employer shall pay all such amounts to the
Participant upon the presentation to the Employer of documentation
of such premiums in a form satisfactory to the Employer. However,
in its discretion, the Employer may pay any of such amounts
directly, in which event the Employer shall be relieved of all
further responsibility with respect to that particular premium.
Participants shall be reimbursed for such premium on a monthly
basis during the Plan Year (no minimum claim) based on accepted
claims filed with the Employer by the last day of the preceding
month. Claims shall be accepted for payment only if they are
presented in proper form.
8.5 FORFEITURES
The amount of the Individual Insurance Premium
Reimbursement Fund as of the end of any Plan Year (and after the
processing of all claims for such Plan Year pursuant to Section 8.6
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 9.2.
8.6 INDIVIDUAL INSURANCE PREMIUM REIMBURSEMENT PLAN CLAIMS
Claims for the reimbursement of Individual Insurance
Premiums incurred in any Plan Year shall be paid as soon
after a claim has been filed as is adminst'ratively practicable;
provided however, that if a Participant fails to submit a claim
within the 60 day period immediately following the end of the Plan
Year, those Medical Expense claims shall not be considered for
reimbursement by the Adminstrator.
Upon presentation of a claim, a Participant shall
expressly represent that the item for which a claim is made is not
subject to reimbursement from any other source.
ARTICLE IX
ERISA PROVISIONS
9.1 CLAIM FOR BENEFITS
(a) Any claim 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
22
Participant of the denial of the claim within the 90 day period
specified above, then the claim shall be deemed denied. The
notice of a denial of a claim shall be written in a manner
calculated to be understood by the claimant and shall set forth:
(1) specific references to the pertinent Plan
provisions on which the denial is based;
(2) a description of any additional material or
information necessary for the claimant to perfect
the claim and an explanation as to why such
information is necessary; and
(3) an explanation of the Plan's claim procedure.
(b) Within 60 days after receipt of the above
material, the claimant shall have a reasonable
opportunity to appeal the claim denial to the
Administrator for a full and fair review. The claimant
or his duly authorized representative may:
(1) request a review upon written notice to the
Administrator;
(2) review pertinent documents; and
(3) submit issues and comments in writing.
(c) A decision on the review by the Administrator
will be made not later than 60 days after receipt of a
request for review, unless special circumstances require
an extension of time for processing (such as the need to
hold a hearing), in which event a decision should be
rendered as soon as 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, Dependent Care Assistance
Account and Individual Insurance Premium 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
23
held beyond the end of the Plan Year shall be forfeited
and credited to the benefit plan surplus.
9.2 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
qual if ied 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 specif ied herein for the f i 1 ing 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
distributed to Participants on a per capita basis as soon as
administratively feasible.
9.3 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.
9.4 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.
9.5 NONASSIGNABILITY 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
24
subjected shall not be recognized, except to such extent as may be
required by law.
ARTICLE X
ADMINISTRATION
10.1 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 under 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 under the Plan;
(d) To reject elections or to limit contributions
or Benefits for certain highly compensated participants
if it deems such to be desirable in order to avoid
discrimination under the Plan in violation of applicable
provisions of the Code;
(e) To provide Employees with a reasonable
notification of their benefits available under 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.
25
10.2 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.
10.3 PAYMENT OF EXPENSES
Any reasonable administrative expenses shall be paid by
the Employer unless the Employer determines that administrative
costs shall be borne by the Participants under the Plan 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.
10.4 INSURANCE'CONTROL CLAUSE
In the event of a conflict between 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.
10.5 INDEMNIFICATION OF ADMINISTRATOR
The Employer agrees to indemnify and to defend to the
fullest extent permitted by law any, Employee serving as the
Administrator or as a member of a committee designated as
Administrator (including any Employee or former Employee who
previously served as Administrator or as a member of such
committee) against all liabilities, damages, costs and expenses
(including attorney's fees and amounts paid in settlement of any
claims approved by the Employer) occasioned by any act or omission
to act in connection with the Plan, if such act or omission is in
good faith.
ARTICLE XI
AMENDMENT OR TERMINATION OF PLAN
11.1 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. Any such amendment shall be adopted by
formal action of the Employer's board of directors and executed by
an officer authorized to act on behalf of the Employer. No
26
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,
statues or regulations.
11.2 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 the 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), or until the
balances of all accounts have been reduced to zero, whichever
occurs first. 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 XII
MISCELLANEOUS
12.1 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
12.12.
12.2 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.
12.3 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.
27
12.4 EXCLUSIVE BENEFIT
This Plan shall be maintained for the exclusive benefit
of the Employees who participate in the Plan.
12.5 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.
12.6 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.
12.7 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, if any, that remained unpaid
for the period in question and the actual insurance
proceeds, if any, received by the Employer or the
Participant as a result of the Participant's claim.
(b) The Employer's liability to the Participant
shall only extend to and shall be limited to any payment
actually received by the Employer from the Insurer. In
the event that the full insurance Benefit contemplated is
not promptly received by the Employer within a reasonable
time after submission of a claim, then the Employer shall
notify the Participant of such facts and the Employer
shall no longer have any legal obligation whatsoever
(except to execute any document called for by a
settlement reached by the Participant). The Participant
shall be free to settle, compromise or refuse to pursue
the claim as the Participant, in his sole discretion,
shall see fit.
(c) The Employer shall not be responsible for the
validity of any Insurance Contract issued hereunder or
for the failure on the part of the Insurer to make
payments provided for under any Insurance Contract. Once
28
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.
12.8 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 forgoing, the
rights of Participants under this Plan shall be legally
enforceable.
12.9 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.
12.10 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.
29
12.11 GOVERNING LAW
This Plan is governed by the Code and 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
California.
12.12 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.
12.13 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.
12.14 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.
our
IN WITNESS
original Plan
WHEREOF,
document
day
this updated Plan document replaces
and is- hereby executed this
of , 19
By
EMPLOYER
WITNESSES AS TO EMPLOYER
30
The Family and Medical Leave Act of 1993 generally
requires covered employers to permit eligible employees to take up
to 12 weeks of unpaid, job protected leave each year
* upon the birth of an employee's child
* upon placement of a child with the employee for
adoption or foster care
* to care for a child, spouse or parent who has a
serious health condition, or
* when the employee is unable to perform the functions
of his or her position because of serious health
condition.
Subject to certain conditions, instead of taking an
unpaid leave, employees or employers may choose to use accrued paid
leave (such as sick or vacation leave) to cover some or a 1 1 of FMLA
leave.
The FMLA applies to all public agencies, including
state, local and federal employers, and local education agencies.
It also applies to private sector employers with 50 or more
employees in 20 or more workweeks in the current or preceding year.
To be eligible for FMLA benefits, an employee must
have worked for a covered employer for a total of at least 12
months, have worked at least 1250 hours over the previous 12
months, and work at a location where at least 50 employees are
employed by the employer within 75 miles.
The Employee's Share of any Health Premiums (if any)
and payment will need to be arranged prior to FMLA leave.
If the FMLA leave is substituted paid leave, the
employee's share of premiums must be paid by the method normally
used during any paid leave, presumably as a payroll deduction.
In contrast, if the FMLA leave is unpaid, the
employer has a number of options of obtaining payment from the
employee. All of the following options assume the employee elects
to continue his group insurance coverage. Note that an employee
may choose not to retain health coverage during FMLA leave.
The employer may require that payment be made to the
emloyer or to the insurance carrier, but no additional charge may
be added to the employee's premium payment for administrative
expenses. The employer may require employees to pay their share of
premium payments in any of the following ways:
* Payment would be due at the same time as it would be
made if by payroll deduction;
* Payment would be due on the same schedule as
payments are made under COBRA;
31
* Payment (during the Plan Year) would be prepaid
pursuant to a cafeteria plan at the employee's option;
* The employer's existing rules for payment by the
employees on "leave without pay" would be followed, provided that
such rules do not require prepayment (i.e. prior to the
commencement date of the leave) of the premiums that will become
due during the period of unpaid FMLA leave or payment of higher
premiums than if the employee had continued to work instead of
taking leave; or
* Another system voluntarily agreed to between the
employer and the employee, which may include prepayment of premiums
(e.g.through increased payroll deductions when the need for FMLA
leave is forseeable).
Whichever employee payment method is selected, "The
employer must provide the employee with advance written notice of
the terms and conditions under which these payments must be made."
Recovering the Group Health Plan Premium by the
Employer if the Employee Doesn't Return From Leave may be made.
The regulations permit an employer to recover a debt owed by the
non-returning employee. To the extent recovery is allowed, the
employer may recover the costs of deduction from any sums due to
the employee (e.g. unpaid wages, vacation pay, profit-sharing,
etc.) provided such deductions do not otherwise violate applicable
Federal or State wage payment or other laws. Alternatively, the
employer may initiate legal action against the employee to recover
such costs.
Exceptions are made to recover when the employee's
return is prevented because of a serious health condition of the
employee or the employee's child, spouse or parent or because of
other circumstances beyond the control of the employee.
32
12.16 CAFETERIA PLAN ELECTION OPTIONS UNDER FMLA
I. Continuing Coverage via Prepayment of Premiums - The
"Pre-Pay" Option. As an option, employees are given the
opportunity to prepay the premiums expected to owe during the FMLA
leave period. Choice of this option allows the employee to
voluntarily elect to have their final pre-leave paycheck to make a
special salary reduction contribution that will cover the
employee's share of the premiums for the expected duration of the
leave. The employee's salary reduction election is then suspended
for the duration of the leave. This reduction then resumes upon
the employee's return to work unless the employee makes a change in
family status election upon return from the leave.
II. Continuing Coverage via After-Tax Contributions -
The Pay-As-You-Go option. As an option, employees are given the
opportunity to pay their share of premiums during the leave with
after-tax dollars. During the FMLA leave, salary reduction
contributions are suspended and then resumed upon return from FMLA
leave. This can be the only option allowed by the employer.
III. Continuing Coverage via Promise to Make "Catch-Up"
Salary Reduction Contributions Upon Return from Leave.
Under the "catch-up" option, the employer pays both
the employer share of the premium and the employee share of the
premium during the FMLA leave. The employee, upon returning from
FMLA leave will repay the premium the employer advanced. Under
this option, the employee will make a special catch-up salary
reduction contribution that will cover the employee's share of the
premiums paid for them by the employer. This option can be the
only option allowed by the employer, if and only if, it is the only
option made available to employee on non-FMLA leave.
IV. Health Flexible Spending Account Options
A health plan that is a flexible spending account
(FSA) offered under a cafeteria plan must conform to the generally
applicable rules concerning employees who take FMLA leave. Thus,
FMLA requires that an employee taking FMLA leave be permitted to
* Continue coverage under a Health FSA while on FMLA
leave; or
* Revoke an existing Health FSA election under the
cafeteria plan for the remainder of the coverage period; or
* Reinstate the Health FSA upon return from FMLA leave
on the same terms as prior to taking FMLA leave.
Based upon the selection of the above, the employee
must exercise their choice of salary reduction contribution in the
same manner as allowed under the Group Health Plan Premium Payment
options. (NOTE: SEE EMPLOYER RESPONSE NOTICE AND SELECTION FORM)
33
MEMORANDUM RESPONDING TO EMPLOYEE'S REQUEST FOR FMLA LEAVE
AND CAFETERIA PLAN OPTION SELECTION FORM
RE: EMPLOYER RESPONSE TO EMPLOYEE
REQUEST FOR FAMILY OR MEDICAL LEAVE
TO:
FROM:
SUBJECT:
(EMPLOYEE
(EMPLOYER REPRESENTATIVE)
REQUEST FOR FAMILY LEAVE
SELECTION OF CAFETERIA PLAN OPTION
On , you notified us of your need to take
family/medical leave.
To continue benefits under the Cafeteria plan, you may elect one of
the following options:
1.
2.
3.
Choice of a "Pre-Pay" option in which the
employee's final pre-leave paycheck is
reduced by the amount of contributions
expected to occur during the FMLA leave.
Choice of a "Suspending" option in which
the employee's contributions are suspended
during the FMLA leave and reinstated at
the original per pay-period amount upon
return from FMLA leave.
Choice of a "Catch-Up" option in which the
employee's contributions are suspended
during the FMLA leave and reinstated upon
return from FMLA leave at the original
annual amount. The new pay period amount
to be calculated on a pro-rata basis for
the remaining pay periods of the plan
year.
SIGNATURE
EMPLOYEE NAME (PRINT)
DATE
34
12.17 INELIGIBLE CLASSIFICATION FOR PREMIUM REIMBURSEMENT
ACCOUNT (OPTIONAL)
For purposes of this , all employee
designated as follows are ineligible for the
Reimbursement Account discussed in Section 4.1.
classifications will have their premiums paid
directly and not under the Cafeteria plan.
classifications are:
s classifications
Premium Expense
These employee
by the employer
The employee
1.) President/Chief Executive officer
2.) Vice President(s)
3.) Treasurer/Controller
4.) All Management Classifications as defined:
35