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HomeMy WebLinkAbout2009/12/15 Item 6 CITY COUNCIL AGENDA STATEMENT ::~},v t-- ClIT OF ~ (HUlA VISTA DECEMBER 15, 2009, Item~ ITEM TITLE: RESOLUTION ADOPTING THE CITY OF CHULA VISTA CAFETERlA BENEFITS PLAt" FOR 2010 DrRECTOR OF HUf RESOURCES i!/J" CITY MANAGER ASSISTANT CITY ANAGER S~ SUBMITTED BY: REVIEWED BY: 4/5THS VOTE: YES D NO [ X I SUMMARY The Internal Revenue Code requires that the Section 125 Cafeteria Benefits Plan offered by the City to its employees be in a written document and that the document be formally adopted by the City Council on or before the first day of the plan year. Adoption by resolution of the attached plan document fulfills the City's obligation for the 2010 plan year. ENVIRONMENTAL REVIEW . Not applicable. RECOMMENDATION That Council adopt the plan by resolution. BOARDS/COMMISSION RECOMMENDATION Not applicable. DISCUSSION In June 1998. the City established its first Section 125 Cafeteria Benefits Plan. In compliance with Internal Revenue Code S 125(d) the City Council annually adopts a written plan document prior to the first day of the plan year. The first day of the City's plan year is January 1,2010. This Plan Document lays out how the City offers eligible employees the choice between cash and certain nontaxable benefits (such as health insurance), thereby allowing employees to pay for the benefits they choose on a pre-tax basis. 6-1 DECEMBER IS, 2009, 1tem~ Page 2 of2 The specific health plans otTered and their structure are not part of this Cafeteria Plan Document. They are included in what is known as the Summary Plan Document that was given to eligible employees as part of their open enrollment materials to assist them in making their benefit choices. The plans offered and their structure are determined after our broker, Barney and Barney, extensively markets and negotiates with providers to provide coverage comparable to the prior year while keeping the increase in costs to the City and its benefited employees to a minimum. All employee groups are advised of the offers and the plan structures that will provide the least increase in premium costs. Under current cafeteria plan regulations having an approved written plan is critical. Without a written plan or if the written plan does not comply with applicable requirements regarding content and timing of adoption, then the plan is not a cafeteria plan and employees' elections will be ta;xable. The City has timed its open enrollment period for 2010 to comply with these regulations and to meet provider cutoff deadlines for enrollment to ensure employees are covered without interruption. The City's Plan includes the following required information: . Description of available benefits . Participation rules . Election procedures . Manner of contributions . Maximum amount of contributions . The plan year . The plans provisions for complying with flexible spending arrangements (FSAs) The attached Plan incorporates all of the operating rules prescribed in Code S 125 and the regulations thereunder. DECISION MAKER CONFLICT Staff has reviewed the decision contemplated by this action and has determined that it is not site specific and consequently the 500 foot rule found in California Code of Regulations section I 8704.2(a)(l) is not applicable to this decision. CURRENT YEAR FISCAL IMPACT None with this action. ONGOING FISCAL IMPACT None with this action. ATTACHMENTS Attachment A -2010 City of Chula Vista Cafeteria Benefits Plan Prepared by: Teri Enos, Risk Manager 6-2 ~{~ -IP$- "-- --- -0::::-:....-- - 0lY OF CHUlA VISTA CAFETERIA BENEFITS PLAN FOR THE CITY OF CHULA VISTA Amended and Restated as of January 1, 2010 Established June 1998 Human Resources Department City of Chula Vista 6-3 SECTION 125 CAFETERIA BENEFIT PLAN ADOPTION AGREEMENT The undersigned Employer hereby adopts the Section 125 Cafeteria Benefit Plan for those Employees who shall qualify as Participants hereunder. The Employer herby selects the following Plan Specifications: A. EMPLOYER INFORMATION Name of Employer: City of Chula Vista Address: 276 Fourth Ave. Chula Vista, CA 91910 Employer Tax 10: 95-6000690 Nature of Business: Municipal Government Name of Plan: City of Chula Vista Cafeteria Benefits Plan B. EFFECTIVE DATE Original Effective Date of Plan: June 1998 Effective Date of Amendment: January 1, 2010 C. ELIGIBILITY REQUIREMENTS FOR PARTICIPATION Eligibility requirements for each component plan under this Section 125 document will be applicable and, if different, will be listed in Item F. Employee Status: Directly employed by the City of Chula Vista in a full- or part-time benefited status. Length of Service: First day of employment in a benefited status. D. PLAN YEAR The current plan year will begin on January 1, 2010 and end on December 31, 2010. 12/1/2009 9:36 AM 6-4 Page 2 of 22 E. EMPLOYER CONTRIBUTIONS Non-Elective Contributions: Non-Elective Contributions (Safetvl: Elective Contributions (Salarv Reductionl: 12/1/2009 9:36 AM The maximum amount available to each Participant for the purchase of certain elected benefits (Group Medical Insurance, Group Dental Insurance, Group Vision, Dental/MedicalNision and Dependent/Child Care Reimbursement and Cash Payment Option) with non- elective contributions will be: Confidential CVEA Executive MM,MMCF,MMUC PROF,PRCF,PRUC Senior Managers WCE Mayor/Council $10,882 $10,382 $13,782 $11,382 $11,382 $12,382 $11,382 $13,782 For Employees represented by PONIAFF -The employer pays the full cost of the Kaiser Permanente Plan for employees and their dependents or the annual premium less $600 for non-Kaiser plans. For dental coverage the City will pay an amount equal to the pre-paid dental premium for the coverage level elected. Each Participant may authorize the Employer to reduce his or her compensation by the amount needed for the purchase of benefits elected, less the amount of non-elective contributions. An election for salary reduction will be made on the Benefit Election Form. 6-5 Page 3 of 22 F. AVAILABLE BENEFITS Each of the following components should be considered a plan that comprises this Plan. 1. Group Medical Insurance Mandatory for all employees except those who are covered by their City Employee Spouse or who are represented by MM, MMUC,MMCF,PROF, PRCF,PRUC and can provide evidence of other qualified coverage. 2. Dental Insurance 3. Vision Insurance 4. Dental/MedicalNision Reimbursement Account 12/1/2009 9:36 AM The terms, conditions, and limitations for the Group Medical Insurance will be as set forth in the insurance policy or policies described below: (See Section V of the Plan Document). The terms, conditions and limitations for the Dental Insurance will be as set forth in the insurance policy or policies described below: (See Section V of the Plan Document) The terms, conditions and limitations for the Dental Insurance will be as set forth in the insurance policy or policies described below: (See Section V of the Plan Document) The terms conditions and Limitations for the DentallMedicalNision Reimbursement Account will be as set forth in Section VI of the Plan Document and described below: Minimum Coverage:- $0 per Plan Year Maximum Contribution: $5,000 from all sources per Plan Year. Recordkeeper: Wage Works 6-6 Page 4 of 22 5. Dependent/Child Care Reimbursement Account The terms conditions and Limitations for the Dependent! Child Care Reimbursement Account will be as set forth in Section VII of the Plan Document and described below: Minimum coverage: $0 per Plan Year Maximum Coverage-$5,000 per plan year from all sources ($2,500 per plan year from all sources for a married employee filing separate tax returns). Recordkeeper: Wage Works 6. Cash Payment Option Any Flex Plan allotment remaining after electing mandatory medical coverage may be allotted to this taxable option. 7. The following benefits are only available through Elective Contributions (Salary Reduction): AFLAC Cancer Insurance AFLAC Basic Dental Coverage AFLAC Accident Insurance AFLAC Hospital Indemnity Insurance AFLAC Specified Health Event Insurance The terms condition and limitations for the AFLAC programs will be as set forth in Section VIII of the Plan Document. Administered by: AFLAC The Plan shall be construed, enforced, administered, and the validity determined in accordance with the applicable provisions of the Employee Retirement Income Security Act of 1974 (as amended) if applicable, the Internal Revenue Code of 1986 (as amended), and the laws of the State of California. Should any provision be determined to be void, invalid, or unenforceable by any court of competent jurisdiction, the Plan will continue to 12/1/2009 9:36 AM 6-7 Page 5 of 22 operate, and for purposes of the jurisdiction of the court only, will be deemed not to include the provision determined to be void. This Plan is hereby adopted the 15th day of December, 2009 By: Title: THIS DOCUMENT IS NOT COMPLETE WITHOUT PAGES 7 THROUGH 22 12/1/2009 9:36 AM 6-8 Page 6 of 22 SECTION 125 CAFETERIA BENEFITS PLAN SECTION 1 PURPOSE The Employer is establishing this Cafeteria Benefits Plan in order to make a broader range of benefits available to its Employees and their Dependents. The Plan allows Employees to choose among different types of benefits and select the combination best suited to their individual goals, desires, and needs. These choices include an option to receive certain benefits in lieu of taxable compensation. In establishing this Plan, the Employer desires to attract, reward, and retain highly qualified, competent employees, and believes this Plan will help achieve that goal. It is the intent of the Employer to establish this Plan in conformity with Section 125 of the Internal Revenue Code of 1986, as amended, and in compliance with applicable rules and regulations issued by the Internal Revenue Service. This Plan will grant to eligible Employees an opportunity to purchase qualified benefits, which when purchased alone by the Employer, would not be taxable. SECTION II DEFINITIONS The following words and phrases appear in this Plan and will have the meaning indicated below unless a different meaning is plainly required by the context: "Administrator" means the Human Resources Department of the City of Chula Vista, or other such person or entity that it appoints as its designee. "Annual Enrollment Period" means the period designated by the Administrator which precedes the commencement of each Plan Year during which Eligible Employees can elect or modify the amount contributed for Benefits. "Applicable Law" means the Internal Revenue Code of 1986, and the same as may be amended from time to time, plus all regulations promulgated with respect thereto. Reference to any section or subsection of the Code includes reference to any comparable or succeeding provision of any legislation which amends, supplements or replaces such section or subsection. "Benefit Election Form" See Enrollment Form. 12/1/2009 9:36 AM 6-9 Page 7 of 22 "Benefit Package Option" means a qualified benefit under Code Section 125 (f) that is offered under the Cafeteria (Flexible) Benefits Plan, or an option for coverage under an underlying health plan (such as an HMO or PPO option under a health plan). "Benefits" or "Qualified Benefits" means the following benefits available under the Flex Plan: (a) Group Medical Insurance (b) DependenUChild Care Reimbursement Account (c) DentallMedicalNision Reimbursement Account (d) Cash Compensation (Post-Tax) (e) Health Premiums for Non-Tax Qualified Dependents (Post- Tax) (f) Vision Insurance (g) Dental Insurance (h) Certain AFLAC Plans available via salary reduction only. "Code" means the Internal Revenue Code of 1986, as amended. "Dental/MedicalNision Reimbursement Account" Shall have the meaning assigned to it by Section 6.01 of the Plan attached hereto as Exhibit A. "Dependent" means an individual that meets all the requirements of Code Section 152, including: (a) Participant's legal spouse (b) Unmarried children who are dependent upon the employee for support it they are under 25 years of age; (c) Unmarried children of any age if they are incapable of self-support due to mental or physical handicap and such handicap began before age 25 And (d) Life Partners (see definition of Life Partner) "DependenUChild Care Reimbursement Account" shall have the same meaning assigned to it by Section 6.02 of the Plan Attached hereto as Exhibit A. "Effective Date" of this Flex Plan was June 1998. "Eligible Employee" means any active, full- or part-time employee of the City of Chula Vista employed in a benefited status. "Employee" means an individual that the Employer classifies as active, full-time or part-time, who is on the Employer's W-2 payroll, include elected and appointed officials but does not include the following: (a) any leased employee or an individual classified as a contract worker; independent contractor, temporary employee or casual employee for the period during which such individual is so classified, whether or not any such individuals are on the Employer's W-2 payroll or determined by the 12/1/2009 9:36 AM 6-10 Page 8 of 22 IRS or others or be common-law employees of the Employer; (b) any individual who performs services for the Employer but who is paid by a temporary or other employment or staffing agency for the period during which such individual is paid by such agency, whether or not such individual are determined by the IRS or others to be common-law employees of the Employer. "Employer" means the City of Chula Vista. "Enrollment Form" means the form or forms whether paper or electronic provided by the Employer or the Administrator for the purpose of allowing an Eligible Employee to participate in this Cafeteria Benefits Plan by employer contributions and by electing Salary Reductions to pay for Benefits. It includes an agreement pursuant to which an Eligible Employee or Participant authorizes the employer to make Salary Reductions. "Enrollment Period" means the period designated by the Administrator which allows new employees to select Benefits for the current Plan Year and shall be the first 30 days following each new Eligible employee's hire date. "Entry Date" shall mean the date that an Eligible Employee shall become a Participant: (a) on the first day of the Flex Plan Year if the Eligible Employee's elects are made during the annual Enrollment Period, or (b) on the first day of the pay period coinciding with the receipt of the Enrollment Form by the Participant's Employer, provided the new hire makes such request within 30 days after the date of employment, or (c) on the first day coinciding with the date of satisfying the plan's eligibility requirements. "FMLA" means the Family and Medical Leave Act of 1993, as amended. "Flex Plan Year" means the twelve-month period commencing on January 1 and ending on December 30th "Health Plan" means the group medical, dental and vision plans maintained by the City for its employees, as amended from time to time and are automatically incorporated by reference under this Flex Plan. A Participant may request a copy of the plan(s) from the Human Resources Benefits Division. "HIPAA" Means the Health Insurance Portability and Accountability Act of 1996 as amended. "Life Partner" means: both you and your partner are eighteen (18) years of age or older and are capable of consenting to the domestic partnership; neither of you can be married to another or be a member of another domestic partnership; you cannot be related by blood in a way that would prevent you from being married to each 12/1/2009 9:36 AM 6-11 Page 9 of 22 other in this state; you must share the same principal place of abode, with the intent to continue doing so indefinitely (this means that both partners share the same residence, however, it is not necessary that the legal right to possess the common residence be in both names); You are jointly financially responsible for "basic living expenses; defined as basic food, water, shelter, and any other basic living expenses. Life partners do not need to contribute equally to the cost of these expenses as long as they agree that both are responsible for the cost; neither of you have had a different domestic partner in the last six (6) months unless a previous domestic partnership terminated by death. "Non-elective Contribution(s)" means any amount which the Employer, pursuant to Labor Agreements contributes on behalf of each Participant to provide benefits for such Participant and his or her Dependents, if applicable, under one or more of the Benefit Plan Option(s) offered under the Plan. The amount shall be calculated for each plan year in a uniform and nondiscriminatory manner and in the case of POA and IAFF employees will be based upon the Participant's elected coverage dependent status, and for all others may be based on the commencement or termination date of the Participant's employment during the Plan Year, and such other factors as the Employer shall prescribe. To the extent set forth in the Summary Plan Description or enrollment material, the Employer may make non- elective contribution available to Participants and allow Participants to allocate the Non-elective Contributions among the various Benefit Plan Options offered under the Plan in a manner set forth in the Summary Plan Description or enrollment material. In no event will any Non-elective Contribution be disbursed to a Participant in the form of additional, taxable Compensation except as otherwise provided in the Summary Plan Description or enrollment material. "Participant" means all Eligible Employees. "Period of Coverage" means that portion of the Flex Plan Year for which one is a Participant. In no event shall the period of coverage commence prior to, nor terminate after, the commencement and ending dates of the Flex Plan Year. "Qualified Benefits" means any benefit excluded from the Employee's taxable income under Chapter 1 of the Code other than Sections 106 (b), 117,124, 127 or 132 and any other benefit permitted by the Income Tax Regulations (i.e. any premiums for Life Partners who are not otherwise tax qualified dependents). Long term care is not a "Qualified Benefit" 12/1/2009 9:36 AM 6-12 Page 10 of 22 SECTION III ELGIBILlTY, ENROLLMENT, AND PARTICIPATION 3.01 ELIGIBILITY: Each Employee of the Employer who has met the eligibility requirements of Item C of the Adoption Agreement will be eligible to participate in the Plan on the entry date specified or the effective date of the Plan, which ever is later. The Employer must notify the Employee of his eligibility to participate in the Plan so that the Employee shall complete the necessary enrollment forms on or before the entry date. 3.02 ENROLLMENT: An eligible Employee may enroll (or re-enroll) in the Plan by submitting to the Employer, during an enrollment period, an Election Form which specifies his or her benefit elections for the Plan Year and which meets such standards for completeness and accuracy as the Employer may establish. A Participant's Election Form shall be completed prior to the beginning of the Plan Year, and shall not be effective prior to the date such form is submitted to the Employer. Any Election Form submitted by a Participant in accordance with this Section shall remain in effect until the earlier of the following dates: the date the Participant terminates participation in the Plan; or, the effective date of a subsequently filed Election Form. A Participant's right to elect certain benefit coverage shall be limited hereunder to the extent such rights are limited in the Policy. Furthermore, a Participant will not be entitled to revoke an election after a period of coverage has commenced and to make a new election with respect to the remainder of the period of coverage unless both the revocation and the new election are on account of and consistent with a change in status, or other allowable events, as determined by Section 125 of the Internal Revenue Code and the regulations thereunder. Notwithstanding anything to the contrary herein, to the extent required by the Health Insurance Portability and Accountability Act of 1996, the Plan shall permit special enrollment period for employees who have previously declined coverage under the Plan; a new dependent may also justify a special enrollment period. 3.03 DEFAULT ENROLLMENT: (a) Employees o(the CVEA, WCE, MAYOR, COUNCIL, CITY ATTORNEY, CITY CLERK, EXECUTIVE, SENIOR MANAGER, MID-MANAGER, MID- MANAGER CONFIDENTIAL, MID-MANAGER UNCLASSIFIED, PROFESSIONAL, PROFESSIONAL CONFIDENTIAL, PROFESSIONAL UNCLASSIFIED, AND CONFIDENTIAL employee groups who fail to make their elections during Open Enrollment will have their current medical and life insurance automatically continued in to the next Plan year as if the Employee elected to keep them. All other coverage, including dental, vision and reimbursement accounts will stop. Any Flex Allotment funds remaining after the health coverage election will be placed in the taxable cash option. 12/1/2009 9:36 AM 6-13 Page 11 of 22 In the case of a newly eligible employee, failure to turn in the completed enrollment forms within 30 days from eligibility date will result in automatic enrollment in the least costly medical coverage for employee only with any remaining funds placed in the taxable Cash Payment Option. (b) POA and IAFF employees who fail to make their benefit elections either within 30 days of their eligibility date or during open enrollment will only be enrolled in the Kaiser Employee Only plan. 3.04 TERMINATION OF PARTICIPATION: A Participant shall continue to participate in the Plan until the earlier of the following dates: a. The date the Participant terminates employment by death, disability, retirement or other separation from service; or b. The date the Participant ceases to work for the Employer as an eligible Employee; c. The date of termination of the Plan; d. The first date a Participant fails to pay required contributions while on a leave of absence, or e. The date an employee is on a leave of absence without benefits. 3.05 SEPARATION FROM SERVICE: The Employer shall, on a reasonable and consistent basis, permit an Employee who separates from the employment service of the Employer during a Plan Year to revoke his existing elections and terminate the receipt of benefits for the remaining portion of the Plan Year. 3.06 QUALIFYING LEAVE UNDER FAMILY LEAVE ACT: Notwithstanding any provision to the contrary in this Plan, if a Participant goes on a qualifying paid or unpaid leave under the Family and Medical Leave Act of 1993 (FMLA), to the extent required by the FMLA, the Employer will continue to maintain the Participant's existing coverage under the Plan with respect to the benefits under Section V and Section VI of the Plan on the same terms and conditions as though they were still an active Employee. If the Employee fails to return to work after such leave for any reason other than the serious illness of the employee or the family member for whom the leave was granted or through no fault of the employee, they will be required to pay all Cafeteria Benefits Plan monies paid to them, or on their behalf during the absence. 3.07 COVERAGE WHILE ON A LEAVE OF ABSENCE WITH BENEFITS: Employees who are authorized to take a leave with benefits (e.g. Military Leave as approved by the City Council) will continue to be covered under the Plan until the expiration of their leave. 12/1/2009 9:36 AM 6-14 Page 12 of 22 3.08 COVERAGE WHILE ON A LEAVE OF ABSENCE WITHOUT BENEFITS: Employees on an unpaid leave of absence for any reason other than those under Section 3.06 and 3.07 are no longer eligible for participation in the Plan. SECTION IV CONTRIBUTIONS 4.01 EMPLOYER CONTRIBUTIONS: The Employer may pay the costs of the benefits elected under the Plan with funds from the sources indicated in Item E of the Adoption Agreement. The Employer Contribution may be made up of Non-Elective Contributions and/or Elective Contributions authorized by each Participant. 4.02 IRREVOCABILITY OF ELECTIONS: A Participant may file a written election form with the Administrator before the end of the current plan year revising the rate of his contributions or discontinuing such contributions effective as of the first day of the following Plan Year. The Participant's Elective Contributions will automatically terminate the date his employment terminates. Except as provided in this Section 4.02 and Section 4.03, a Participant's election under the Plan is irrevocable for the duration of the plan year to which it relates. The exceptions to the irrevocability requirement which would permit a mid-year election change in benefits and the salary reduction amount elected are set out in the Treasury regulations promulgated under Code Section 125, which include the following: (a) ChanQe in Status. A Participant may change or revoke his election under the Plan upon the occurrence of a valid change in status, but only if such change or termination is made on account of, and is consistent with, the change in status in accordance with the Treasury regulations promulgated under Section 125. The Employer, in its sole discretion as Administrator, shall determine whether a requested change is on account of and consistent with a change in status, as follows: (1) Change in Employee's legal marital status, including marriage, divorce, death of spouse, legal separation, and annulment; (2) Change in number of Dependents, including birth, adoption, placement for adoption, and death; (3) Change in employment status, including any employment status change affecting benefit eligibility of the Employee, spouse or Dependent, such as termination or commencement of employment, change in hours, strike or lockout, a commencement or return from an unpaid leave of absence and change in work site. If the eligibility for either the cafeteria Plan or any underlying benefit plans of the 12/1/2009 9:36 AM 6-15 Page 13 of 22 Employer of the Employee, spouse or Dependent relies on the employment status of that individual, and there is a change in that individual's employment status resulting in gaining or losing eligibility under the Plan, this constitutes a valid change in status. This category only applies if the benefit eligibility is lost or gained as a result of the event. If an Employee terminates and is rehired within 30 days, the Employee is required to step back into his previous election. If the Employee terminates and his rehired after 30 days, the Employee may either step back into the previous election or make a new election; (4) Dependent satisfies, or ceases to satisfy, Dependent eligibility requirements due to attainment of age, gain or loss of student status, marriage or any similar circumstances; and (5) Resident change of Employee, spouse or Dependent, affecting the Employee's eligibility for coverage. (b) Special HIPAA Enrollment Riqhts. If a Participant, spouse, or Dependent enrolls in the health insurance plan pursuant to special enrollment rights under HIPAA, the Participant may make a corresponding change in election under this Plan. Special enrollment rights under the health insurance plan will be determined by the terms of the health insurance plan. (c) Certain Judqments, Decrees or Orders. If a judgment, decree or order resulting from a divorce, legal separation, annulment or change in legal custody (including a qualified medical child support order [OMCSO]) requires accident or health coverage for a Participant's child or for a foster child who is a dependent of the Participant, the Participant may have a mid-year election change to add or drop coverage consistent with the Order. . (d) Entitlement to Medicare or Medicaid. If a Participant, Participant's spouse or Participant's Dependent who is enrolled in an accident or health plan of the Employer becomes entitled to Medicare or Medicaid (other than coverage consisting solely of benefits under Section 1928 of the Social Security Act providing for pediatric vaccines), the Participant may cancel or reduce health coverage under the Employer's Plan. Loss of Medicare or Medicaid entitlement would allow the Participant to add health coverage under the Employer's Plan. (e) Familv Medical Leave Act. If an Employee is taking leave under the rules of the Family Medical Leave Act, the Employee may revoke previous elections and re-elect benefits upon return to work. (f) COBRA Oualifvinq Event. If an Employee has a COBRA qualifying event (a reduction in hours of the Employee, or a Dependent ceases eligibility), the Employee may increase his pre-tax contributions for coverage under the Employee's Plan if a COBRA event occurs with respect to the Employee, the 12/1/2009 9:36 AM 6-16 Page 14 of 22 Employee's spouse or Dependent. The COBRA rule does not apply to COBRA coverage under another Employer's Plan. 4.03 OTHER EXEPTIONS TO THE IRREVOCABILITY OF ELECTIONS. Other exceptions to the irrevocability of election requirement permit mid-year election changes an apply to all qualified benefits except for Dental/MedicalNision Reimbursement Plan, as follows: (a) Chanqe in Cost. If the cost of a benefit package option under the Plan significantly increases during the plan year, Participants may (i) make a corresponding increase in their salary reduction amount, (ii) revoke their elections and make a prospective election under another benefit option offering similar coverage, or (iii) revoke election completely if no similar coverage is available, including in spouse or dependent's plan. If the cost significantly decreases, employees may elect coverage even if they had not previously participated and may drop their previous election for a similar coverage option in order to elect the benefit package option that has decreased in cost during the year. If the increased or decreased cost of a benefit package option under the Plan is insignificant, the participant's salary reduction amount shall be automatically adjusted. (b) Siqnificant curtailment of coveraqe. (iL) With no loss of coverage. If the coverage under a benefit package option is significantly curtailed or ceases during the Plan Year, affected Participants may revoke their elections for the curtailed coverage and make a new prospective election for coverage under another benefit package option providing similar coverage. With loss of coverage. It there is a significant curtailment of coverage with loss of coverage, affect Participants may revoke election for curtailed coverage an make a new prospective election for coverage under another benefit package option providing similar coverage, or drop coverage if no similar benefit package option is available. (i.) (c) Addition or Siqnificant Improvement of Benefit Packaqe Option. If during the Plan Year a new benefit package option is added or significantly improved, eligible employees, whether currently participating or not, may revoke their existing election and elect the newly added or newly improved option. (d) Chanqe in Coveraqe of a Spouse or Dependent Under Another Emplover's Plan. If there is a change in coverage of a spouse, former spouse, or Dependent under another employer's plan, a Participant may make a prospective election change that is on account of and corresponds with a change made under the plan of the spouse or Dependent. This rule applies if (1) mandatory changes in coverage are initiated by either the insurer of 12/1/2009 9:36 AM 6-17 Page 15 of 22 spouse/dependent's plan or by the spouse/dependent's employer, or (2) option changes are initiated by the spouse/dependent's employer or by the spouse/dependent through open enrollment. (e) Loss of coveraqe under other qroup health coveraqe, If during the Plan Year coverage is lost under any group health coverage sponsored by a governmental or educational institution, a Participant may prospectively change his or her election to add group health coverage for the affected Participant or his or her spouse or dependent. 4.04 CASH BENEFIT: Available amounts not used for the purchase of benefits under this Plan may be considered a cash benefit under the Plan payable to the Participant as taxable income to the extent indicated in Item E of the Adoption Agreement. 4.05 PAYMENT FROM EMPLOYER'S GENERAL ASSETS: Payment of benefits under this Plan shall be made by the Employer from Elective Contributions which shall be held as part of its general assets. 4.06 EMPLOYER MAY HOLD ELECTIVE CONTRIBUTIONS: Pending payment of benefits in accordance with the terms of this Plan, Elective Contributions may be retained by the Employer in a separate account, or if elected by the Employer and as permitted or required by regulations of the Internal Revenue Service, Department of Labor or other governmental agency, such amounts of Elective Contributions my be held in a trust pending payment. 4.07 MAXIMUM EMPLOYER CONTRIBUTIONS: With respect to each Participant, the maximum amount made available to pay benefits for any Plan Year shall not exceed the Employer's Contribution specified in the Adoption Agreement and as provided in this Plan. SECTION V GROUP MEDICAL INSURANCE BENEFIT PLAN 5.01 PURPOSE: These benefits provide the group medical insurance benefits to Participants. 5.02 ELIGIBILITY: Eligibility will be required in Items F(1), F(2), and F(3) of the Adoption Agreement. 5.03 DESCRIPTION OF BENEFITS: The benefits available under this Plan will be as defined in items F(1), F(2), and F(3) of the Adoption Agreement. 5.04 TERMS. CONDITONS AND LIMITATIONS: limitations of the benefits offered shall be as Policy identified in the Adoption Agreement. 12/1/2009 9:36 AM The terms, conditions and specifically described in the 6-18 Page 16 of 22 5.05 COBRA: To the extent required by Section 4980B of the Code and Sections 601 through 607 of ERISA, Participants and Dependents shall be entitled to continued participation in this Group Medical Insurance Benefit Plan by contributing monthly (form their personal assess previously subject to taxation) 102% of the amount of the premium for the desired benefits during the period that such individual is entitled to elect continuation coverage, provide, however, in the event the continuation period is extended to 29 months due to disability, the premium to be paid for the continuation coverage for the 11 month extension period shall be 150% of the applicable premium. 5.06 SECTION 105 AND 106 PLAN: It is the intention of the Employer that these benefits shall be eligible for exclusion from the gross income of the Participants covered by this benefit plan, as provided in Code Sections 105 and 106, and all provisions of this benefit plan shall be construed in a manner consistent with that intention. It is also the intention of the Employer to comply with the provision of the Consolidated Omnibus Budget Reconciliation Act of 1985 as outlined in the policies identified in the Adoption Agreement. . 5.07 CONTRIBTUIONS: Contributions for these benefits will be provided by the Employer on behalf of a Participant as provided for in Item E of the Adoption Agreement. 5.08 UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT: Notwithstanding anything to the contrary herein, the Group Medical Insurance Benefit Plan shall comply with the applicable provision of the Uniformed Services Employment and Reemployment Rights Act of 1994. SECTION VI DENTALlMEDICALNISION REIMBURSEMENT PLAN 6.01 The Plan Document for this option is included in the attached Exhibit A and is incorporated by reference. SECTION VII DEPENDENT/CHILD CARE REIMBURSEMENT PLAN 7.01 The Plan Document for this option is included in the attached Exhibit A and is incorporated by reference. 12/1/2009 9:36 AM 6-19 Page 17 of 22 SECTION VIII AFLAC CANCER, BASIC DENTAL COVERAGE, ACCIDENT INSURANCE, HOSPITAL INDEMNITY INSURANCE, SPECIFIED HEALTH EVENT INSURANCE . 8.01 The Plan Document for these options is included in the attached Exhibit 8 and is incorporated by reference. SECTION IX AMENDMENT AND TERMINATION 9.01 AMENDMENT: The Employer shall have the right at any time, and from time to time, to amend, in whole or in part, any or all of the provisions of this Plan, provided that no such amendment shall change the terms and conditions of payment of any benefits to which Participants and covered dependents otherwise have become entitled to under the provisions of the Plan, unless such amendment is made to comply with federal or local laws or regulations. The Employer also shall have the right to make any amendment retroactively, which is necessary to bring the Plan into conformity with the Code. In addition, the Employer may amend any provision or any supplements to the Plan and may merge or combine supplements or add additional supplement to the Plan, or separate existing supplements into an additional number of supplements. 9.02 TERMINATION: The Employer shall have the right at any time to terminate this Plan, provided that such termination shall not eliminate any obligations of the Employer which therefore have arise under the Plan. SECTION X ADMINISTRATION 10.01 NAMED FIDUCIARIES: The Administrator shall be the fiduciary of the Plan. 10.02 APPOINTMENT OF RECORDKEEPER: The Employer may appoint a Reimbursement Recordkeeper which shall have the power and responsibility of performing Recordkeeping and other ministerial duties arising under the Dental/MedicalNision Reimbursement Plan and the Dependent/Child Care Reimbursement Plan provisions of this Plan. The Reimbursement Recordkeeper shall serve at the pleasure of, and may be removed by, the Employer without cause. The Recordkeeper shall receive reasonable compensation for its services as shall be agreed upon from time to time between the Administrator and the Recordkeeper. 12/1/2009 9:36 AM 6-20 Page 18 of 22 10.03 POWERS AND RESPONSIBILITIES OF ADMINISTRATOR: a. General. The Administrator shall be vested with all powers and authority necessary in order to amend and administer the Plan, and is authorized to make such rules and regulations as it may deem necessary to carry out the provisions of the Plan. The Administrator shall determine any questions arising in the administration (including all questions of eligibility and determination of amount, time and manner of payments of benefits), construction, interpretation and application of the Plan, and the decision of the Administrator shall be final and binding on all persons. b. Recordkeeping. The Administrator shall keep full and complete records of the administration of the Plan. The Administrator shall prepare such reports and such information concerning the Plan and the administration thereof by the Administrator as may be required under the Code or ERISA and the regulation promulgated thereunder. c. Inspection of Records. The Administrator shall, during normal business hours, make available to each Participant for examination by the Participant at the principal office of the Administrator a copy of the Plan and such records of the Administrator as may pertain to such Participant. No Participant shall have the right to inquires as to or inspect the accounts or records with respect to other Participants. 10.04 COMPENSATION AND EXPENSES OF ADMINISTRATOR: The Administrator shall serve without compensation for services as such. All expenses of the Administrator shall be paid by the Employer. Such expenses shall include any expense incident to the functioning of the Plan, including, but not limited to, attorneys' fees, accounting and clerical charges, actuary fees and other costs of administering the Plan. 10.05 LIABILITY OF ADMINISTRATOR: Except as prohibited by law, the Administrator shall not be liable personally for any loss or damage or depreciation which may result in connection with the exercise of duties or of discretion hereunder or upon any other act or omission hereunder except when due to willful misconduct. In the event the Administrator is not covered by fiduciary liability insurance or similar insurance arrangements, the Employer shall indemnify and hold harmless the Administrator from any and all claims, losses, damages, expenses, (including reasonable counsel fees approved by the Administrator) and liability (including any reasonable amounts paid in settlement with the Employer's approval) arising from any act or omission of the Administrator, except when the same is determined to be due to the willful misconduct of the Administrator by a court of competent jurisdiction. 12/1/2009 9:36 AM 6-21 Page 19 of 22 10.06 DELEGATION OF RESPONSIBILITY: The Administrator shall have the authority to delegate, from time to time, all or any part of its responsibilities under the Plan to such person or persons as it may deem advisable and in the same manner to revoke any such delegation of responsibility which shall have the same force and effect for all purposes hereunder as if such action had been taken by the Administrator. The Administrator shall not be liable for any acts or omissions of any such delegate. The delegate shall report periodically to the Administrator concerning the discharge of the delegated responsibilities. 10.06 RIGHT TO RECEIVE AND RELEASE NECESSARY INFORMATION: The Administrator may release or obtain any information necessary for the application, implementation and determination of this Plan or other Plans without consent or notice to any person. This information may be released to or obtained from any insurance company, organization, or person subject to applicable law. Any individual claiming benefits under this Plan shall furnish to the Administrator such information as may be necessary to implement this provision. 10.07 CLAIM FOR BENEFITS: To obtain payment of any benefits under the Plan a Participant must comply with the rules and procedures of the particular benefit program elected pursuant to this Plan under which the Participant claims a benefit. 10.08 PROTECTED HEALTH INFORMATION: The provisions of this Section shall be effective on April 14, 2004 or at such other date required by45 CFR Section 164.534. The Plan may disclose PHI to employees of the Employer with employee benefits responsibility or to employees with oversight responsibility for third party administrator claims administration. Access to and use by such individual must be restricted to plan administration functions that the plan sponsor performs for the Plan. The applicable claims procedures under the Plan shall be used to resolve any issues of non- compliance by such individuals. The Plan may disclose PHI to such individual only if the Employer certifies that the Plan documents have been amended to incorporate the following specific provisions, and the Employer agrees to comply with them. The Employer will: . Not use or further disclose PHI other than as permitted by the plan documents or as required by law; . Ensure that any agents or subcontractors to whom it provides PHI received from the Plan agree to the same restrictions and conditions that apply to the Employer; . Not use or disclose PHI for employment-related actions or in connection with any other employee benefit plan; 12/1/2009 9:36 AM 6-22 Page 20 of 22 . Report to the Plan any use of disclosure of the information that is inconsistent wit the permitted uses or disclosures; . Make available to Plan participants, consider their amendments, and upon their request, provide them with an accounting of PHI disclosures; . Make its internal practices and records relating to the use and disclosure of PHI received from the Plan available to the Department of Health and Human Services upon request; and . Will, if feasible, return or destroy all PHI received from the Plan that the Employer still maintains in any form and retain no copies of such information when no longer needed for the purposes for which the disclosure was made, except that, if such return or destruction is not feasible, limit further uses no disclosure to those purposes that make the return or discretion 0 the information infeasible. For purposes of this Section, "PHI" is "Protected Health Information" as defined in 45 CFR Section 164.501, which is individually identifiable health information that is maintained or transmitted any a covered entity, as defined in 45 CFR Section 16.4104. SECTION XI MISCELLANEOUS PROVISIONS 11.01 FORMS AND PROOFS: Each Participant or Participant's Beneficiary eligible to receive any benefit hereunder shall complete such forms and furnish such proofs, receipts, and release as shall be required by the Administrator. 11.02 NON-ASSIGNABILITY: No benefit under the Plan shall be liability for any debt, liability, contract, engagement or tort of any Participant or his Beneficiary, nor be subject to charge, anticipation, sale, assignment, transfer, encumbrance, pledge, attachment, garnishment, execution or other voluntary or involuntary alienation or other legal or equitable process, nor transferability by operation of law. 11.03 CONSTRUCTION: (a) Words used herein in the masculine or feminine gender shall be construed as the feminine or masculine gender, respectively where appropriate. (b) Words used herein in the singular or plural shall be construed as the plural or singular, respectively, where appropriate. 12/1/2009 9:36 AM 6-23 Page 21 of 22 11.04 NONDISCRIMINATION: In accordance with Code Section 125(b)(1), (2), and (3), this Plan is intended not to discriminate in favor of Highly Compensated Participants (as defined in Code Section 125(e)(1) as to contributions and benefits nor to provide more that 25% of all qualified benefits to Key Employees. If, in the judgment of the Administrator, more than 25% of the total non-taxable benefits are provided to Key Employees, or the Plan discriminates in any other manner (or is at a risk of possible discrimination), then notwithstanding any other provision contained herein to the contrary, and in accordance with the applicable provision of the Code, the Administrator shall, after written notification to affected Participants, reduce or adjust such contributions and benefits under the Plan as shall be necessary to insure that, in the judgment of the Administrator, the Plan shall not be discriminatory. 11.05 ERISA The Plan shall be construed, enforced, and administered and the validity determined in accordance with the applicable provision of the Employee Retirement Income Security Act of 1974 (as amended), the Internal Revenue Code of 1986 (as amended), and the laws of the State indicated in the Adoption Agreement. Notwithstanding anything to the contrary herein, the provisions of ERISA will not apply to this Plan if the Plan is exempt from coverage under ERISA. Should any provisions be determined to be void, invalid, or unenforceable by any court of competent jurisdiction, the Plan will continue to operate, and for purposes of the jurisdiction of the court only will be deemed not to include the provision determined to be void. 121112009 9:36 AM 6-24 Page 22 of 22 EXHIBIT A ~~~ ~-- ~~.~~ OlY OF CHULA VISTA DENT ALl M E DICAL/VISION AND DEPENDENT ICHILD CARE REIMBURSEMENT ACCOUNTS PLAN DOCUMENT Amended as of January 1, 2010 Established June 1998 6-25 Intentionally Left Blank 6-26 Table of Contents PREAlVIDLE ...................................................................................................................................1 ARTICLE 1- DEFlNITIONS .......................................................................................................2 1.01 Affiliated Employer........................... ...... ................. ............... ...... .......................2 1.02 After-Tax Con tributions...... ... ............................... .............. ......... .......... .............2 1.03 Anniversary Date ............................ ..................................................... ......... ....... 2 1.04 Benefit Plan Option(s).... ......... ...... .... ........................... ............ ............................ 2 1.05 Board of Directors............................................. ....... ... .... ............... ...... .... ............ 2 1.06 Change in Status.. ...... ............... ............ ........................... .......... ........... ................2 1.07 Code........... ...... ........ ... ........... .............. .............. .... ......... ................. ................ ......2 1.08 Com pensation .................. ..................... ....... ......... ......... .................... .......... ......... 2 1.09 Dependent....... ..................................... .... ............. ........... .......... ..... .................. ...2 1.10 Dependent Care Spending Acconnt....................................................................2 1.11 Earned Income..... ........... .......... ......... ... ... ........................ ... ................. ..... ....... .... 3 1.12 Effective Date............................ ...... ...... .... ............ ...................... ..... .......... ........... 3 1.13 Eligible Employment Related Expenses.............................................................3 1.14 Eligible Medical Expenses ...................................................................................3 1.15 Em ployee.... ....... ....... ................. ..... ........ ............................................. ........ .......... 3 1.16 Em ployer..... ................ ...... ......... ............... .... ......... ........... ....... ............ .......... .......4 1.17 ERISA........... ........................................... ... ............ ................................... ......... ...4 1.18 Flexible Spending Account(s) ..... ............. ................. ........ ...... ...... ................ .......4 1.19 Health Care Spending Acconnt...........................................................................4 1.20 Highly Compensated Individnal.........................................................................4 1.21 Key Em ployee .. .... ............ ......... ..... ..................... ... ........... .... ... ...... ............... ..... ...4 1.22 Non-elective Contribution(s) ... ....... ...... ............. ... ............ ... '" ................. ..... .......4 1.23 Participant. ................ ................. .......... .............. .............. ....... ... .............. ..... .......5 1.24 Plan ...........:. ...... .... ............ ........... ................. ... ....... .... ....... .... ... ....... ..... ..... ..... .:...... 5 1.25 Plan Administrator ... ............................ ......... .... .................. ... .............................5 1.26 Plan Year... ...... ..... ...... ..... ...... ...... ....... ................ .... ........................................ .......5 1.27 Pretax Contribntion(s).... ........... .......... .............. .................. ............ ....... ...... ....... 5 1.28 Qnalified Benefit. ........... .................... ..... .......................... ... .......... ............... ........5 1.08B Qualifying Individnal................ ....................... ............... ............................... .....5 1.30 Qnalifying Services......... ................. ..... .......... .... ............... ............... .... ...... ..... ..... 5 1.31 Salary Rednction Agreement .............................................................................. 5 1.32 S po nse.................................................................................................................... 6 1.33 Summary Plan Description or SPD ....................................................................6 1.34 Student ..... ................. ...... ......... ..... ..... ................ ................ ....... ...... ...... ................ 6 ARTICLE 11-- ELIGID1LITY AND PARTICIPATION ..........................................................7 2.01 Eligibility to Participate....................................................................................... 7 2.02 Termination of Participation.. ............. .............. ...... .................... ...... .......... ..... '" 7 2.03 Eligibility to Participate in Flexible Spending Accounts .................................. 7 2.04 Qualifying Leave Under Family Leave Act .......................................................7 2.05 N on-FMLA Leave....................................... ... ........ ...... ... ........................ ........ .....7 -I- 6-27 ARTICLE III -- ELECTIONS ......................................................................................................8 3.01 Election of Contributions. ............ .... ....... ... .......... ........... ........ ......... ....................8 3.02 Initial Election Period... ........ ... ... ............... .................. ................. ..... ... ...............8 3.03 Ann ual Election Period............. ..... ... ............................... ....................... ............. 8 3.04 Change of Elections ............. ....... ..... ... ... ... ...................... ....... ... ....... ..... .... ......... ... 9 3.05 Impact of Termination of Employment on Election .........................................9 ARTICLE IV -- PREMIUM PAYMENTS AND CREDITS AND DEBITS TO ACCO UNTS ....................................................................................................................10 4.01 Source of Benefit Funding ................................................................................. 10 4.02 Reduction of Certain Elections to Prevent Discrimination ............................10 ARTICLE V - BENEFITS .........................................................................................................11 5.01 Qualified Benefits ...............................................................................................11 5.02 Cash Benefit...................... ................ ..................... ........... ........... ..... .................. 11 ARTICLE VI -- REIM:BURSEMENTS .....................................................................................12 6.01 Health Care Spending Account Reimbursement ............................................12 6.02 Dependent Care Spending Account Reimbursement...................................... 12 6.03 Receiving Reim bursement .... ... ........... ... ....... ... ..... .... ....... ..... ... .... ............ ..........13 6.04 Substantiation of Expenses ................................................................................13 6.05 Repayment of Excess Reimbursements............................................................13 6.06 Reimbursement Following Cessation of Participation.................................... 13 6.07 Coordination of Benefits Under the Health Care Spending Account............14 6.08 Disbursement Reports. ... .... .... ........... .... ......... .... ............. .............. ........ ............. 14 6.09 Timing of Reim bursements . ...... ..... .................... ...... ....... ....... .... ............ ..... ... ... 14 6.10 Statements........ ..... .... ..... ........ .................. .... ....... .... ........ ........... ................ .........14 6.11 Post-Mortem Payments......................................................................................14 6.12 Non-Alienation of Benefits... ...... ............ ... ...... .... ...... ..................... ..... ............... 14 6.13 Mental or Physical Incompetency.....................................................................14 6.14 Inability to Locate Payee ....................................................................................14 6.15 Tax Effects of Reimbursements ........................................................................15 6.16 Forfeiture of Unclaimed Reimbursement Account Benefits ..........................15 ARTICLE VII-- PLAN ADlYllNISTRATION..........................................................................16 7.01 Allocation of Anthority ......................................................................................16 7.02 Provision for Third Party Adminstrators ........................................................16 7.03 Fiduciary Liability .............................................................................................17 7.04 Compensation of Plan Administrator ..............................................................17 7.05 Bonding........ ...... ............. ..... ....................... ..... ...... .... ............. ....... ................. .... I 7 7.06 Payment of Administrative Expenses ...............................................................17 7.07 Funding Policy ....................................................................................................17 ARTICLE VIII -- FUNDING AGENT .......................................................................................18 ARTICLE LX -- CLAl1"IS PROCEDURES ...............................................................................19 ARTICLE X - AMENDMENT OR TERMINATION OF PLAN ..........................................20 10.01 Permanency. ..... ..... ...... ... ................. .................. ..... ..... ... ..... ........ ... ..... ....... ........ 20 10.02 Employer's Right to Amend ..............................................................................20 10.03 Employer's Right to Terminate ........................................................................20 10.04 Determination of Effective Date of Amendment or Termination ..................20 ARTICLE XI -- GENERAL PROVISIONS ..............................................................................21 11.01 Not an Employment Contract ...........................................................................21 11.02 Applicable Laws. ..... ... ... ... .............. ... .... ... ....... ..... ...... ..... ............. ....... .... ... ....... .21 -ii- 6-28 11.03 Requirement for Proper Forms ........................................................................21 11.04 Multiple Fuuctions .............................................................................................21 11.05 Tax Effccts ..........................................................................................................21 11.06 Gender and Number ..........................................................................................21 11.07 Headings.............................................................................................. .............. ..21 11.08 Incorporation by Reference............................................................................... 21 11.09 Severability......................................................................................................... 21 11.10 Effect of Mistake ................................................................................................22 ARTICLE XlI -- CONTINUATION COVERAGE UNDER COBRA ...................................23 ARTICLE XIlI - HIP AA PRIVACY AND SECURITY..........................................................24 13.01 Scope and Purpose .............................................................................................24 13.02 Effective Date..... ..................................................................... ................ ............ 24 13.03 Use and Disclosure ofPffi.................................................................................24 13.04 Conditions Imposed on Employer ....................................................................24 13.05 Designated Employees Who May Receive PHI ...............................................25 13.06 Restrictions on Employee with Access to PHI .................................................25 13.07 Policies and Procedures .....................................................................................25 13.08 Organized Health Care Arrangement..............................................................25 13.09 Privacy Official................................................................................................... 26 13.10 Noncompliance ................................................................................................... 26 13.11 Definitions ......... ......... .................................. ................................................ .......26 13.12 Interpretation and Limited Applicability ........................................................27 13.13 Services Performed for the Employer ..............................................................27 -iii- 6-29 PREAMBLE Effective prior to 1991 (and as Amended and Restated on Jannary 1, 2009), CITY OF CHULA VISTA established a Cafeteria Plan (the "Plan") for its Employees for purposes of providing eligible Employees with the opportunity to choose from among the Benefit Plan Options available under the Plan. The Plan is intended to qualify as a cafeteria plan under the provisions of Code S 125. The Health Care Spending Account ("HCSA"), is intended to qualify as a Code S 105 self-insured medical expense reimbursement plan, and that the benefits provided under the Health Care Spending Account be eligible for exclusion from the Participant's income for federal income tax purposes under Code S 105(b). The Dependent Care Spending Account ("DC SA"), is intended to qualify as a Code S 129 dependent care assistance plan and that the benefits provided under the Dependent Care Spending Account be eligible for exclusion from the Participant's income for federal income tax purposes under Code S 129. Although printed within this document, the HCSA and DCSA Plans are separate written plans for purposes of administration and nondiscrimination requirements imposed by Sections 105 and 129 of the Code. -16-30 21S3pdll CITY OF CHULA VISTA CAFETERIA PLAN ARTICLE I DEFINITIONS 1.01 "Affiliated Employer" means any entity who is considered with the Employer to be a single employer in accordance with Code Section 4l4(b), (e), or (m). 1.02 "After-tax Contribution(s)" means amounts withheld from an Employee's Compensation pursuant to a Salary Reduction Agreement after all applicable state and federal taxes have been deducted. Such amounts are withheld for purposes of purchasing one or more of the Benefit Plan Options available under the Plan. 1.03 "Anniversary Date" means the first day of any Plan Year. 1.04 "Benefit Plan Option(s)" means those Qualified Benefits available to a Participant under this Plan as set forth in the Summary Plan Description, as amended and/or restated from time to time. 1.05 "Board of Directors" means the Board of Directors or other governing body of the Employer (the "Board"). The Board of Directors, upon adoption of this Plan, appoints the Plan Administrator to act on the Employer's behalf in all matters regarding the Plan. 1.06 "Change in Status" means any of the events described in the Summary Plan Description, as well as any other events included under subsequent changes to Code Section 125 or regulations issued under Code Section 125, that the Plan Administrator (in its sole discretion) decides to recognize on a uniform and consistent basis as a reason to change the election mid-year. Note: See the Summary Plan Description for requirements that must be met to permit certain mid-year election changes on account of a Change in Status. 1.07 "Code" means the Internal Revenue Code of 1986, as amended. 1.08 "Compensation" means the cash wages or salary paid to an Employee by the Employer. 1.09 "Dependent" means any individual who is a tax dependent of the Participant as defined generally in Code Section 152; however, for health plan purposes, a Dependent is defined as set forth in Code Section 105(b) and for Dependeut Care FSA (if offered under the Plan) purposes, a Dependent also means an individual described in Code Section 21(e)(5) (i.e., dependent of the parent with custody for the greatest portion ofthe year). 1.10 "Dependent Care Spending Account" shall have the meaning assigned to it by Section 6.02 of the Plan. - 2 6-31 2tS:1pdll 1.11 "Earned Income" means all income derived from wages, salaries, tips, self-employment, and other Compensation (such as disability or wage continuation benefits), but only if such amounts are includible in gross income for the taxable year. Earned income does not include any amounts excluded from earned income under Code S 32(c)(2), such as amounts received under a pension or annuity, or pursuant to workers' compensation. 1.12 "Effective Date" of this Plan means the original effective date of the Cafeteria plan, or the amended and restated effective date, set forth in the SPD. 1.13 "Eligible Employment Related Expenses" means those expenses that would be considered to be Employment-Related Expenses under Code S 21(b)(2) (relating to expenses for household and dependent care services necessary for gainful employment) if paid for by the Employee to provide QualifYing Services other than amounts paid to: (a) an individual with respect to whom a Dependent deduction is allowable under Code S 151(a) to the Participant or his Spouse; (b) the Participant's Spouse; or (c) a child of the Participant who is under 19 years of age at the end of the taxable year in which the expenses were incurred. 1.14 "Eligible Medical Expenses" means those expenses that are eligible for reimbursement under the Health Care Spending Account as set forth in the SPD, incurred by the Employee, or the Employee's Spouse or Dependents, after the date of the Employee's participation in the Health Care Spending Account and during the Plan Year to the extent that the expense satisfies the conditions set forth in the Summary Plan Description and are for medical care as defined by Code S 213(d). For purposes of this Plan, the following expenses are not considered Eligible Medical Expenses even if they otherwise constitute medical care under Code S 213(d): i) Expenses for qualified long term care services (as defined in Code S n02B); and ii) Expenses for health insurance premiums. For purposes of this Plan, an expense is "incurred" when the Participant or beneficiary is furnished the medical care or services giving rise to the claimed expense, regardless of when the expense is paid. 1.15 "Employee" means an individual who the Employer classifies as a common-law employee and who is on the Employer's W-2 payroll, but does not include any of the following: (a) any leased employee (including, but not limited to, those individuals defined in Code S 414(n)); (b) an individual classified by the Employer as a contract worker or independent contractor; (c) an individual classified by the Employer as a temporary employee or casual employee, whether or not any such persons are on the Employer's W-2 payroll; and (d) any individual who performs services for the Employer but who is paid by a temporary or other employment agency such as ;;Kelly," "Manpower," etc.; or any employee covered under a collective bargaining agreement, except as otherwise provided for in the collective bargaining agreement. -36-32 2i33pdll 1.16 "Employer" means CITY OF CHULA VISTA and any Affiliated Employer who adopts the Plan pursuant'to authorization provided by the Employer. Notwithstanding the previous sentence when the Plan provides that the Employer has a certain power (e.g., the appointment of a third party administrator, entering into a contract with a third party insurer, or amendment or termination of the plan) the term "Employer" shall mean only CITY OF CHULA VISTA. Affiliated Employers who adopt the Plan shall be bound by the Plan as adopted and subsequently amended unless they clearly withdraw from participation herein. Affiliated Employers who have adopted the Plan are set forth in the Summary Plan Description. 1.17 "ERISA" shall mean the Employee Retirement Income Security Act of 1974, as amended. 1.18 "Flexible Spending Account(s)" shall be the funding mechanism by which amounts are withheld from an Employee's Compensation and retained for future Health Care Spending Account Payments (the "HCSA") (as defined in Section 1.18 herein) and Dependent Care Spending Account Payments (the "DCSA")(as defined in Section 1.10 herein) to the extent adopted by the Employer as set forth in the Summary Plan Description. No money shall actually be allocated to any individual Participant Account(s); any such Account(s) shall be of a memorandum nature, maintained by the Administrator for accounting purposes, and shall not be representative of any identifiable trust assets. No interest will be credited to or paid on amounts credited to the Participant Account(s). 1.19 "Health Care Spending Acconnt" shall have the meaning assigned to it by Section 6.01 of the Plan. 1.20 "Highly Compensated Individual" means an individual defined under Code S 105(h), 125(e) or 414(q), as amended, as a "highly compensated individual" or a "highly compensated employee." 1.21 "Key Employee" means au individual who is a "key employee" as defined in Code S 125(b)(2), as amended. 1.22 "Non-elective Contribution(s)" means any amount which the Employer, in its sole discretion, may contribute on behalf of each Participant to provide benefits for such Participant and his or her Dependents, if applicable, under one or more of the Benefit Plan Option(s) offered under the Plan. The amount of employer contribution that is applied towards the cost of the Benefit Plan Option(s) for each Participant and/or level of coverage shall be subject to the sole discretion of the Employer and may be adjusted upward or downward at any time in the contributing Employer's sole discretion. The amount shall be calculated for each Plan Year in a uniform and nondiscriminatory manner and may be based upon the Participant's dependent status, commencement or termination date of the Participant's employment during the Plan Year, and such other factors as the Employer shall prescribe. To the extent set forth in the Summary Plan Description or enrollment material, the Employer may make Non-elective Contributions available to Participants and allow Participants to allocate the Non-elective Contributions among the various Benefit Plan Options offered under the Plan in a manner set forth in the Summary Plan Description or enrollment material. In no event will any Non-elective Contribution be disbursed to a Participant in the form of additional, taxable Compensation except as otherwise provided in the Summary Plan Description or enrollment material. -46-33 llS3pdll 1.23 "Participant" means an Employee who becomes a Participant pursuant to Article II. 1.24 "Plan" means this Cafeteria Plan as set for herein. 1.25 "Plan Administrator" means the person(s) or Committee identified in the Summary Plan Description that is appointed by the Employer with authority, discretion and responsibility to manage and direct the operation and administration of the Plan. If no such person is named, the Plan Administrator shall be the Employer. 1.26 "Plan Year" shall be the period of coverage set forth in the Summary Plan Description. 1.27 "Pretax Contribution(s)" means any amount withheld from the Employee's Compensation pursuant to a Salary Reduction Agreement before any applicable state and federal taxes have been deducted. The amounts are withheld for purposes of purchasing one or more of the Benefit Plan Options available under the plan. This amount shall not exceed the premiums or contributions attributable to the most costly Benefit Plan Option afforded hereunder, and for purposes of Code S 125, shall be treated as an Employer contribution (this amount may, however, be treated as an Employee contribution for purposes of state insurance laws). 1.28 "Qualified Benefit" means any benefit excluded from the Employee's taxable income under Chapter I of the Code other than Sections I06(b), 117, ]24, 127, or ]32 and any other benefit permitted by the Income Tax Regulations (i.e., any group-term life insurance coverage that is includable in gross income by virtue of exceeding the dollar limitation on nontaxable coverage under Code S 79). Notwithstanding the previous sentence, long-term care insurance is not a "Qualified Benefit." 1.29 "Qualifying Individual" means an individual defined as a "Qualifying Individual" in the Summary Plan Description. 1.30 "Qualifying Services" means services relating to the care of a Qualifying Individual that enable the Participant or his Spouse to remain gainfully employed which are performed: (a) in the Participant's home; or (b) outside the Participant's home for (I) the care of a Dependent of the Participant who is under age 13, or (2) the care of any other Qualifying Individual who resides at least eight (8) hours per day in the Participant's household. If the expenses are incurred for services provided by a dependent care center (i.e., a facility that provides care for more than 6 individuals not residing at the facility), the center must comply with all applicable state and local laws and regulations. 1.31 "Salary Reduction Agreement" means the actual or deemed agreement pursuant to which an eligible Employee or Participant elects to contribute his share of the cost of chosen Benefit Plan Options with Preta.x or After-tax Contributions and/or Benefit Credits (if offered under the Plan) in accordance with Article III herein. If the Employer utilizes an interactive voice response (IVR) system or web-based program for enrollment, the Salary Reduction Agreement may be maintained on an electronic database in accordance with all applicable federal and/or state laws. -56-34 21S3pdll 1.32 "Spouse" means an individual who is legally married to a Participant (and who is treated as a spouse under the Code), but for purposes of the Dependent Care Spending Account Plan provisions, shall not include an individual who, although married to the Participant, files a separate federal income tax return, maintains a separate, principal residence from the Participant during the last six months of the taxable year, and does not furnish more than one-half of the cost of maintaining the principal place of abode of the Qualifying Individual. 1.33 "Summary Plan Description" or SPD" means the Cafeteria Plan SPD and all appendices incorporated into and made a part of the SPD that is adopted by the Employer and associated to this Plan Document, and as amended from time to time. The SPD and appendices are incorporated hereto by reference. 1.34 "Stndent" means an individual who, during each of five (5) or more calendar months during the Plan Year, is a full time student at any college or university, the primary function of which is the conduct of formal instruction, and which routinely maintains a regular faculty and curriculum and nonnally has an enrolled student body in attendance at the location where its educational activities are regularly presented. -66-35 2!83pdll ARTICLE II ELIGIDILITY AND P ARTICIP A TION 2.01 Eligibility to Participate. Each Employee who satisfies the eligibility requirements set forth in the SPD shall be eligible to participate in this Plan as of the Eligibility Date set forth in the SPD. Eligibility to participate in this Plan means only that the Eligible Employee is entitled to contribute his share of the cost of applicable Benefit Plan Options for which he is eligible with Pretax Contributions. The provisions of this Article are not intended to override any eligibility requirement(s) or waiting period(s) specified in the applicable Benefit Plan Option(s) and the terms of eligibility and participation for the Benefit Plan Option(s) offered under the Plan shall be subject to the requirements specified in the governing documents of the Benefit Plan Options. 2.02 Termination of Participation. Participation shall terminate on the earliest of the dates set forth in the SPD. 2.03 Eligibility to Participate in Flexible Spending Accounts. Each employee who satisfies the eligibility requirements set forth in the SPD shall be eligible to participate in the Flexible Spending Accounts, if adopted by the Employer, on the applicable Eligibility Date set forth in the SPD. 2.04 Qualifying Leave Under Family Leave Act. Notwithstanding any provision to the contrary in this Plan, if a Participant goes on a qualifying leave under the Family and Medical Leave Act of 1993 (the "FMLA"), then to the extent required by the FMLA, the Participant will be entitled to continue the Participant's Benefits Package Options that provide health coverage (including Health Care Spending Account benefits to the extent offered under the Plan) on the same terms and conditions as if the Participant were still an active Employee. The requirements for continuing coverage, procedures for FMLA leave and payment option( s) provided by the Employer (as described above) will be set forth in the SPD and will be administered in accordance with the regulations issued under Code S 125 and in accordance with the FMLA. 2.05 Non-FlVILA Leave. If a Participant goes on an unpaid leave of absence that does not affect eligibility under this Plan or the Benefit Plan Options chosen by the Participant, then the Participant will continue to participate and the contributions due for the Participant will be paid by one or more of the payment options described in the SPD and implemented by the Employer on a uniform and consistent basis in accordance with the Employer's internal policy and procedure. If a Participant goes on an unpaid leave that affects eligibility, under this Plan or the Benefit Plan Options chosen by the Participant, the election change rules in Section 3.04 will apply. If snch policy reqnires coverage to continue during the leave but permits a Participant to discontinue contributions while on leave, the Participant will, upon returning from leave, be required to repay the contributions not paid by the Participant during the leave. -76-36 2183pdll ARTICLE IU ELECTIONS 3.01 Election of Contributions. A Participant may elect any combination of Pretax Contributions or After-tax Contributions (to the extent set forth in the enrollment material) to ftind any Benefit Plan Option available under the Plan, provided that only Qualified Benetits may be funded with Pretax Contributions. The Employer may, but is not required, to allocate Non-elective Contributions to one or more Benefit Plan Options offered under the Plan and to the extent set forth in the SPD or enrollment material, may allow the Participants to allocate his allotted share of Non-elective Contributions among the various Benetit Plan Options in a manner set forth in the SPD or enrollment material. 3.02 Initial Election Period. (a) Currently Eligible Employees. An Employee who is eligible to become a Participant in this Plan as of the Effective Date must complete, sign and file a Salary Reduction Agreement with the Plan Administrator (or its designated third party administrator as set forth on the Salary Reduction Agreement) during the election period (as specified by the Plan Administrator) immediately preceding the Effective Date of the Plan in order to become a Participant on the Effective Date. The elections madc by the Participant on this initial Salary Reduction Agreement shall be effective, subject to Sections 3.04 and 3.05, for the Plan Year beginning on the Effective Date. (b) New Employees and Employees Who Have Not Vet Satisfied The Plan's Waiting Period. An Employee who becomes eligible to become a Participant in this Plan atter the Effective Date must complete, sign and file a Salary Reduction Agreement with the Plan Administrator (or its designated third party administrator as set forth on the Salary Reduction Agreement) during the initial Election Period set forth in the SPD or the enrollment material. Participation will commence under this Plan as set forth in the SPD. Coverage under the component Benefit Plan Options will be effective in accordance with the governing provisions of such Benefit Plan Options (but in no event prior to the election). (c) Failure to Elect. An eligible Employee who fails to complete, sign and file a Salary Reduction Agreement in accordance with paragraph (a) or (b) above during an initial election period may become a Participant on a later date in accordance with Section 3.03 or 3.04. 3.03 Annual Election Period. Each Employee who is a Participant in this Plan or who is eligible to become a Participant in this Plan shall be notified, prior to each Anniversary Date of this Plan, of his right to become a Participant in this Plan, to continue participation in this Plan, or to modify or to cease participation in this Plan, and shall be given a reasonable period of time in which to exercise such right: such period of time shall be known as the "Annual Election Period." The date on which the Annual Election Period commences and ends will be set forth in the SPD or the enrollment material. An Election is made during the Annual Election Period in the manner set forth in the SPD. The consequences of failing to make an election during the Annual Election Period will be set forth in the SPD. .86-37 2183pdll 3.04 Change of Elections. A Participant shall not make any changes to the Pretax Contribution amount or, where applicable, to the Participant's elected allocation of Non-elective Contributions except for under the circumstances set forth in the SPD and for changes made during the Annual Election Period, changes caused by termination of employment or cessation of eligibility, and changes pursuant to the Family and Medical Leave Act. Except as provided in the SPD for HIP AA special enrollment rights ansmg from the birth, adoption, or placement for adoption of a child, all election changes shall be effective on a prospective basis only (i.e., election changes will become effective no earlier than the first day of the first pay period coinciding with or immediately following the date that the election change was filed) but, as determined by the Plan Administrator, election changes may become effective later to the extent the coverage in the applicable component plan commences later. The circumstances under which a Participant may change his election under this Plan is set forth in the SPD. 3.05 Impact of Termination of Employment on Election or Cessation of Eligibility. Termination of employment or cessation of eligibility shall automatically revoke any Salary Reduction Agreement. Except as provided below, if revocation occurs under this Section 3.05, no new election, with respect to Pretax Contributions may be made by such Participant during the remainder of the Plan Year except as set forth in the SPD. -96-38 2133pdl1 ARTICLE IV PRElVllUM P A YlVIENTS AND CREDITS AL~D DEBITS TO ACCOUNTS 4.01 Source of Benefit Funding. The cost of coverage under the component Benefit Plan Options shall be funded by Participant's Pretax and/or After-tax Contributions and/or any Non-elective Contributions provided by the Employer. The required contributions for each Benefit Plan Options offered under the plan shall be made known to employees in enrollment materials. Pretax or After-tax Contributions (as elected by the Employee on the Salary Reduction Agreement and permitted by the Employer) shall equal the contributions required from the Participant less an available Non-elective Contributions allocated thereto by the Employer, or where applicable, the Participant for covcrage of the Participant or the Participants Spouse or Dependents under the Benefit Plan Options elected by the Participant under this Plan. Amounts withheld from a Participant's Compensation as Pretax Contributions or After-tax Contributions shall be applied to fund benefits as soon as administratively feasible. The maximum amount of Pretax Contributions, plus any Non-elective Contribution made available by the Employer, shall not exceed the aggregate cost of the Benefit Plan Options elected. 4.02 Reduetiou of Certain Elections to Prevent Discrimination. If the Plan Administrator determines, before or during any Plan Year, that the Plan may fail to satisfY for such Plan Year any requirement imposed by the Code or any limitation on Pretax Contributions allocable to Key Employees or to Highly Compensated Individuals, the Plan Administrator shall take such action(s) as he deems appropriate, under rules uniformly applicable to similarly situated Participants, to assure compliance with such requirement or limitation. Such action may include, without limitation, a modification or revocation of a Highly Compensated Individuals or Key Employee's election without the consent of such Employee. .115-39 21S3pul1 ARTICLE V BENEFITS 5.01 Qualified Benefits. The maximum benefit a Participant may elect under this Plan shall not exceed the sum of the aggregate premium and/or contribution for all Benefit Plan Option(s) set forth in the SPD. 5.02 Cash Bcnelit. To the extent that a Participant does not elect to have the maximum amount of his Compensation contributed as a Pretax Contribution or After-tax Contribution hereunder, such amount not elected shall be paid to the Participant in the form of normal Compensation payments; provided however, that any applicable Non-elective Contributions may not be received in the form of cash compensation, except as otherwise provided for in the SPD or the enrollment material. -16~40 21S3pdll ARTICLE VI REIMBURSEMENTS 6.01 Health Care Spending Account Reimbursement. Each Participant's Health Care Spending Account will be credited with amounts withheld from the Participant's Compensation and any Non-elective Contributions allocated thereto by the Employer or where applicable, the Participant. The Account will be debited for health care reimbursements disbursed to the Participant in accordance with this Article VI. The entire amount elected by the Participant on the salary Reduction Agreement as an annual amount for the Plan Year for health care reimbursement less any health care reimbursements already disbursed to the participant for Expenses incurred during the plan year shall be available to the Participant at any time during the Plan Year without regard to the balance in the Health Care Spending Aecount (provided that the periodie contributions have been made). Thus, the maximum amount of Health Care Reimbursement at any particular time during the Plan Year will not be related to the amount that a Partieipant has had eredited to his Hcalth Care Spending Account. In no event will the amount of Health Care Reimbursements in any Plan Year exceed the annual amount speeified for the Plan Year in the Salary Reduction Agreement for Health Care Reimbursement. Any amount credited to the Health Care Spending Account shall be forfeited by the Participant and restored to the Employer if it has not been applied to provide Health Care Reimbursement within the run out period set forth in the SPD. Amounts so forfeited shall be used in a manner that is permitted within the applicable Department of Labor or Internal Revenue Service regulations. The maximum annual reimbursement under the Health Care Spending Account shall be set forth in the SPD. The Employer may establish a minimum annual reimbursement amount as set forth in the SPD. The Employer has the discretion to establish a grace period following the end of the Plan Year during which amounts unused as of the end of the Plan Year may be used to reimburse Eligible Medieal Expenses incurred during the graee period. In no event ean the graee period exceed two (2) months and fifteen (15) days following the end of the Plan Year. The Employer may establish a Run-out Period following the end of the graee period. If adopted, all amounts alloeated to the HCSA that are not used to reimburse Eligible Medical Expenses ineurred during the Plan Year and/or the grace period shall be forfeited. 6.02 Dependent Care Spending Account Reimbursement. Each Partieipant's Dependent Care Spending Aeeount will be eredited with amounts withheld from the Partieipant's Compensation and any Non-elective Contributions alloeated thereto by the Employer or where applicable, the Participant. The Aeeount will be debited for Dependent Care Reimbursements disbursed to the Partieipant in accordanee with this Article VI. In the event that the amount in the Account is less than that amount of reimbursable claims at any time during the Plan Year, the excess part of the claim will be earried over into following months within the same Plan year, to be paid out as the Dependent Care Spending Account balance becomes adequate. In no event will the amount of Dependent Care Reimbursements exceed the amount eredited to the Dependent Care Spending Aceount. Any amount alloeated to the Dependent Care Spending Aeeount shall be forfeited by the Participant and restored to the Employer if it has not been applied to provide Dependent Care Reimbursement for the Plan Year within the run out period set forth in the SPD. Amounts so forfeited shall be used in a manner that is not prohibited by applicable federal or state law. The maximum annual reimbursement under the Dependent Care Spending Account shall be set forth . 1:S~41 21SJpdll in the SPD. The Employer may establish a minimum annual reimbursement amount as set forth in the SPD. The Employer has the discretion to establish a grace period following the end of the Plan Year during which amounts unused as of the end of the Plan Year may be used to reimburse Eligible Employment Related Expenses incurred during the grace period. In no event can the grace period exceed two (2) months and fifteen (15) days following the end of the Plan Year. The Employer may establish a Run-out Period following the end of the Plan Year. All amounts allocated to the DCSA that are not used to reimburse Eligible Employment Related Expenses incurred during the Plan year and/or the Grace Period shall be forfeited. 6.03 Receiving Reimbnrsement. Payment shall be made to the Participant in cash as reimbursement for Eligible Medical Expenses incurred by the Participant or his Dependents or Eligible Employment Related Expenses incurred by the Participant while he is a Participant during the Plan Year for which the Participant's election is effective provided that the substantiation requirements of Section 6.04 herein are satisfied. If applicable, however, the employer may offer to have the participant choose to make payment for eligible medical expense or eligible employment related expenses with an electronic payment card arrangement. The terms of the electronic payment card arrangement will be set forth in the SPD. 6.04 Substantiation of Expenses. Each Participant must submit an expense for reimbursement in accordance with the terms of the SPD and provide the required substantiation set forth in the SPD or as otherwise requested by the Plan Administrator (or its designee). 6.05 Repayment of Excess Reimbursements. If, as of the end of the any Plan Year, it is determined that a Participant has received payments under this Plan that exceed the amount of Eligible Medical Expenses or Eligible Employment Related Expenses that have been substantiated by such Participant during the Plan Year as required by Section 6.04 herein, the Plan Administrator shall give the Participant prompt written notice of any such excess amount, and the Participant shall repay the amount of such excess to the Employer within sixty (60) days of receipt of such notification. 6.06 Reimbursement Following Cessation of Participation. Participants in the Health Care Spending Account may submit claims for reimbursement for Eligible Medical Expenses incurred during the Plan Year and before the date of participation in the Plan ceases so long as the claim is submitted prior to the end of the run out period set forth in the SPD. Unless a COBRA election is made as set forth in the SPD, Participants shall not be entitled to receive reimbursement for Eligible Medical Expenses incurred after employment ceases under this Section. Participants in the Dependent Care Spending Account may submit claims for reimbursement for Eligible Employment Related Expenses incurred during the Plan Year and before the date of participation in the Dependent Care Spending Account ceases so long as the claim is submitted prior to the end of the run out period set forth in the SPD. Any unused reimbursement benefits at the expiration of the Plan Year (as set forth in the SPD) for the Health Care or Dependent Care Spending Accounts shall be treated in accordance with Section 6.0 I. .llj-42 2183pdll 6.07 Coordination of Benefits Under the Health Care Spending Aeeonnt. The Health Care Spending Account is intended to pay benefits solely for otherwise unreimbursed medical expenses. Accordingly, it shall not be considered a group health plan for coordination of benefits purposes, and its benefits shall not be taken into account when determining benefits payable under any other plan. 6.08 Disbursement Reports. The Plan Administrator shall issue directions to the Employer concerning all benefits that are to be paid from the Employer's general assets pursuant to the provisions of the Plan. 6.09 Timing of Reimbursements. Reimbursements shall be made as soon as administratively feasible after the Plan Administrator or its designee has received the required forms. 6.10 Statements. The Plan Administrator or its designated third party administrator may periodically furnish each Participant with a statement, showing the amounts paid or expenses incurred by the Employer in providing reimbursements under the Health Care Spending Account and/or Dependent Care Spending Account. 6.11 Post-Mortem Payments. Any benefit payable under the Health Care Spending Account or Dependent Care Spending Account after the death of a Participant shall be paid to his surviving Spouse, otherwise, to his estate. If there is doubt as to the right of any beneficiary to receive any amount, the Plan Administrator may retain such amount until the rights thereto are dctermined, without liability for any interest thereon. 6.12 Non-Alienation of Benefits. Except as expressly provided by the Administrator, no benefit under the Plan shall be subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance or charge, and any attempt to do so shall be void. No benefit under the Plan shall in any manner be liable for or subject to the debts, contracts, liabilities, engagements or torts of any person. 6.13 Mental or Physical Incompetency. Every person receiving or claiming benefits under the Plan shall be presumed to be mentally and physically competent and of age until the Plan Administrator receives a written notice, in a form and manncr acceptable to it, that such person is mentally or physically incompetent or a minor, and that a guardian, conservator or other person legally vested with the care of his estate has been appointed. 6.14 Inability to Locate Payee. If the Plan Administrator is unable to make payment to any Participant or other person to whom a payment is due under the Plan because he cannot ascertain the identity or whereabouts of such Participants or other person after reasonable efforts have been made to identify or locate such person, such payment and all subsequent payments otherwise due to such Participant or other person shall be forfeited after a reasonable time after the date any such payment first became due. -1-6-43 2133pdll 6.15 Tax Effects of Reimbursements. Neither the Employer, nor the Plan Administrator makes any warranty or other representation as to whether any reimbursements made under the Plan will be treated as excludable from gross income for local, state, or federal income tax purposes. If for any reason it is determined that any amount paid for the benefit of a Participant or Beneficiary are includable in an Employee's gross income for local, federal, or state income tax purposes, then under no circumstances shall the recipient have any recourse against the Plan Administrator or the Employer with respect to any increased taxes or other losses or damages suffered by the Employees as a result thereof. The Plan is designed and intended to be operated as a self-insured medical reimbursement plan under Code S 105 or a self-dependent care assistance plan under Code S 129. 6.16 Forfeiture of Unclaimed Reimbursement Account Benefits. Any Health Care or Dependent Care Spending Account reimbursement benefit payments that are unclaimed (e.g. uncashed benefit checks) by the close of the Plan Year following the Plan Year in which the Eligible Medical Expense or Eligible Employment Related Expense was incurred shall be forfeited. - Q,-44 2J83pdll ARTICLE VII PLAN ADMINISTRATION 7.01 Allocation of Authority. The Board of Directors or applicable governing body (or an authorized officer of the Employer) appoints a Plan Administrator that keeps the records for the Plan and shall control and manage the operation and administration of the Plan. The Plan Administrator shall have the exclusive right to interpret the Plan and to decide all matters arising thereunder, including the right to make determinations of fact, and construe and interpret possiblc ambiguities, inconsistencies, or omissions in the Plan and the SPD issued in connection with the Plan. All determinations of the Plan Administrator with respect to any matter hereunder shall be conclusive and binding on all persons. Without limiting the generality of the foregoing, the Plan Administrator shall have the following powers and duties: (a) To require any person to furnish such reasonable information as he may request for the purpose of the proper administration of the Plan as a condition to receiving any benefits under the Plan; (b) To make and enforce such rules and regulations and prescribc the use of such forms as he shall deem necessary for the efficient administration of the Plan; (c) To decide on questions concerning the Plan and the eligibility of any Employee to participate in the Plan and to make or revoke elections under the Plan, in accordance with the provisions of the Plan; (d) To determine the amount of benefits which shall be payable to any person in accordance with the provisions of the Plan; to inform the Employer, insurer as appropriate, of the amount of such benefits; and to provide a full and fair review to any Participant whose claim for benefits has been denied in whole or in part; (e) To designate other persons to carry out any duty or power which mayor may not otherwise be a fiduciary responsibility of the Plan Administrator, under the terms of the Plan. Such entity will be referred to as a third party administrator and shall be identified in the SPD; (I) To keep records of all acts and determinations, and to keep all such records, books of account, data and other documents as may be necessary for the proper administration of the Plan; and (g) To do all things necessary to operate and administer the Plan in accordance with its prOVISlons. 7.02 Provision for Third Party Administrators. The Plan Administrator, subject to approval of the Employer, may employ the services of such persons, as it may deem necessary or desirable in connection with the operation of the Plan and may rely upon all tables, valuations, certificates, reports and opinions furnished thereby. Such entity will be identified in the SPD as a third party administrator. Unless otherwise provided in the service agreement, obligations under this Plan shall remain the obligation of the Employer. - 1'6-45 2lSJpdll 7.03 Fiduciary Liability. To the extent permitted by law, the Plan Administrator shall not incur any liability for any acts or for failure to act except for their own willful misconduct or willful breach of this Plan. 7.04 Compensation of Plan Administrator. Unless otherwise determined by the Employer and permitted by law, any Plan Administrator who is also an employee of the Employer shall serve without compensation for services rendered in such capacity, but the Employer shall pay all reasonable expenses incurred in the performance of their duties. 7.05 Bonding. Unless otherwise determined by the Employer, or unless required by any federal or state law, the Plan Administrator shall not be required to give any bond or other security in any jurisdiction in connection with the administration of this Plan. 7.06 Payment of Administrative Expenses. The Employer currently pays all reasonable expenses incurred in administering the Plan. 7.07 Funding Policy. The Employer shall have the right to enter into a contract with one or more insurance companies for the purposes of providing any Benefit Plan Options offered under the Plan and to replace any of such insurance companies or contracts. Any dividends, retroactive rate adjustments or other refunds of any type that may become payable under any such insurance contract shall not be assets of the Plan but shall be the property of, and shall be retained by the Employer. The Employer will. not be liable for any loss or obligation relating to any insurance coverage except as is expressly provided by this plan. Such limitation shall include, but not be limited to, losses or obligations, which pertain to the following: (a) Once insurance is applied for or obtained, the Employer will 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; (b) To the extent premium notices are received by the Employer, the Employer's liability for the payment of such premiums will be limited to such premiums and will not include liability for any other loss which result from such failure; (c) The Employer will not be liable for the payment of any insurance premium or any loss that may result from the failure to pay an insurance premium if the benefits available under this plan are not enough to provide for such premium cost at the time it is due. In such circumstances, the Employee will be responsible for and see to the payment of such premiums. The Employer will undertake to notifY a Participant if available benefits under this plan are not enough to provide for an insurance premium but will not be liable for any failure to make such notification; (d) When employment ends, the Employer will have no liability to take any step to maintain any policy in force except as may be specifically required otherwise in this plan, and the Employer will not be liable for or responsible to see to the payment of any premium after employment ends. -lo~46 2J33pdll ARTICLE VIII FUNDING AGENT The Plan shall be funded with amounts withheld from Compensation pursuant to Salary Reduction Agreements, and/or Non-elective Contributions provided by the Employer, if any. The Employer will apply all such amounts, without regard to their source, to pay for the welfare benefits provided herein as soon as administratively feasible and shall comply with all applicable regulations. -1:S-47 2133pdll ARTICLE IX CLAIMS PROCEDURES The Plan has established procedures for reviewing claims denied under this Plan and those claims review procedures are set forth in the SPD, The Plan's claim review procedures set forth in the' SPD shall only apply to issues germane to the pretax benefits available under this Plan (i,e" such as a determination of: a Change in Status; change in costs or coverage; or eligibility and participation matters under this Cafeteria plan document) and to the extent offered under the Plan, claims for benefits under the Flexible Spending Accounts, - 1'6-48 2l83pdl1 ARTICLE X AMENDMENT OR TERMINATION OF PLAN 10.01 Permanency. While the Employer fully expects that this Plan will continue indefinitely, due to unforeseen, future business contingencies, permanency of the Plan will be' subject to the Employer's right to amend or terminate the Plan, as provided in Sections 10.02 and 10.03, below. Nothing in this Plan is intended to be or shall be construed to entitle any Participant, retired or otherwise, to vested or non-terminable benelits. 10.02 Employer's Right to Amend. The Employer reserves the right to amend at any time any or all of the provisions of the Plan. All amendments shall be made in writing and shall be approved by the Employer in accordance with its normal procedures for transacting business (e.g. by approval by the Board of Directors through a meeting or unanimous consent of all Board members). Such amendments may apply retroactively or prospectively as set forth in the amendment. Each Benefit Plan Option shall be amended in accordance with the terms specified therein, or, if no amendment procedure is prescribed, in accordance with this section. Any amendment made by the Employer shall be deemed approved and adopted by any Affiliated Employer. 10.03 Employer's Right to Terminate. The Employer reserves the right to discontinue or tenninate the Plan without prejudice at any time and for any reason without prior notice. Such decision to terminate the Plan shall be made in writing aud shall be approved by the Employer in accordance with its normal procedures for transacting business. Affiliated Employers may withdraw from participation in the Plan, but may not terminate the Plan. 10.04 Determination of Effective Date of Amendment or Termination. Any such amendment, discontinuance or termination shall be effective as of such date as the Employer shall determine. - 2CS~4 9 2l33pdll . ARTICLE XI GENERAL PROVISIONS 11.01 Not an Employment Contract. Neither this Plan nor any action taken with respect to it shall confer upon any person the right to continue employment with any Employer. 11.02 Applicable Laws. The provisions of the Plan shall be construed, administered and enforced according to applicable federal law and the laws of the State of Controlling Law, as set forth in the Plan Information Appendix of the SPD, to the extent not preempted. 11.03 Requirement for Proper Forms. All communications in connection with the Plan made by a Participant shall hecome effective only when duly executed on any forms as may be required and furnished by, and filed with, the Plan Administrator. 11.04 Multiple Functions. Any person or group of persons may serve in more than one fiduciary capacity with respect to the Plan. 11.05 Tax Effects. Neither the Employer, nor the Plan Administrator makes any warranty or other representation as to whether any Pretax Contributions made to or on behalf of any Participant hereunder will be treated as excludable from gross income for local, state, or federal income tax purposes. If for any reason it is determined that any amount paid for the benefit of a Participant or Beneficiary are includable in an Employee's gross income for local, federal, or state income tax purposes, then under no circumstances shall the recipient have any recourse against the Plan Administrator or the Employer with respect to any increased taxes or other losses or damages suffered by the Employees as a result thereof. The Plan is designed and intended to operate as a "cafeteria plan" under Code!i 125. 11.06 Gender and Number. Masculine pronouns include the feminine as well as the neuter genders, and the singular shall include the plural, unless indicated otherwise by the context. 11.07 Headings. The Article and Section headings contained herein are for convenience of reference only, and shall not be construed as defining or limiting the matter contained thereunder. 11.08 Incorporation by Reference. The actual terms and conditions of the separate component Benefit Plan Options offered under this Plan are contained in separate, written documents governing each respective benefit, and shall govern in the event of a conflict between the individual plan document, and this Plan as to substantive content. To that end, each such separate document, as amended or subsequently replaced, is hereby incorporated by reference as if fully recited herein. In addition, the SPD for this Plan contains many of the actual terms and conditions of this Plan. To that end, the SPD as amended from time to time, is incorporated . herein. 11.09 Severability. Should a court of competent jurisdiction subsequently invalidate any part of this Plan, the remainder thereof shall be given effect to the maximum extent possible. -26-50 2133pdll 11.10 Effect of Mistake. In the event of a mistake as to the eligibility or participation of an Employee, or the allocations made to the account of any Participant, or the amount of distributions made or to be made to a Participant or other person, rhe Plan Administrator shall, to the extent it deems possible, cause to be allocated or cause to be withheld or accelerated, or otherwise make adjustment of, such amounts as will in its judgment accord to such Participant or other person the credits to the account or distributions to which he is properly entitled under the Pian. Such action by the Plan Administrator may include withholding of any amounts due the Plan or the Employer from Compensation paid by the Employer. - 2:0-51 2lSJpdll ARTICLE XII CONTINUATION COVER>\GE UNDER COBRA The SPD includes COBRA continuation of coverage provisions that shall be applicable to the Health Care Spending Account, if offered under the Plan, to the extent the plan sponsor is subject to COBRA (as it amended ERISA, the Code and the Public Health Service Act). - 2:jj-S 2 2183pdll ARTICLE XUI HIP AA PRIVACY AND SECURITY 13.01 Scope ami Purpose. The Health Care Spending Account (the "Plan" will use protected health information ("PHI") to the extent of and in accordance with the uses and disclosures permitted by the Health Insurance Portability and Accountability Act of 1996 CHIP AA"). Specifically, the Plan will use and disclose PHI for purposes related to health care treatment, payment for health care and health care operations as set forth below. 13.02 Effective Date. This Article XIII is effective on April 14,2003 or such later effective date of the Privacy Rules with respect to the client 13.03 Use and Disclosure of PHI. a) General. The Plan will use PHI to the extent of and in accordance with the uses and disclosures permitted by HIP AA, including but not limited to health care treatment, payment for health care, health care operations and as required by law. The Privacy Notice will list the specific uses and disclosure of PHI that will be made by the Plan. b) Disclosure to the Employer. The Plan will disclose PHI to thc Employer, or where applicable, an Affiliate only upon receipt of written certification from the Employer that: i. The Plan document has been amended to incorporate the provisions in this Article XIII; and ii. The Employer agrees to implement the provisions in Section 13 .04 herein. 13.04 Conditions Imposed on Employer. Notwithstanding any provision of the Plan to the contrary, the Employer agrees: a) Not to use or disclose PHI other than as permitted or required by this Article XIII or as required by law; b) To ensure that any agents, including a subcontractor, to whom the Employer provides PHI receivcd from the Plan agree to the same restrictions and conditions that apply to the Employer with respect to PHI received or created on behalf of the Plan; c) Not use or disclose an Individual's PHI for employment related purposes (including hiring, firing, promotion, assignment or scheduling) unless authorized by the Individual; d) Not to use or disclose an Individual's PHI in connection with any other non-health benefit program or employee benefit plan of the Employer unless authorized by the Individual; e) To report to the Plan any use or disclosure of PHI that is inconsistent with this Article XIII, if it becomes aware of an inconsistent use or disclosure; f) To provide Individuals with access to PHI in accordance with 45 C.F.R. S 164.524; -2'6-53 2l33pdll g) To make available PHI for amendment and incorporate any amendments to PHI 10 accordance with 45 C.F.R. S 164.526; h) To make available the information required to provide an accounting of disclosure in accordance with 45 C.F.R. S 154.528; i) To make internal practices, books and records relating to the use and disclosure of PHI received from the Plan available to the Secretary of Health and Human Services for purposes of determining the Plan's compliance with HIPAA; j) If feasible, to return or destroy all PHI received from the Plan that the Employer maintains in any form, and retain no copies of such PHI when no longer needed for the purpose for which disclosure was made. If return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction infeasible; and k) To ensure adequate separation between the Plan and Employer as required by 45 C.F.R. S 164.504(f)(2)(iii) and described in this Article XIlI. 13.05 Designated Employees Who May Receive PID. In accordance with the Privacy Rules, only certain Employees who perform Plan administrative functions may be given access to PHI. Those Employees who have access to PHI from the Plan are listed in the Privacy Notice, either by name or individual position. 13.06 Restrictions on Employee with Access to PID. The employees who have access to PHI listed in the Privacy Notice may only use and disclose PHI for Plan Administration functions that the Employer performs for the Plan, as set forth in the Privacy Notice, including but not limited to, quality assurance, claims processing auditing, and monitoring. 13.07 Policies and Procedures. The Employer will implement Policies and Procedures setting forth operating rules to implement the provisions hereof. 13.08 Organized Health Care Arrangement. The Plan Administrator intends the Plan to form part of an Organized Health Care Arrangement along with any other Benefit under a covered health plan (under 45 C.F.R. S 160.103) provided by the Employer. - 21)-54 218Jpdll 13.09 Privacy Official. The Plan shall designate a Privacy Official, who will be responsible for the Plan's compliance with HIPAA. The Privacy Official may contract with or otherwise utilize the services of attorneys, accountants, brokers, consultant, or other third party experts as the Privacy Official deems necessary or advisable. In addition, and notwithstanding any provision of this Plan to the contrary, the Privacy Official shall have the authority to and be responsible for: a) Accepting and veritying the accuracy and completeness of any certification provided by the Employer under this Article XIII; b) Transmitting the certification to any third parties as may be necessary to permit them to disclose PHI to Employer; c) Establishing and implementing policies and procedures with respect to PHI that are designed to ensure compliance by the Plan with the requirements ofHIPAA; d) Establishing and overseeing proper training of the Plan, or Employer personnel who will have access to Protected Health Information; ej Any other duty or responsibility that the Privacy Official, in his or her sole capacity, deems necessary or appropriate to comply with the provisions of HIP AA and the purposes of this Article XliI. 13.10 Noncompliance. The Employer shall provide a mechanism for resolving issues of noncompliance, including disciplinary sanctions for personnel who do not comply with the provisions of this Article XIII. 13.11 Definitions. As used in this Article XIII, each of the following capitalized terms shall have the respective meaning given below: "Individual" means the person who is the subject of the health information created, received or maintained by the Plan or Employer "Organized Health Care Arrangement" means the relationship of separate legal entities as defined in 45 C.F .R. S 160.103. "Privacy Notice" means the notice of the Plan's privacy practices distributed to Plan participants in accordance with 45 C.F.R. S 164.520, as amended from time to time. "Privacy Rules" means the privacy provisions of HIPAA and the regulation in 45 C.F.R. Parts 160 and 164. "Protected Health [nformation or PHI" means individually identifiable health information as defined in 45 C.F.R. S 160.103. -2(6--55 2tSJpdll 13.12 Interpretation and Limited Applicability. Tbis Article XIII serves the sole purpose of complying with the requirements ofHIPAA and shall be interpreted and construed in a manner to effectnate this purpose. Neither this Article XIII nor the duties, powers, responsibilities, and obligations listed herein shall be taken into account in determining the amount or natnre of the Benefits provided to any person covered under this Plan, nor shall they insure to the benefit of any third parties. To the extent that any of the provisions of this Article XIII are no longer required by HIP AA, they shall be deemed deleted and shall have no further force or effect. 13.13 Services Performed for the Employer. Notwithstanding any other provision of this Plan to the contrary, all services performed by a business associate for the Plan in accordance with the applicable service agreement shall be deemed to be performed on behalf of the Plan and subject to the administrative simplification provisions of HIPAA contained in 45 C.F.R. parts 160 through 164, except services that relate to eligibility and enrollment in the Plan. If a business associate of the Plan performs any services that relate to eligibility and enrollment to the Plan, these services shall be deemed to be performed on behalf of the Employer in its capacity as Plan Sponsor and not on behalf of the Plan. 13.14 Security of Electronic PHI. Effective the date that HIPAA's security regulations apply to the HCSA, the Employer will ensure the following with respect to electronic PHI: a) That administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic PHI that it creates, receives, maintains or transmits on behalf of the plan are implemented in accordance with the applicable rules and regulations under HIP AA. b) That reasonable and appropriate security measures are implemented to support adequate separation as required by Section 13.03(k) herein. c) That any agents, including a subcontractor, to whom the Employer provides PHI received from the Plan agree to the same restrictions and conditions that apply to the Employer under this Section 13.13. d) That any security incidents of which it becomes aware that are inconsistent with this Section 13.14 are reported to the Plan. - 21)--56 2lSJpdll The Plan shall also designate a Security Official, who will be responsible for the Plan's compliance with the security provisions of HIPAA. The Security Official may contract with or otherwise utilize the services of attorneys, accountants, brokers, consultants, or other third party experts as the Security Official deems necessary or advisable. In addition, and notwithstanding any provision of this Plan to the contrary, the Security Official shall have the authority to and be responsible for: (a) Accepting and verifying the accuracy and completeness of any certification provided by the Employer under this Article VII; (b) Transmitting the certification to any third parties as may be necessary to permit them to disclose electronic PHI to Employer; (c) Establishing and implementing policies and procedures with respect to electronic PHI that are designed to ensure compliance by the Plan with the security requirements of HIP AA; (d) Establishing and overseeing proper training of the Plan, or Employer personnel who will have access to electronic PHI; (e) Any other duty or responsibility that the Security Official, in his or her sole capacity, deems necessary or appropriate to comply with the security provisions of HIP AA and the purposes of this Article VIII. IN WITNESS WHEREOF, the Employer has executed this Cafeteria Plan as of the date set forth below. CITY OF CHULA VISTA By: Title: Date: - 2~~ 57 2133pdll - - - = = <0 - "' <0 - - - - - - - N - "' 0 - "' 0 " 0 0 - l' . '--7<~'." '""",:';1;.+" '., FLEXIBLE BENEFITS PLAN SUMMARY PLAN DESCRIPTION EXHIBIT B PLAN INFORMATION SUMMARY The Employer named below establishes a Flexible Benefits Plan (the "Plan") as set forth in this Summary Plan Description" ("SPD") as of the Effective Date set forth below. The purpose of the Plan is to provide eligible Employees a choice between cash and the specified welfare benefits described in this Plan Information Summary (see "Benefits Provided Under the Plan"). Pre-tax Contribution elections under the Plan are intended to qualify for the exclusion from income provided in Section 125 of the Internal Revenue Code of 1986. FLEXIBLE BENEFITS PLAN EMPLOYER INFORMATION 1) Name and Address of Employer Plan Administrator' CITY OF CHULA VISTA EDITH QUICHO.. 276 FOURTH AVENUE CHULA VISTA, CA 91910 The Plan Administrator has the exclusive right to interpret the Plan and to decide all matters arising under the Plan, including the right to make determinations of fact and to construe and interpret possible ambiguities, inconsistencies, or omissions in the Plan and this SPD. (619) 585-5620 2) Employer's Telephone Number: 3) Employer's Federal Tax Identification Number: 4) Plan Number Assigned to Cafeteria Plan (e.g., 501 if this is the first ERISA Plan Number assigned): 5) 125 Start Date: 6) Effective Date of this Plan: 7) Last Day of the Plan Year' Subsequent Plan Years: 8) Name and Address of FSA Claim Administrator: 95-6000690 01/01/10 01/01/10 12/31/10 01/01-12/31 SAME 9) Name and Address of registered agent for service of legal process: IRENE MOSLEY 10) Affiliated Employers that will participate in the Plan (affiliates in excess of 30 are listed in Appendix 1): 11) Employer's Type of Business: OTHER ELIGIBILITY All Employees employed by the Employer shall be eligible to participate under the Plan except the following: An eligible Employee may become a Participant in the Plan: [X] Immediately, upon the first day of employment (but'not prior to the Effective Date of the Plan). [ ] On the day following commencement of employment. [ ] On the first day olthe month following days of employment. [ ] Other: OTHER provided the Employee completes a Salary Redirection Agreement ("SRA"). However, eligibility for coverage under any given Benefit Plan or Polley shall be determined by the terms of that Benefit Plan of Policy, and reductions of the Employee's Compensation to pay Pre-tax or After-tax Contribution(s) shall commence when the Employee becomes covered under the applicable Benefit Plan or Policy. An eligible Employee may become a Participant in the Dependent Care and/or Medical Expense Reimbursement Plan(s) (if elected below): On the same day such Employee is eligible for the Pre-Tax Contribution benefits under the Plan. On the day following commencement of employment. On the first day of the month following days of employment. Other: OTHER, provided the Employee completes an SRA selecting such benefits. 6-58 1 SPD BENEFITS PROVIDED UNDER THE PLAN The following Benefit Plans and Policies subject to the terms and conditions of the Plan are available for election by eligible Employees. The maximum a Participant can contribute via the SRA is the maximum aggregate cost of the Benefit Plans or Policies elected minus any Nonelective Contribution made by the Employer. It is intended tha;t such Pre-tax ContrIbution amounts shall, for tax purposes, constitute an Employer contribution, but may constitute Employee contributjons for state insurance law purposes. Copies of the Benefit Plans or Policies (or a list of eligible Policy numbers) shall be attached as an appendix to this Plan. ] Medical Coverage ] Vision Care Coverage [ ] Disability Income - Short Term (A&S) [ X] Cancer Insurance [ X] Dental Coverage [ ] Group Term Life Insurance [ ] Disability Income - Long Term (L TD) [ ] Intensive Care Insurance [ X] Accident Insurance [ X] Hospital Indemnity Insurance (HiP) [ X ] Specified Health Event [ ] Personal Sickness Indemnity (PSI) [ ] Medical Care Expense Reimbursement described In Appendix I to this SPO, not to exceed $ to the CITY OF CHULA VISTA Medical Care Expense Reimbursement Plan. o per Plan Year pursuant Name and Address of Medical Care Expense Reimbursement Plan COBRA Administrator (if applicable): Dependent Care Expense Reimbursement described in Appendix I to this SPO, not to exceed $5,000 per Plan Year or $2,500 for married filing separate returns pursuant to the CITY OF CHULA VISTA Dependent Care Expense Reimbursement Plan. Health Savings Account (as defined in Code Section 223) established with the following CustodianlTrustee: Opt-out Option: See Employer enrollment material. THE FUNDING AGENT The Employer selects the following Funding Agent for the Plan (check one): o The Employer, which will comply with the requirements of Article Vii of the Plan. o The Flexible Benefits Trust created concurrently with the execution of the Plan, which shall receive contributions under the Plan in accordance with Article VII of the Plan. ADMINISTRATIVE EXPENSES Administrative Expenses incurred in operating the Plan shall be paid by (check one): o The Employer, except as otherwise noted in the Plan. o The Participants, except as otherwise noted in the Plan. 6-5~ SPO - - = = "" - '" <0 - - = - - - - - N '" = 0 "' - 0 - 19 0 0 = f FLEXIBLE BENEFITS PLAN SUMMARY PLAN DESCRIPTION Introduction Your employer (the "Employer") is pleased to sponsor an employee benefit program known as a "Flexible Be'nefits Plan" (the "Plan") for you and your fellow employees. Under federal tax laws, it is also known as a "cafeter,la plan". It is so called because it lets you choose from several different insurance and fringe benefit programs according to your individual needs. The Employer provides you with the opportunity to use pre-tax dollars to pay for them by entering into a salary redirection arrangement instead of receiving a corresponding amount of your regular pay. This arrangement helps you because the benefits you eled are nontaxable; you save Social Security and income taxes on the amount of your salary redirection. Alternatively, your Employer may allow you to pay for any of the available benefits with after-tax contributions on a salary deduction basis. This Summary Plan Description ("SPD") describes the basic features of the Plan, how it operates, and how you can get the maximum advantage from it. Information relating to the Plan that is specific to your Employer is described in the Plan Information Summary attached to the front of this SPD You will be referred to the Plan Information Summary throughout the SPD The Plan is also established pursuant to a plan document into which this SPD has been incorporated. If there is a conflict between the official plan document and the SPD, the plan document will govern. In some cases, the Employer may adopt a Medical Care and/or Dependent Care Reimbursement Plan. If so, they will be listed in the Plan Information Summary as "Benefits Provided under the Plan: and the SPD for each Reimbursement Plan adopted by the Employer will be set forth in Appendix I to this SPD, To the extent that the Employer adopts a Medical Care Reimbursement Plan as indicated in the Plan Information Summary, a summary of your rights and obligations under HIPAA's privacy rules is attached to this SPD as Appendix II. You may also be able to make pre-tax contributions to a Health Savings Account (as defined in Code Section 223) through this Plan if Health Savings Accounts are identified as an included benefit under "Benefits Provided under the Plan" in the Plan Information Summary. If Health Savings Accounts are identified as a benefit plan option offered under the Plan, your rights and obligations in regard to such contributions will be set forth in the Health Savings Account Contribution Appendix attached hereto. Questions & Answers about the Flexible Benefits Plan Q-1. What is the purpose of the Plan? The purpose of the Plan is to allow eligible employees to pay for certain benefits offered under the Plan (called "Benefit Plans or Policies") with pre-tax dollars called "Pre-tax Contributions". Pre-tax Contributions are describe9 in more detail in Q-8 of this SPD, Q-2. What benefits can I purchase on a pre-tax basis ~hrough the Plan? You will be able to choose to participate in the Plan's various pre-tax options by filling out any required enrollment form(s) for the component Benefit Plans or Policies offered under the Plan. The complete list of Benefit Plans or Policies offered under the Plan is located in the Plan Information Summary under ~Benefits Offered Under the Plan." NOTE. You may only contribute with Pre-tax Contributions towards the cost of Benefit Plans or Policies that cover you, your legal Spouse, and/or your tax Dependents defined under Internal Revenue Code Section 152. Each Benefit Plan or Policy may define eligible Dependents more narrowly for purposes of coverage under the particular Benefit Plan or Policy, Q-3. Who can .participate in the Plan? Each employee of the Employer (or an Affiliated Employer identified in the Plan Information Summary) who satisfies the eligibility requirements described in the Plan Information Summary and who is eligible to participate in any of the Benefit Plans or Policies offered under the Plan will be eligible to participate in this Plan as of the date described In the Plan Information Summary (see Q-5 of this SPD for instructions on how to become a Participant). Those employees who actually participate in the Plan are called "Participants." The terms of eligibility of this Plan do not override the terms of eligibility of each of the Benefit Plans or Policies offered under the Plan. For the details regarding eligibility provisions, benefit amounts, and premium schedules for each of the Benefit Plans or Policies, please refer to the plan summary for each of the Benefit Plans or Policies listed in the Plan Information Summary. Only coverage for an Employee and the Employee's Dependents may be paid for under this Plan. A dependent is defined generally as an individual who would be considered the Employee's spouse under the federal income tax code or the Employee's tax dependents as defined in Code Section 152; however, for purposes of health benefits and Dependent Care Reimbursement ("DDC") benefits offered under the Plan, a dependent is defined as (i) for health plan purposes, as set forth in Code Section 105(b) and (ii) for DOC purposes, as any person who meets the requirements to be a "qualifying individual" as defined in the DOC component SPD. Q-4, When does my participation in the Plan end? You continue to participate in the Plan until (I) you elect not to participate in accordance with Q-9 of this SPD; (ii) you no longer satisfy the eligibility requirements described in the Plan Information Summary; (iii) you terminate employment with the Employer; or (iv) the Plan is terminated or amended to exclude you or the class of employees of which you are a member. If your employment With the Employer is terminated during the Plan Year or you otherwise cease to be eligible, your active participation in the Plan will automatically cease, and you will not be able to make any more 6-69 SPD Pre-tax Contributions under the Plan. If you are rehired within the same Plan Year or you become eligible again, you may make new elections, provided that you are rehired or become eligible again more than 30 days after you terminated employment or lost eligibility If you are rehired or again become eligible within 30 days or less, your prior elections will be reinstated and remain in effect for the remainder of the Plan Year unless you again lose eligibility 0-5. How do I become a Participant? You become a Participant by signing an individual Salary Redirection Agreement ("SRA") on which you elect one or more of the Benefit Plans or Policies available under the Plan, as well as agree to a salary redirection to pay for those benefits so elected. You wil] be provided an SRA when you first become eligible to particip'ate in this Plan. You must complete the form and turn it in to the Personnel Office during the applicable enrollment period described in Q-6 belmv. 0-6. What are the enrollment periods for entering the Plan? If you are eligible on the effective date of the Plan, you must enroll during the enrollment period immediately preceding the effective date of the Plan. Othervvise, you must enroll during either the "Initial Enrollment Period" or the "Annual Enrollment Period". You will be notified of the dates that each enrollment period begins and ends in the enrollment material provided to you prior to each enrollm~nt period. If you make an election during the Initial Enrollment Period, your participation in this Plan will begin on the later of your eligibility date described in the Plan Information Summary, the first pay period coinciding with or next following the date that your election is received by the Plan Administrator (or its designated claims administrator) or the date coverage under a Benefit Plan or polley that you elect begins. The effective date of coverage under the applicable Benefit Plan(s) or Policy(ies) is governed by the terms of each Benefit Plan or Policy, as set forth in the governing documents for each Benefit Plan or Policy. The election that you make during the Initial Enrollment Period is effective for the remainder of the Plan Year and generally cannot be revoked during the Plan Year unless you have a Change in Status event as described in Q-9 below If you do not make an election during the Initial Enrollment Period, you will be deemed to have elected not to participate in this Plan for the remainder of the Plan Year. You may, however, be covered by certain Benefit Plans or Policies automatically (and be required to contribute with pre-tax dollars) even if you fail to make an election. These automatic Benefit Plans or Policies are called uOefault Benefits" and will be identified in the enrollment material that you receive. The election that you make during the Annual Enrollment Period is effective the first day of the next Plan Year and is irrevocable for the entire Plan Year unless you have a Change in Status event described in Q-9 below. A Participant who fails to complete, sign, and file an SRA during the Annual Enrollment Period as required shall be deemed to have elected to continue participation in the Plan with the same benefit elections as during the prior Plan Year (adjusted to reflect any increase/decrease in apppcable premiums), and except for a Change in Status, will not be permitted to modify his election until the next Annual Enrollment Period. Notwithstanding the foregoing, annual elections for participation in the Medical Care and Dependent Care Expense Reimbursement Plans, if offered under the Plan, must be made by submitting an SRA prior to the beginning of each Plan Year -- no deemed ejections shall occur with respect to such benefits. The Plan Year is generally a 12-month period (except during the initial or last Plan Year of the Plan). The beginning and ending dates of the Plan Year are described in the Plan Information Summary. Q-7. What tax advantages are available through the Plan? Suppose your monthly gross pay is $2,500 per month and your cost for coverage is $140 per month. Also, suppose your total with holdings (income tax and Social Security) are 22.65%. After paying for coverage from your after-tax pay, your take home pay is $1,794. However, under the pre-tax premium plan, .you will be considered to have received $2,360 gross pay rather than $2,500 for tax purposes with $140 contributed for medical coverage. This means your take home pay wili be $1,825 with the pre-tax premium plan rather than $1,794 without it. Thus, you save $31 per month ($372 per year) by participating in the pre-tax premium plan. The Table below illustrates this savings. Gross Monthly Pay Pre-Tax Coverage Under Plan Taxable Income Estimated Federal Tax (15%) FICA Tax After-tax Coverage Take Home Pay With Cafeteria Plan $2,500 140 2360 354 181 Without Cafeteria Plan $2,500 1,825 2500 375 191 140 1,794 Monthly Savings: $31.00 0-8. How are my contributions under the Benefit Plans or Policies made? When you become a Participant, your share of the contributions for the elected Benefit Plan or Policy(ies) will be paid with Pre-tax Contributions elected on the SRA. Pre-tax Contributions are amounts withheld from your gross income before any applicable federal and state taxes have been deducted (some state tax laws do not recognize Pr~tax Contributions). In addition, all or a portion of the cost of the Benefit Plans or Policies may, in the Employer's discretIon, be paid with contributions made by the Employer on behalf of each Participant (these are called "Nonelective Contributions"). The amount of Nonelective Contribution that is applied towards the cost of the Benefit Plan(s) or 6-61 4 SPD - - - = - - '" - '" '" - - - = - - - " - '" " - "' " " - 0 0 - 1" Policy(ies) for each Participant and/or level of coverage is subject to the sole discretion of the Empioyer, and it may be adjusted upward or downward in the Employer's sole discretion. The Nonelective Contribution amount will be calculated for each Plan Year in a uniform and nondiscriminatory manner and_- may be based upon your Dependent status, commencement or termination date of your employment during the Plan Year, and such other factors that the Employer deems relevant In no event will any Nonelective Contribution be disbursed to you in the form of additional, taxable Compensation except as otherwise provided in the enrollment material. To the extent set forth in the enrollment material, the Employer may make available a certain amount of Nonelective Contributions and then allow you to allocate the Noneiective Contributions among the various Benefit Plan(s) or Policy(ies) that you choose (subject to restrictions described in the enrollment material). 0-9. Can I ever change my election during the Plan Year? Generally, you cannot change your election to participate in the Plan or vary the Pre-tax Contribution amounts although your election will.terminate if you are no longer \Norking for the Employer or no longer eligible under the terms of the Plan. Othervvise, you may change your elections for Pre-Tax Contributions only during the Annual Enrollment Period, and then, only for the coming Plan Year, There are several important exceptions to this general rule: You may change or revoke your previous election during the Plan Year jf you file a written request for change with the Plan Administrator (or its designated claims administrator) within 30 days of any of the following events: 1. Change in Status. If one or more of the following "Changes in Status" occur, you may revoke your old election and make a new election, provided that both the revocation and new election are on account of and correspond with the Change in Status (as described below). Those occurrences that qualify as a Change in Status include the events described below, as well as any other events that the Plan Administrator determines are permitted under subsequent IRS regulations: a change in your legal marital status (such as marriage, legal separation, annulment, or divorce or death of your Spouse); a change in the number of your tax Dependents (such as the birth of a child, adoption or placement for adoption of a Dependent, or death of a Dependent); any of the following events that change the employment status of you, your Spouse, or your Dependent that affect benefit eligibility under a cafeteria plan (including this Plan and the Plan of another employer) or other employee benefit plan of yours, your Spouse, or your Dependents, Such events include any of the following changes in employment status: termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence, a change in worksite, switching from salaried to hourly-paid, union to non-union, or 'part-time to full-time; incurring a reduction or increase in hours of employment; or any other similar change which makes the individual become (or cease to be) eligible for a particular employee benefit (NOTE: The specific rules governing election changes when you take a leave of absence are described in Q-13 of this SPD); an event that causes your Dependent to satisfy or cease to satisfy an eligibility requirement 'for a particular benefit (such as attaining a specified age, getting married, or ceasing to be a student); a change in your, your Spouse's or your Dependent's place of residence. If a Change in Status occurs and you want to make a corresponding election change, you must inform the Plan Administrator and complete a new election within 30 days from the date of the event. The election change must be on account of and correspond with the Change in Status event as determined by the Plan Administrator with the exception of special enrollment resulting from birth, placement for adoption or adoption, all election changes are prospective. As a general rule, a desired election change will be found to be consistent with a Change in Status event if the event affects eligibility for coverage. A Change in Status affects eligibility for coverage if it results in an increase or decrease in the number of Dependents who may benefit under the plan. In addition, you must also satisfy the following specific requirements in order to alter your election based on that Change in Status: Los.s of Dependent Eligibifity. For accident and health benefits (e.g., health, dental and vision coverage, and Medical Care Reimbursement Plan), a special rule governs which types of election changes are consistent with the Change in Status. For a Change in Status involving your divorce, annulment or legal separation from your Spouse, the death of your Spouse or your Dependent, or your Dependent ceasing to satisfy the eligibility requirements for coverage, your election to cancel accident or health benefits for any individual other than your Spouse involved in the divorce, annulment, or legal separation, your deceased Spouse or Dependent, or your Dependent that ceased to satisfy the eligibility requirements, would fail to correspond with that Change in Status, Hence, you may only cancel accident or health coverage for the affected Spouse or Dependent. Example: Employee Mike is married to Sharon, and they have one child. The employer offers a calendar year cafeteria plan that allows employees to elect no health coverage, employee-only coverage, employee-plus-one-Oependent coverage, or family coverage. Before the plan year, Mike elects family coverage for himself, his wife Sharon, and their child. Mike i3nd Sharon subsequently divorce during the plan year; Sharon loses eligibility for coverage under the plan, while the child is still eligible for coverage under the plan. Mike now wishes to cancel his previous election and elect no health coverage. The divorce between Mike 6-6~ SPD and Sharon constitutes a Change in Status. An election to cancel coverage for Sharon is consistent with this Change in Status. However, an election to cancel coverage for Mike and/or the child is not consistent with this Change in Status. In contrast, an election to change to employee-plus-one-Dependent coverage would be consistent with this Change in Status. However, there are instances in which you may be able to increase your Pre-tax Contributions to pay for COBRA coverage of a Dependent child or yourself. Gain of Coverage Eligibility Under Another Employer's Plan. For a Change in Status in which you, your Spouse, or your Dependent gain eligibility for coverage under another employer's cafeteria plan (or Benefit Plan or Policy) as a result of a change in your marital status or a change in your, your Sp.ouse's, or your Dependents employment status, your election to cease or decrease coverage for that individual under the .Plan would correspond with that Change in Status only if coverage for that individual becomes effective or is increased under the other employer's plan. Dependent Care Reimbursement Plan "Benefits (if offered under the Plan. See the list of Benefit Plans or Policies offered under the Plan in the Plan Information Summary). With respect to the Dependent Care Reimbursement Plan benefit (if offered by the Plan), you may change or terminate your election only if (1) such change or termination is made on account of and corresponds with a Change in Status that affects eligibility for coverage under the Plan; or(2) your election change is on account of and corresponds with a Change in Status that affects the eligibility of Dependent care assistance expenses for the available tax exclusion. Example: Employee Mike is married to Sharon, and they have a 12 year-old daughter The employer's plan offers a Dependent care expense reimbursement program as part of its cafeteria plan. Mike elects to reduce his salary by $2,000 during a plan year to fund Dependent care coverage for his daughter. In the middle of the plan year when the daughter turns 13 years old, however, she is no longer eligible to participate in the Dependent care program. This event constitutes a Change in Status. Mike's election to cancel coverage under the Dependent care program would be consist~nt with this Change in Status. Group Term Ufe Insurance, Disability Income, or Dismemberment Benefits (if offered under the Plan. See the list of Benefit Plans or Policies offered under the Plan in the Plan Information Summary). For group term life insurance, disability income, and accidental death and dismemberment benefits, if you experience any Change in Status (as described above), you may elect either to increase or decrease coverage. Example: Employee Mike is married to Sharon, and they have one child. The employer's plan offers a cafeteria plan which funds group-term life insurance cove~age (and other benefits) through salary reduction. Before the plan year Mike elects $10,000 of group-term life insurance. Mike and Sharon subsequently divorce during the plan year The divorce constitutes a Change in Status. An election by Mike either to increase or to de.crease h.is group-t~rm life insurance coverage would each be consistent with this Change in Status. 2. Special Enrollment Rights. If you, your Spouse, and/or a Dependent are entitled to special enrollment rights under a Benefit Plan or Policy that is a group health plan, you may change your election to correspond with the special enrollment right. Thus, for example, if you declined enrollment in medical coverage for yourself or your eligible Dependents because of outside medical coverage and eligibility for such coverage is subsequently lost due to certain reasons (i.e., due to legal separation, divorce, death, termination of employment, reduction in hours, or exhaustion of COBRA period), you may be able to elect medical coverage under the Benefit Plan or Policy for yourself and your eligible Dependents who lost such coverage. Furthermore, if you have a new Dependent as a result of marriage, birth, adoption, or placement for adoption, you may also be able to enroJJ yourself, your Spouse, and your newly acquired Dependents, provided. that you request enrollment within the Election. Change Period. An election change that corresponds .with a special enrollment must be prospective, unless the special enrollment is attributable to the birth, adoption, or placement for adoption of a child, which may be retroactive up to 30 days. Please refer to the group health plan description for an explanation of special enrollment rights. Effective April 1, 2009, if you or your eligible Dependent (1) lose coverage under a Medicaid Plan under Title XIX of the Social Security Act; (2) lose coverage under a State Children's Health Insurance Program (SCHIP) under Title XXI ofthe Social Security Act; or (3) become eligible for group health plan premium assistance under Medicaid or SCH!P and you are entitled to special enrollment rights under a Benefit Plan or Policy that is a group health plan, you may change your election to correspond with the special enrollment right. Thus, for example, if you declined enrollment in medical coverage for yourself or your eligible Dependent(s) because of medical coverage under Medicaid or SCHIP and eligibility for such coverage is subsequently lost, you may be eligible to elect medical coverage under a Benefit Plan or Policy for yourself and your Dependent(s). You must request an election change to enroll in group plan coverage within 60 days from the date (1) the coverage terminates under the Medicaid or SCHIP plan or (2) the Employee or dependent child is determined eligible for state premium assistance. Please refer to the group health plan summary description for an explanation of special enrollment rights. 3. Certain Judgments, Decrees and Orders. If a judgment, decree or order from a divorce, separation, annulment, or custody change requires your Dependent child (including a foster child who is your tax Dependent) to be covered under this Plan, you may change your election to provide coverage for the Dependent child identified in the order. If the order requires that another individual (such as your former Spouse) cover the Dependent child, and such coverage is actually provided, you may change your election to revoke coverage for the Dependent child. 4. Entitlement to Medicare or Medicaid. If you, your Spouse, or a Dependent becomes entitled to Medicare or Medicaid, you may cancel that person's accident or health coverage. Similarly, if you, your Spouse, or a Dependent who has been entitled to Medicare or Medicaid loses eligibility for such, you may, subject to the terms of the underlying plan, elect to begin or increase that person's accident or health coverage. 6-6~ SPO 5. Change in Cost. If you are notified that the cost of your Benefit Plan or Policy coverage under the Plan significantly ~ncreases or decreases dun~g the Plan Year, you n:ay make c~rta!n election changes. . If the cos~ significantly Increases, you may ~hoose elther.to make an .lncrea.se,ln your contributIOns, revoke your election and receive coverage un.der another Bene~lt ~Ian or PoliCY that provides sImIlar coverage, o.r drop coverage altogether if no similar coverage eXists. \f the cost significantly decreases, you may revoke your election and elect to receive coverage provided under the option that decreased in cost. For insignificant increases or decreases in the cost of Benefit Plans or Policies' however, your Pre-tax Contributions will automatically be adjusted to reflect the minor change in cost The Pla~ Administrator will have final authority to determine whether the requirements of this section are met. (Please note that none of the above "Change in Cost" exceptions are applicable to a Medical Care Reimbursement Plan, to the extent offered under the Plan.) Example: Employee Mike is covered under an indemnity option of his employer's accident and health insurance coverage. If the cost of this option significantly" increases during a period of coverage, the Employee may make a corresponding increase in his payments or may instead revoke his election and elect coverage under an HMO option. 6 Change in Coverage. If you are notified that your Benefit Plan or Policy coverage under the Plan is significantly curtailed, you may revoke your election and elect coverage under another Benefit Plan or Policy that provides similar coverage. If the significant curtailment amounts to a complete loss of coverage, you may also drop coverage if no other similar coverage is available. Further, if the Plan adds or significantly improves a benefit option during the Plan Year, you may revoke your election and elect to receive on a prospective basis coverage provided by the newly added or significantly improved option, so long as the newly added or significantly improved option provides similar coverage. Also, you may make an election change that is on account of and corresponds with a change made under another employer plan (including a plan of the Employer or another employer), so long as: (a) the other employer plan permits its participants to make an election change permitted under the IRS regulations; or (b) the Plan Year for this Plan is different from the Plan Year of the other employer plan. Finally, you may change your election to add coverage under this Plan for yourself, your Spouse, or your Dependent if such individual(s) loses coverage under any group health coverage sponsored by a governmental or educational institution. The Plan Administrator will have final discretion to determine whether the requirements of this section are met (Please note that none of the above "Change in Coverage" exceptions are applicable to the Medical Care Reimbursement Plan, to the extent offered under the Plan.) Additionally, your election(s), may be modified downward during the Plan Year if you are a Key Employee or .Highly Compensated Individual (as defined by the Internal Revenue Code), if necessary to prevent the Plan from becoming discriminatory within the meaning .of the federal income tax law. Q-10. How long will the Plan remain in effect? Although the Employer expects to maintain the Plan indefinitely, It has the right to modify or terminate the program at any time for any reason. It is also possible that future changes In state or federal tax laws may require that the Plan be amended accordingly. Q-11. What happens if my claim for benefits under this Plan is denied? This SPD describes the basic features of the Plan. If your claim is for a benefit under one of the component Benefit Plans or Policies, you will generally proceed under the claims procedures applicable under the component Benefit Plan or Policy (see the plan summary for each of the Benefit Plans or Policies that you elect). However; if you are denied a benefit under this Plan, the claims procedure under this Plan will apply You will be notified if your claim under the Plan is denied. The notice of denial will be furnished to you within 30 days after receiving your claim. However, if additional time is needed to process your claim you will be notified before the initial 3D-day period has expired. The notice will explain why an extension is necessary and the date a decision is expected to be rendered. In no event will an extension go beyond 15 days after the end of the initial 3D-day period. The notice of the denial will include the specific reasons for the denial and the relevant plan provisions on which the denial was based. - - - ~ ~ '" - "' <D - - ~ - ~ - Q-1 2. - N - "' - 5 "' 5 - " 0 0 f' If your claim is denied in whole or in part, you may appeal by requesting a review of the denied claim, as set forth in the notice of denial, within 180 days after you receive notice of the denial. If there are two levels of appeal (as indicated In the notice of denial), you will have a reasonable amount of time in which to request a second review and such time period will be identified in the notice of denjal. As part of the appeal process (whether there is one or two appeals), you or your authorized representative may ex~mine documents, records, and other information relevant to your claim and submit issues, documents and comments in writing. Within 60 days after the request for review is received, you will be notified in writing of the decision on review The notlce of denial will indicate whether there are one or two levels of appeals and will contain the same type of information provided to you in the first notice of denial. If there are two levels of Plan appeals, the decisions on appeal will be made within 30 days after the request for each review is received. The Plan Administrator is the claims fiduciary for making the final decision under the plan. In the event of your death, your beneficiary has the same rights and is subject to the same time limits and other restrictions that would otherwise apply to you under the claims procedures explained above. What effect will Plan participation have on Social Security and other benefits? Plan participation will reduce the amount of your taxable compensation. Accordingly, there could be a decrease in your Social Security benefits and/or other benefits (e.g., pension, disability and life insurance) that are based on taxable compensation. 6-64 7 SPD Q-13. What happens if I take a leave of absence? (a) If you go on 'a qualifying unpaid leave under the Family and. Medical Leave Act of 1993 (FMLA), to the extent required by the FMLA, the Employer will continue to maintain your Benefit Pians or Policies providing health coverage on the same terms and conditions as though you were still active (e.g., the Employer will continue to pay its share of the contribution to the extent you opt to continue coverage). (b) Your Employer may elect to continue all coverage for Participants while they are on paid leave (provided Participants on non-FML../\ paid leave are required to continue coverage). If so, you will pay your share of the contributions by the method normally used during any paid leave (for example, with Pre-tax Contributions if that IS what was used before the FMLA leave began). . (c) In the event of unpaid FMLA leave (or paid leave where coverage is not required to be continued), if you opt to continue your group health coverage, you iTray pay your share of the contribution with after-tax dollars while on leave, or you may be given the option to pre-pay all or a portion of your share of the contribution for the expected duration of the leave with Pre-tax Contributions from your pre-leave compensation by making a special election to that effect before the date such compensation would normally be made available to you provided, however, that pre-payments of Pre-tax Contributions may not be utilized to fund coverage during the next Plan Year, or by other arrangements agreed upon between you and the Plan Administrator (for example, the Plan Administrator may fund coverage during the leave and withhold amounts from your compensation upon your return from leave). The payment options provided by the Employer will be established in accordance with Code Section 125, FMLA and the Employer's internal policies and procedures regarding leaves of absence. Alternatively, the Employer may require all Participants to continue coverage during the leave. If so, you may elect to discontinue your share of the required contributions until you return from leave. Upon return from leave, you will be required to repay the contribution not paid during the leave in a manner agreed upon with the Administrator. (d) If your coverage ceases while on FMLA leave (e.g., for non-payment of required contributions), you will be permitted to re-enter the Plan upon return from such leave on the same basis as you were participating in the Plan prjor to the leave, or as otherwise required by the FML../\. Your coverage under the Benefit Plans or Policies providing health coverage may be automatically reinstated provided that coverage for Employees on non-FMLA leave is automatically reinstated upon return from leave. (e) The Employer may, on a uniform and consistent basis, continue your group health coverage for the duration of the leave following your failure to pay the required contribution. Upon return from leave, you will be required to repay the contribution in a manner agreed upon by you and Employer. (f) !f you are commencing or returning from unpaid FML../\ leave, your election under this Plan for Benefit Plans or Policies providing non-health benefits shall be treated in the same manner that elections for non-health Benefit Plans or ~olicies ~re treated with respect to Participants commencing and returning. from unpaid non-FMLA leave. (g) If you go on an unpaid non-FMLA leave of absence (e.g., personal leave, sick leave, etc.) that does not affect eligibility in thiS Plan or a Benefit Plan or Policy offered under this plan, then you will continue to participate and the contribution due will be paid by pre-payment before going on leave, by after-tax contributions while on leave, or with catch-up contributions after the leave ends, as may be determined by the Administrator If you go on an unpaid leave that affects eligibility under this Plan or a Benefit Plan or Policy, the election change rules it'} Q-9 of this SPD will apply. The Plan Administrator will have discretion to determine whether taking an unpaid non-FMLA leave of absence affects eligibility Q-14. Is there any other information that I should know about the Plan? Participation in the Plan does not give any Partjcipant the right to be retained in the employ of his or her Employer or any other right not specified in the Plan. The Plan Administrator's name, address and telephone number appear in the Plan Information Summary attached to the front of this SPD. The Plan Administrator has the exclusive right to interpret the Plan and to deCide all matters arising under the Plan, including the right to make determinations of fact, and construe and interpret possible ambiguities, inconsistencies, or or:nissions In the Plan and thiS SPD. Other important information such as the Plan Number and Plan Sponsor's name and address has also been provided in the Plan Information Summary 6-6~ SPD - g '" ~ - ~ - - N _M E "' E (9 o o M " TABLE OF CONTENTS FLEXIBLE BENEFITS PLAN PREAMBLE 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 8 8 8 8 8 8 PLANDOC ARTICLE 1- DEFINITIONS 1.01 "Affiliated Employer" 1 02 "After-taxContribution(s)" 1 03 "Anniversary Date" 1.04 "Benefit Plan(s) or Policy(ies)" 1.05 "Board of Directors" 1.06 "Change in Status" 1 07 "Code" 1 08 "Compensation" 1.09 "Dependent" 1 1 0 "Dependent Care Expense Reimbursement" 1 11 "Earned Income" 1.12 "Effective Date" 1.13 "Eligible Employment-RelatedExpenses" 1.14 "Eligible Medical Expenses" 1 15 "Employee" 1.16 "Employer' 1 17 "ERISA" 1 18 "Medicare Care Expense Reimbursements" 1.19 "Highly Compensated Individual" 1.20 "Key Employee" 1.21 "Nonelective Contribution(s)" 1.22 "Participant" 1.23 "Plan" 1.24 "Plan Administrator" 1.25 "Plan Year" 1.26 "Pre-tax Contribution(s)" 1.27 "Qualified Benefit" 1.28 "Qualifying Empioyment-RelatedExpenses" 1.29 "Qualifying Individual" 1.30 "Qualifying Services" 1.31 "ReimbursementAccount(s)" or "Account(s)" 1.32 "Salary Redirection Agreement" or "SRA" 1.33 "Spouse" 1 34 "Student" 1.35 "Summary Plan Description" or"SPD" 1.36 "Trustee" ARTICLE 11- ELlGIBILlTYAND PARTICIPATION 2.01 Eligibility to Participate 2.02 Termination of Participation 2.03 Eligibility to Participate in ReimbursementAccounts 2.04 Qualifying Leave Under FMLA 2.05 Non-FMLA Leave ARTICLE 111- BENEFIT ELECTIONS 3.01 Election of Contributions 3.02 Initial Election Period 3.03 Annual Election Period 3.04 Change of Elections 3.05 Impact of Terminatio~ of Employmenton Election or Cessation of Eligibility ARTICLE IV - BENEFIT FUNDING AND CREDITS AND DEBITS TO ACCOUNTS 4.01 Source of Benefit Funding 4.02 Reduction of Certain Elections to Prevent Discrimination 4.03 Medical Care Expense Reimbursement 4.04 Dependent Care Expense Reimbursement ARTICLE V - BENEFITS 5.01 Qualified Benefits 5.02 Cash Benefit 5.03 Repayment of Excess Reimbursements 5.04 Termination of ReimbursementAccounts 5.05 Coordination of Benefits Under the URM 6-6~ ARTICLE VI - PLAN ADMINISTRATION 6.01 Allocation of Authority 6.02 Payment of Administrative Expenses 6.03 Reporting and Disclosure Obligations 604 Indemnification 6.05 Substantiation of Expenses 6.06 Reimbursement 6.07 Annual Statements 8 8 9 9 9 9 9 9 ARTICLE VII - FUNDING AGENT 9 ARTICLE VIII - CLAIMS PROCEDURES 9 ARTICLE IX - AMENDMENT OR TERMINATIONOF PLAN 9,01 Permanency 9.02 Employer's Ri9ht to Amend 9.03 Employer's Right to Terminate 904 Determination of Effective Date of Amendment or Termination 10 10 10 10 10 ARTICLE X - GENERAL PROVISIONS 10.01 Not an Employment Contract 10.02 Applicable Laws 10.03 Post-Mortem Payments 10.04 Nonalienation of Benefits 10.05 Mental or Physical Incompetency 10 06 Inability to Locate Payee 10.07 Requirement for Proper Forms 10.08 Source of Payments 10.09 . Multiple Functions 10.10 Tax Effects 10.11 Gender and Number 10.12 Headings 10.13 Incorporation by Reference 10.14 Severability 10.15 Effect of Mistake 10.16 Provisions Relating to Insurers 10.17 Forfeiture of. Unclaimed Reimbursement Account Benefits 10.18 HIPAA Privacy 10 10 10 10 10 10 10 10 10 11 11 11 11 11 11 11 11 11 11 ARTICLE XI - CONTINUATION COVERAGE UNDER COBRA 11 EMPLOYER'S ACKNOWLEDGEMENT 12 ATTACHMENT 1- SUMMARY PLAN DESCRIPTION (SPD) 6-li} PLAN DOC PREAMBLE The Employer hereby establishes a Flexible Benefits Plan ("Plan") for its Employees for purposes of providing eligible Employees with the opportunity to choose from among the fringe benefits available under the Plan. The Plan is intended. to qualify as a cafeteria plan under the provisions of Code Section 125. The Dependent Care Expense Reimbursement Plan ("DOC") is intended to qualify as a Code Section 129 dependent care assistance plan, and the Medical Care Expense Reimbursement Plan ("l,JRM") is intended to qualify as a Code Section 105 medical expense reimbursement plan. Although printed within this document, the DOC and URM Plans are separate written plans for purposes of administration and all reporting and nondiscrimination requirements imposed by Sections 105 and 129 of the Code and all applicable provisions of ERISA. The DOC and the URM are available only if designated as a Benefit Plan or Policy in the Summary Plan Description (SPD). FLEXIBLE BENEFITS PLAN ARTICLE I - DEFINITIONS 1.01 "Affiliated Employer" means any entity who is considered with the Employer to be" a single employer in accordance with Code Section 414(b), (c), or (m) of the Code. 1.02 "After-tax Contribution{s)" means amounts withheld from an Employee's Compensation pursuant to a Salary Redirection Agreement (SRA) after all applicable state and federal taxes have been deducted. Such amounts are withheld for purposes of purchasing one or more of the Benefit Plans or Policies available under the Plan. 1.03 "Anniversary Date" means the first day of any Plan Year. 1.04 "Benefit Plan(s) or Policy(ies)" means those Qualified Benefits available to a Participant under this Plan as set forth in the SPD, as amended and/or restated from time to time. 1.05 "Board of Directors" means the Board of Directors or ather governing body of the Employer (the "Board"). The Board, upon adoption of this Plan, appoints the Plan Administrator to act an the Employer's behalf in all matters regarding the Plan. 1.06 "Change in Status" means any of the events described in the SPD, as well as any other events included under subsequent changes to Code Section 125 Of regulations issued under Code Section 125, that the Plan Administrator (in Its sole discretion) decides to recognize on a uniform and consistent basis as a reason to change the election mid-year. Note: See the SPD for requirements that must be met to permit certain mid-year election changes on account of a Change in Status. 1.07 "Code" means the Internal Revenue Code of 1986, as amended. 1.08 "Compensation" means the cash wages or saiary paid to an Employee by the Employer 1.09 "Dependent" means any individual who is a tax dependent of the Participant as defined generally in Code Section 152(a) except as otherwise set forth in Code Section 21 (far Dependent Care FSA purposes, if offered under the Plan), Code Section 105 (far health plan purposes, if offered under the Plan), arid Code Section 223 (far Health Savings Account purposes, if offered under the Plan). Also, far DDC purposes, a Dependent shall also be defined as in Code section 21(e)(5) (i.e, dependent of the custodial parent as defined in Code Section 152(e)). 1.10 "Dependent Care Reimbursement" shall have the meaning assigned to it by Section 5.01 of the Plan. 1.11 "Earned Income" means all income derived from wages, salaries, tips, self-employment, and other Compensation (such as disability or wage continuatIon benefits), but only if such amounts are includable in gross income for the taxable year. Earned income does not include any other amounts excluded from earned income under Code S 32(c)(2), such as amounts received under a pension or annuity, or pursuant to workers' compensation. -= - ;;; '" 1.12 "Effective Date" of this Plan is the effective date set forth in the SPD 1.13 "Eligible Employment-Related Expenses" means those Qualifying Employment-Related Expenses (as defined below) paid or incurred incident to maintaining employment after the date of the Employee's participation in the DOC and during the Plan Year (plus any applicable grace period extension as described in the SPD), ather than amounts paid to: - -= - (a) '" (b) '" 13 "' 13 c; 0 0 '" '" an individual with respect to wham a Dependent deduction is allowable under Code Sec. 151(c) to the Participant or his Spouse; the Participant's Spouse; or 6-68 3 PLANDOC (c) a child of the Participant who is under 19 years of age at the end of the taxable year in which the expenses were incurred. 1.14 "Eligible Medical Expenses" means those expenses incurred by the Employee, or the Employee's Spouse or Dependents, after the date of the Employee's participation in the URM and during the Plan Year (plus any applicabl~ grace period extension as described in the SPD) to the extent that the expense satisfies the conditions set forth in the Summary Plan. Description and are for "medical care" as defined by Code Section 213(d).. For purposes of this Plan, the following expenses are not considered "Eligible Medical Expenses" even if they otherwise constitute "medical care" under Code Section 213(d): i) expenses for qualified long term care services (as defined in Code S 77028(c)); and ii) expenses incurred for health insurance premiums. For purposes of this Plan, an expense is "incurred" when the Participant or beneficiary is furnished the medical ca.re or services giving rise to the claimed expense, regardless of when the expense is paid. 1.15 "Employee" means any individual who is considered to be in a legal employer-em.ployee relationship with the Employer for federal tax-withholding purposes. Such term includes "former employees" for the limited purpose of allowing continued eligibility for benefits hereunder for the remainder of the Plan Year in which an employee ceases to be employed by the Employer. The term "Employee" shall not include any leased employee (as that term is defined in Code Section 414(n)) or any self- employed individual who receives from the Employer "net earnings from seif- employment" within the meaning of Code Section 401(c)(2) unless such individual is also an Employee. 1.16 "Employer" means the Employer and the Affiliated Employers named in the SPD provided, however, that when the Plan provides that the Employer has a certain power (e.g., the appointment of a Plan Administrator, entering into a contract with a third party insurer, or amendment or termination of the plan) the term "Employer" shall mean only that entity named on the first line of the Plan Information Summary of the SPD, and not any Affiliated Employer. Affiliated Employers who sign the Plan Information Summary and/or otherwise adopt the Plan shall be bound. by the Plan as adopted and subsequently amended unless they clearly withdraw from participation herein. 1.17. "ERISA" shall mean the Employee Retirement Income Security Act of 1974, as amended. 1.18 "Health Care Reimbursement" shall have the meaning assigned to it by Section 5.01 of the Plan. 1.19 "Highly Compensated Individual" means an individual defined under Code Section 105(h), 125(e), or 414(q), as amended, as a "highly compensated individual" or a "highly compensated employee." 1.20 "Key Employee" means an individual who is a "key employee" as defined in Code Section 125(b)(2), as amended. 1.21 "Nonelective Contribution(s)" means any amount that the Employer, in its sole discretion, may contribute on behalf of each Participant to provide benefits for such Participant and his or her Spouse and Dependents, if applicable, under one or more of the Benefit Plan(s) or Policy(ies) offered under the Plan..The amount of employer contribution that is applied towards the cost of the Benefit Plan(s) or Policy(ies) for each Participant and/or level of coverage shall be subject to the sole discretion of the Employer. The amount of Nonelective Contribution for each Participant may be adjusted upward' or downward in the contributing Employer's sole discretion. The amount shall be calculated for each Plan Year in a uniform and nondiscriminatory manner and may be based upon the Participant's dependent status, commencement or termination date of the Participant's employment during the Plan Year, and such other factors as the Employer shall prescribe. To the extent set forth in the SPD or enrollment material, the Employer may make Nonelective Contributions available to Participants and allow Participants to allocate the Nonelective Contributions among the various Benefit Plans or Policies offered under the Plan in a manner set forth in the SPD of additional, taxable Compensation except as otherwise provided in the SPD or enrollment material. 1.22 "Participant" means an Employee who becomes a Participant pursuant to Article I!. 1.23 "Plan" means the Flexible Benefits Plan, the SPD (defined in Section 1 35 herein) and (if applicable) the related Trust .created by this document. 1.24 "Plan Administrator" means the person(s) or Committee identified in the SPD that is appointed by the Employer with authority, discretion, and responsibility to manage and direct the operation and administration of the Plan. If no such person is named, the Plan Administrator shall be the Employer. 1.25 "Plan Year" shall be the period of coverage set forth in the SPD (as extended by any applicable grace period as set forth in the SPD). 1.26 "Pre-tax Contribution(s)" means amounts withheld from an Employee's Compensation pursuant to a Salary Redirection Agreement before any appiicable state and federal taxes have been deducted. The amounts are withheld for purposes of purchasing one or more of the Benefit Plans or Policies available under the Plan. This amount shall not exceed the premiums or contributions attributable to the most costly Benefit Plan or Policy afforded hereunder, and for 6-6~ PLAN DOC purposes of Code Section 125, shall be treated as an Employer contribution (this amount may, however, be treated as an Employee contribution for purposes of state insurance laws). 1.27 "Qualified Benefit" means any benefit excluded from the Employee's taxable income under Chapter 1 of the Code other than Sections 106(b), 117, 124, 127, or 132 and any other benefit permitted by the Income Tax Regulations (i.e., any life insurance coverage that is includable in gross income by virtue of exceeding the dollar limitation on nontaxable coverage under Code Sec. 79). Notwithstanding the previous sentence, long-term care insurance is not a "Qualified Benefit." 1.28 "Qualifying Employment-Related Expenses" means those expenses that would be considered to be employment-related expenses under Section 21(b)(2) of the Code (relating to expenses for household and dependent care services necessary for gainful employment) itpaid for by the Employee to provide Qualifying Services. 1.29 "Qualifying Individual" means an individual defined as a "Qualifying Individual" in the Summary Plan Description. 1.30 "Qualifying Services" means services relating to the care of a Qualifying Individual that enable the Participant or his Spouse to remain gainfully employed which are performed: (a) in the Participant's home; or (b) outside the Participant's home for (1) the care of a Dependent of the Participant who is under age 13, or (2) the care of any other Qualifying Individual who resides at least eight (8) hours per day in the Participant's household. If the expenses are incurred for services provided by a dependent care center (Le., a facility that provides care for more than six (6) individuals not residing at the facility), the center must comply with all applicable state and local laws and regulations. 1.31 "Reimbursement Account(s)" or "Account(s}" shall be the funding mechanism by which amounts are withheld from an Employee's Compensation and retained for future Health Care Reimbursement (as defined in Section 1.18 herein) and Dependent Care Reimbursement (as defined in Section 1.10 herein) to the extent adopted by the Employer as set forth in the SPD. No money shall actually be allocated to any individuai Participant Account(s); any such Account(s) shall be of a memorandum nature, maintained by the Administrator for accounting purpqses, and shall not be representative of any identifiable trust assets. No interest will be credited to or paid on amounts credited to the Participant Account(s). 1.32 "Salary Redirection Agreement" or "SRA" means the actual or deemed agreement pursuant to which a.n eligible Employee or Partidpant elects to contribute his share of the cost of chosen Benefit Plans or Policies with Pre-tax or After-tax Contributions and/or Benefit Credits' (if offered under the Plan) in accordance with Article III herein. If the Employer utilizes an interactive voice response (IVR) system or web-based program for enrollment, the SRA may be maintained on an electronic database in accordance with all applicable federal and/or state laws. - 1.33 "Spouse" means an individual who is legally married to a Participant (and who is treated as a spouse under the Code), but for purposes of the Dependent Care Reimbursement Plan provisions, shall not include an individual who, although married to the Participant, files a separate federal income tax return, maintains a separate, principal residence from the Partidpant during the last six months of the taxable year, and does not furnish more than one-half of the cost of maintaining the principal place of abode of the Qualifying Individual. 1.34 - - - 1.35 -= - N - '"' <0 1.36 - - - -= - - 2.01 - - N '"' = 0 "' - 0 '" - 0 0 - '"' '" "Student" means an individual who, during each of five (5) or more calendar months during the Plan Year, is a full time student at any college or university, the primary function of which is the conduct of formal instruction, and which routinely maintains a regular faculty and curriculum and normally has an enrolled student body in attendance at the. location where its educational activities are regularly presented. "Summary Plan Description" or "SPD" means the document attached as Attachment I to the Plan document that describes the term of Plan not set forth herein. The SPD and all applicable appendices are incorporated hereto by reference. . "Trustee" (if appllcable) means the person(s) or institution (and their successors) named on the signature page attached hereto, who have assented to being so named by their signature to this Agreement, otherwise empowered to hold and disburse the funds that are created hereunder. ARTICLE II - ELIGIBILITY AND PARTICIPATION Eligibility to Participate. Each Employee who satisfies the eligibility requirements set forth in the SPD shall be eligible to participate in this Plan as of any applicable entry date set forth in the SPD. The provisions of this ArtiCle are not intended to override any eligibility requirement(s) or waiting period(s) specified in the applicable Benefit Plans or Policies and the terms of eligibility and participation for the Benefit Plan(s) or Policy(les) offered under the Plan shall be subject to the requirements specified in the governing documents of the Benefit Plans or Policies. 6-70 5 PLAN DOC 2.02 Termination of Participation. Participation shall terminate on the earliest of the dates set forth in the SPD. 2.03 Eligibility to Participate in Reimbursement Accounts. Each, Employee who satisfies the eligibility requirements set forth in the SPD shall be eligible to participate in the Reimbursement Accounts, if adopted by the Employer, .on the date set forth in the SPD Participation in the Reimbursement Accounts shall be effective on the date set forth in the SPD. 2.04 Qualifying Leave Under FMLA. Notwithstanding any provision to the contrary in this Plan, if a Participant goes on a qualifying leave under the Family and Medical Leave Act of 1993 (the "FMLA"), then to the extent required by the FMLA, the Participant will be entitled to continue the Participant's Benefit Plans or Policies that provide health coverage (including URM benefits to the extent offered under the Plan) on the same terms and conditions as if the Participant were still an active Employee. The requirements for continuing coverage, procedures for FMLA leave, and payment option(s) provided by the Employer (as described above) will be set forth in the SPD and will be administered in accordance with the regulations issued under Code Section 125 and in accordance with the FMLA. 2.05 Non-F:MLA Leave. )f a Participant goes on an unpaid leave of absence that does not affect eligibHity under thi~ Plan or the Benefit Plans or Policies chosen by the Participant, then the Participant will continue to participate and the contributions due for the Participant will be paid by one or more of the payment options described in the SPD. If a Participant goes on an unpaid leave that affects eligibility under this Plan or the Benefit Plans or Policies chosen by the Participant, the election change rules in Section 3.04 will apply If such policy requires coverage to continue during the leave but permits a Participant to discontinue contributions while on leave, the Participant will, upon returning from leave, be required to repay the contributions not paid by the Participant during the leave, ARTICLE III - BENEFIT ELECTIONS 3.01 Election of Contributions. A Participantmay elect any combination of Pre-tax Contributions or After-tax Contributions (as set forth in the SPD) to fund any Benefit Plan or Policy available under the Plan, provided that only Qualified Benefits may be funded with Pre-tax Contributions. The Employer may, but is not required, to allocate Non-elective Contributions to one or more Benefit Plans or Policies offered under the Plan and to the extent set forth in the SPD or enrollment material, may allow the Participants to allocate his allotted share of Nonelective Contributions among the 'various Benefit Plans or Policies in a manner set forth in the SPD or enrollment material. 3.02 Initial Election Period. (a) Currently Eligible Employees. An Employee who is eligible to become a Participant in this Plan as of the Effective Date must complete, sign and file an SRA with the Plan Administrator during the election period (as specified by the Plan Adminis~rator) immediately preceding the Effective Date of the Plan in order to become a Participant on the Effective Date. The elections made by the Participant on this mitial.SRA shall be effective, subject to Section 3.04, for the Plan Year beginning on the Effective Date. (b) New Employees and Employees Who Have Not Yet Satisfied The Plan's Waiting Period. An Employee who becomes eligible to become a Participant in this Plan after the Effective Date must complete, sign and file a SRA with the Plan Administrator (or its designated third party administrator as set forth on the SRA) during the Initial Election Period set forth in the SPD or the enrollment material. Participation will commence under this Plan as set forth in the SPD Coverage under the component Benefit Plans or Policies will b'e effective in accordance with the governing provisions of such Benefit Plans or Policies. (c) Failure to Elect. An eligible Employee who fails to complete, sign and file a SRA in accordance with paragraph (a) or (b) above during an initial election period may become a Participant on a later date in accordance with Section 3.03 or 3.04. 3.03 Annual Election Period. Each Employee who is a Participant in this Plan or who is eligible to become a Participant in this Plan shall be notified, prior to each Anniversary Date of this Plan, of his right to become a Participant in this Plan, to continue participation in this Plan, or to modjfy or to cease participation in this Plan, and shall be given a reasonable period of time in which to exercise such right such period of time shall be known as the Annual Election Period. The date that the Annual Election Period commences and ends will be set forth in the SPD or the enrollment material. An election is made during the Annual Election Period in the manner set forth in the SPD The consequences of failing to make an election during the Annual Election Period will be set forth in the SPD 3.04 Change of Elections. A Participant shall not make any changes to the Pre-tax Contribution amount 'or, where applicable, to the Participant's elected allocation of Nonelective Contributions except for election changes permitted under this Section 3.04, and for changes made during the Annual Election Period (Section 3.03), changes caused by termination of employment (Section 3.05) and changes pursuant to the Family and Medical Leave Act (Section 2.04). Except as provided in the SPD for HIPAA special enrollment rights arising from the birth, adoption, or placement for adoption of a child, all election changes shall be effective on a prospective basis only (i.e., election changes will become effective no earlier than the first day of the first pay period coinciding with or "immediately following the date that the 6-71 6 PLAN DOC -= "' "' _<0 - N -"' o on o " o o "' r' = election change was filed) but, as determined by the Plan Administrator, election changes may become effective later to the extent the coverage in the applicable component plan commences later. The circumstances under which a Participant may change his election under this Plan are set forth in the SPD. 3.05 Impact of Termination of Employment on Election or Cessation of Eligibility. Termination of employment or cessation af eligibility shall automatically revoke any SRA. Except. as provided below, if revocation occurs under this Section 3.05, no new election with respect to Pre-Tax Contributions may be made by such Participant during the remainder of the Plan Year. Rules governing elections for former participants rehired during the same Plan Year shall be set forth in the SPD. ARTICLE IV _ BENEFIT FUNDING AND CREDITS AND DEBITS TO ACCOUNTS 4.01 Source of Benefit Funding. The cost of coverage under the component Benefit Plans or Policies shall be funded by the Participant's Pre-tax and/or After-tax Contributions and/or any Nonelective Contributions provided by the Employer. The required contributions for each of the Benefit Plans or Policies offered under the Plan shall be made known to employees in enrollment materials. Pre-tax or After-tax Contributions (as elected by the Employee on the SRA) shall equal the contributions required from the Participant less any available Nonelective Contributions allocated thereto by the Employer, or where applicable, the Participant for coverage of the Participant or the Participant's Spouse or Dependents under the Benefit Plans or Policies elected by the Participant under this Plan. Amounts withheld from a Participant's Compensation as Pre-tax Contributions or After-tax Contributions shall be applied to fund benefits as soon as administratively feasible. The maximum amount of Pre-tax Contributions plus any Nonelective Contributions made available by the.Employer for Benefit Plan(s) or Policy(ies) offered under this Plan shall not exceed the aggregate cost of the Benefit Plan(s) or Policy(ies) elected by the Employee. 4.02 Reduction of Certain Elections to Prevent Discrimination. If the Plan Administrator determines, before or during any Plan Year, that the Pian may fail. to satisfy for such Plan Year any requirement imposed by the Code or any. limitation on Pre-tax Contributions allocable to Key Employees or to Highly Compensated Individuals, the Plan Administrator shall take such action(s) as he deems appropriate, under rules uniformly applicable to similarly situated Participants, to assure compliance with such requirement or Iimitatjon. Such action may include, without limitation, a modification or revocation of a Highly Compensated Individual's or Key Employee's election without the consent of such Employee. 4.03 Health Care Reimbursement. To the extent offered under the Pian, each Participant's URM will be credited for Health Care Reimbursement with amounts withheid from the Participant's Compensation and any Nonelective Contributions allocated thereto by the Employer or where applicable, the Participant. The Account will be debited for Health Care Reimbursements disbursed to the Participant in accordance with Article V of this document. The entire amount elected by the Participant on the SRA as an annual amount for the Plan Year for Health Care Reimbursement less any Health Care Reimbursements already disbursed to the participant for Expenses incurred during the Plan Year (plus any grace period as set forth in the SPD) shall be available to the Participant at any time during the Plan Year without regard to the balance in the Health Care Account (provided that the periodic contributions have been made). .Thus, the maximum amount of Health Care Reimbursement at any particular time during the Plan Year will not relate to the amount that a Participant has had credited to his URM. In no event will the amount of Health Care Reimbursements in any Plan Year (plus any grace period as set forth in the SPD) exceed the annual amount specified for the Plan Year in the SRA for Health Care Reimbursement. Any amount credited to the Health Care Account shall be forfeited by the Participant and restored to the Employer if it has not been applied to provide Health Care Reimbursement within the Run-Off period set forth in the SPD Amounts so forfeited shall be used in a manner that is permitted within the applicable Department of Labor ("DOL") or Internal Revenue Service ("IRS") regulations. The maximum annual reimbursement under the URM shall be set forth in the SPD. The Employer may establish a minimum annual reimbursement amount as set forth in the SPD. 4.04 Dependent Care Reimbursement. To the extent offered under the Plan, each Participant's DOC will be r;::redited for Dependent Care Reimbursement with amounts withheld from the Participant's Compensation, and any Nonelective Contributions allocated thereto by the Employer or where applicable, the Participant. The Dependent Care Account will be debited for Dependent Care Reimbursements disbursed to the Participant in accordance with Article V of this document. . In the event that the amount in the Account is less than the amount of reimbursable claims at any time during the Plan Year, the excess part of the claim Will be carried over into following months. within the same Plan Year, to be paid out as the Dependent Care Account balance becomes adequate. In no event will the amount of Dependent Care Reimbursements exceed the amount credited to the Dependent Care Account for any Plan Year. Any amount allocated to the Dependent Care Account shail be forfeited by the Participant and restored to the Employer if it has not been applied to provide Dependent Care Reimbursement for the Plan Year within the Run-Off period set forth in the SPD Amounts so forfeited shall be used in a manner that is not prohibited by applicable federal or state law. The maximum annual reimbursement amount shall be set forth in the SPD. The Employer may establish a minimum annual reimbursement amount as set forth in the SPD 6-72 7 PLANDOC ARTICLE V - BENEFITS 5.01 Qualified Benefits. The maximum benefit a Participant may elect under this Plan shall not exceed the sum of i) the aggregate premium for all Benefit Pian!s) or Policy!ies) set forth in the SPD (other than Health and DOC); ii) the maximum annual Health Care Reimbursement under the URM as set forth in the SPD (if offered under the Plan); and iii) the maximum annual Dependent Care Reimbursement under the DOC as set forth in the SPD (if offered under the Plan). (a) Special Rules for Health Care Reimbursement. To the extent offered under the Plan, payment shall be made to the Participant in cash as reimbursement for Eligible Medical Expenses incurred by the Participant or his Spouse or Dependents while he is a Participant during the Plan Year (plus any grace period extension as specified in the SPD) for which the Participant's election is effective provided that the substantiation requirements of Section 6.05 herein are satisfied. (b) Special Rules for Dependent Care Reimbursement. To the extent offered under the Plan, payment shall be made to the Participant in cash as reimbursement for Eligible Employment Related Expenses incurred by him while a Participant, during the Plan Year (plus any applicable grace period extension as described in the SPD) for which the Participant's ejection is effective, provided that the substantiation requirements of Section 6.05 have been satisfied. 5.02 Cash Benefit. To the extent that a Participant does not elect to have the maximum amount of his Compensation contributed as a Pre-tax Contri_bution or After-tax Contribution hereunder, such amount not elected shall be paid to,the Particip~nt .in the form of normal Compensation payments; provided, however, that any applicable Nonelective Contributions may not be received in the form of cash compensation, except as otherwise provided for in the SPO or the enrollment material. 5.03 Repayment of Excess Reimbursements. If, as of the end of any Plan Year, it is determined that a Participant has received payments under this Rlan that exceed the amount of Eligible Medical Expenses and/or Eligible Employment Related Expenses that have been substantiated by such Participant during the Plan Year as required by Section 6.05 ~erein, the Plan Administrator shall give the Participant prompt written notice of any such excess amount, and the Participant shall repay the amount of such excess to the Employer within sixty (60) days of receipt of such notification. 5.04 Termination of Reimbursement Accounts. Coverage under the URM and/or DOC shall cease as of the day in which a Participant is no longer employed by the Employer or when a premium payment for the respective plan{s) has been missed for any reason. Provided, however, that Participants may submit claims for reimbursement for Eligible Employment-Related Expenses arising during the Plan Year at any time until the end of the RUn-Off period set forth in the SPD Participants in the URM may submit claims f<?r reimbursement for Eligible Medical ~xpenses arising during the Plan Year and before the date of separation from service at any time until the end of the Run-Off period set forth in the SPD. Unless a COBRA election is made as set forth in the SPD, Participants shall not be entitled to. receive reimbursement for Eligible Medical Expenses incurred after employment ceases under this Section. Any unused reimbursement benefits at the expiration of the Plan Year (as set forth in the SPO) shall be treated in accordance with Sections 4.03 or 4.04. A special grace period may be applicable with regard to URM and/or DOC participation after the close of the Plan Year (see SPD). 5.05 Coordination of Benefits Under the URM. The URM is intended to pay benefits solely for otherwise unreimbursed medical expenses. Accordingly, it shall not be considered a group health plan for coordination of benefits purposes, and its benefits shall not be taken into account when determining benefits payable under any other plan. ARTICLE VI - PLAN ADMINISTRATION 6.01 Allocation of Authority. The Board of Directors or applicable governing body (or an authorized officer of the Employer) appoints a Plan Administrator that keeps the records for the Plan and shall control and manage the operation and administration of the Plan. The Plan Administrator shall have the exclusive right to interpret the Plan and to decide all matters arising thereunder, Including the right to make determinations of fact, and construe and interpret possible ambiguities, inconsistencies, or omissions in the Plan and the SPD issued in connection with the Plan. In the case of an insured Benefit Plan or Policy, the insurer shall be the named fiduciary with respect to benefit claim determinations thereunder, and with respect to benefit claims shall have ~.I1 of the powers of the Plan Administrator described herein. All determinations of the Plan Administrator with respect to any matter hereunder shall be conclusive and binding on all persons. Without limiting the generality of the foregoing, the Plan AdrT1inistrator shall have the following powers and dutjes: (a) To require any person to furnish such reasonable information as he may request for the purpose of the proper administration of the Plan as a condition to receiving any benefits under the Plan; 6-7g1 PUlNDOC - =- - - - - ..- - '" <D - - = =- = - - = N '" 0 - "' - 0 5 - 0 0 '" " (b) To make and enforce such rules and regulations and prescribe the use of such forms as he shall deem necessary for the efficient administration. of the Plan; (c) 'To decide on questions concerning the Plan and the eligibility of any Employee to participate in the Plan and to make or revoke elections under the Plan, in accordance with the provisions of the Plan; (d) To determine the amount of benefits which shall be payable to any person in accordance with the provisions of the Plan; to inform the Employer or insurer as approprIate, of the amount of such benefits, and to provide a full and fair review to any Participant whose claim for benefits has been denied in whole or in part; (e) To designate other persons to carry out any duty or power which mayor may not otherwise be a fiduciary responsibility of the Plan Administrator,under the terms of the Plan, Such entity will be referred to as a third party administrator and shall be identified in the SPD; (f) To keep records of all acts and determinations, and to keep all such ,records, books of account, and data and other documents as may be necessary for the proper administration of the Plan; and (9) To do all things necessary to operate and administer the Plan in accordance with its provisions. 6,02 Payment of Administrative Expenses, Except as otherwise provided in the SPD, the Employer currently pays all reasonable expenses incurred in administering the Plan. 6,03 Reporting and ~isclosure Obligations, Unless specified otherwise, it shall be the Employer and Plan Administrator's sole responsibility to comply with all filing, reporting, and disclosure requirements, imposed by the DOL and/or IRS, specifically including, but not limited to creating, filing and distributing Summary Annual Reports, Form 5500s, and SPDs, Furthermore, the Employer and Plan Administrator shall be required to amend the Plan as is necessary to ensure compliance with applicable tax and other laws and regulations. 6.04 Indemnification, The Plan Administrator shall be indemnified by the Employer against claims, and the expenses of defending against such claims, resulting from any action or conduct relating to the administration of the Plan except claims arising from gr'055 negligence, willful neglect, or willful misconduct. 6.05 Substantiation of Expenses. Each Participant must submit a written Claim Form to the Plan Administrator identified in the SPD or its designated plan service provider to receive reimbursements from the URM and/or DOC, on a form provided by the Plan Administrator accompanied by a written statement/bill from an independent third party stating that the expense has been incurred, and the amount thereof. The forms shall contain ,such evidence, as the Plan Administrator shall deem necessary as to substantiate the nature, the amount, and timeliness of any expenses that may be reimbursed. 6.06 Reimbursement. Reimbursements shall be made as soon as administratively feasible after the required forms have been received by the Plan Administrator identified in the SPD or its designated plan service provider Reimbursements of less than $15 may be carried forward and aggregated with future reimbursements until the reimbursable amount is greater than $15. However, claims for reimbursements outstanding at the end of the Plan Year (phis any grace period as set forth in the SPDj shall be reimbursed without regard to the $15 threshoid limit Year-end expense reimbursements must be submitted to the Plan Administrator within 90 days of the close of the Plan Year for which the SRA is effective, and during which such expense was incurred, in order to be eligible for reimbursement. 6.07 Annual Statements. The Plan Administrator shall furnish each Participant with an annual statement, showing the amounts paid or expenses incurred by the Employer in providing Medical and/or Dependent Care Expense Reimbursement during the previous calendar year and the respective Reimbursement Account baJance(s) on or before January 31 following the close of the applicable Plan Year. ARTICLE VII - FUNDING AGENT The Plan shall be funded with amounts withheld from Compensation pursuant to SRAs, and/or Nonelective Contributions provided by the Employer, if any The Employer will apply all such amounts, without regard to their source. to pay for the welfare benefits provided herein as soon as administratively feasible and shall comply with all applicable regulations promulgated by the DOL taking into consideration any enforcement procedures adopted by the DOL. If a Trust is designated Funding Agent in the SPD, an appropriate Trust Agreement shall be attached at the end of this Plan, ARTICLE VIII - CLAIMS PROCEDURES The Plan has establ1shed procedures for reviewing claims denied under this Plan and those claims review procedures are set forth in the SPD, The Plan's claim review procedures set forth in the SPD shall only apply to issues germane to the pre-tax benefits available under this Plan (i.e., such as a determination of: a Change in Status; change in cost or coverage; or eligibility 6-7~ PLAN DOC and participation matters under this Cafeteria Plan document), and to the extent offered under the Plan, claims for benefits under th'e Reimbursement Accounts. ARTICLE IX - AMENDMENT OR TERMINATION OF PLAN 9.01 Permanency. While the Employer fully expects that this Plan will continue indefinitely, due to unforeseen, future business contingencies, permanency of the Plan will be subject to the Employer's right to amend or terminate the Plan, as provIded in Sections 9.02 and 9.03 below. Nothing In this Plan IS intended to be or shall be construed to entitle any Partlcipant, retired or otherwise, to vested or non-terminable benefits. 9.02 Employer's Right to Amend. The Employer reserves the right to amend at any time any or all of the provisions of the Plan. All amendments shall be made in writing .and shall be approved by the Employer in accordance with Its normai procedures for transacting business (e.g. by approval by the Board of Directors through a meeting or unanimous consent of all Board'members). Such amendments may apply retroactively or, prospectively as set forth in the amendment. Each Benefit Plan or Polley shall be amended in accordance with the terms specified thereln, or, if no amendment procedure is prescriqed, in accordance with this section. Any amendment made by the Employer shall be deemed to be approved and adopted by any Affiliated Employer. 9.03 Employer's Right to Terminate. The Employer reserves the right to discontinue or terminate the Plan without prejudice at any time and for any reason without prior notice. Such decision to terminate the Plan shall be made in writing and shall be approved by the Employer in accordance with its normal procedures for transacting business. Affiliated Employers may withdraw from particlpation in the Plan, but may not terminate the Plan. 9.04 Determination of Effective Date of Amendment or Termination. Any such amendment, discontinuance, or termination shall be effective as of such date as the Employer shall determine. No amendment, discontinuance or termination shall allow the return to any Employer of any Reimbursement Account balance for its use for any purpose other" than for the exclusive benefit of the Participants and their beneficiaries except as provided in Se~tion 4.03 and 4.04 herein. ARTICLE X - GENERAL PROVISIONS 10.01 Not an Employment Contract. Neither this Plan nor any action taken with respect to it shall confer upon any person the right to continue employment with any Employer 10.02 Applicable Laws. The provisions of the Plan shalf be construed, administered and enforced according to applicable federal law and the laws of the state of the principal place of business of the Employer to the extent not preempted. 10.03 Post-Mortem Payments. Any benefit payable under the Plan after the death of a Participant shall be paid to his surviving spouse (if any), otherwise, to his estate. If there is doubt as to the right of any beneficiary to receive any amount, the Plan Administrator may retain such amount until the rights thereto are determined, without liability for any interest thereon. 10.04 - Nonalienation of Benefits. Except as expressly provided by the Plan Administrator, no benefit under th'e Plan shall be subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, or charge, and any attempt to do so shall be void. No benefit under the Plan shall in any manner be liable for or subject to the debts, contracts, liabilities, engagements, or torts of any person. 10.05 Mental or Physical Incompetency. Every person receiving or claiming benefits under the Plan shall be presumed to be mentally and physically competent and of age until the Plan Administrator receives a written notice, in a form and manner acceptable to it, that such person is mentally or physically incompetent or a minor, and that a guardian, conservator or other person legally vested with the care of his estate has been appointed. 10.06 Inability to Locate Payee. If the Plan Administrator is unable to make payment to any Participant or other person to whom a payment is due under the Plan because it cannot ascertain the identity or whereabouts of such Participants or other person after reasonable efforts have been made to identify or locate such person, such payment and all subsequent payments otherwise due to such Participant or other person shall be forfeited one year after the date any such payment first became dUe. 10.07 Requirement for Proper Forms. All communlcations in connection with the Plan made by a Participant shall become effective only when duly executed on any forms as may be required and furnished by, and filed with, the Plan Administrator. 10.08 Source of Payments. The Employer, the Trust fund (if selected as Funding Agent), and any insurance company contracts purchased or held by the Employer or funded pursuant to this Plan shall be the sole sources of benefits under the Plan. No Employee or beneficlary shall have any right to, or interest in, any assets of the Employer upon 6-7 ~o PLAN DOC = = =", '" <0 - - - - - - - N -'" o '" o = (j _0 o '" -r' termination of employment or otherwise, except as provided from time to time under the Plan, and then only to the extent of the benefits payable under the Plan to such Employee or beneficiary 10.09 Multiple Functions. Any person or group of persons may serve in more than one fiduciary capacity with respect to the Plan. 10.10 Tax Effects. Neither the Employer, its agents, the Plan Administrator, nor the Trustee makes any warranty or other representation as to whether any Pre-tax Premiums made to or on behalf of any Participant hereunder will be treated as excludable from gross income for local, state, or federal income tax purposes. If for any reason it is determined that any amount paid for the benefit of a Participant or Beneficiary IS includable in an Employee's gross income for local, federal, or state income tax purposes, then under no circumstances shall the recipient have any recourse against the Plan Administrator or the Employer with respect to. .any increased taxes or other losses or damages suffered by the Employees as a result thereof. The Plan is designed and is intended to be operated as a "cafeteria plan" under Section 125 of the Code. 10.11 Gender and Number. Masculine pronouns include the feminine as well as the neuter genders, and the singular shall include the plural, unless indicated otherwise by the context. 10.12 Headings. The Article and Section headings contained herein are for convenience of reference only, and shall not be construed as defining or limiting the matter contained thereunder 10.13 Incorporation by Reference. Except forthe Medical and Dependent Care Expense Reimbursement Plan(s), the actual terms and conditions of the separate component Benefit Plans or Policies offered under this Plan are contained in separate, written documents governing each respective benefit, and shall govern in the event of a conflict between the individual plan document, and this Plan as to substantive content. To t~at end, each such separate document, as amended or subsequently replaced, is hereby incorporated by reference as if fully recited herein. The provisions of the Medical and Dependent Care Expense Reimbursement Plan(s) are reproduced herein, but shall constitute separate plans for purposes of all applicable Code and ERISA provisions. . 10.14 Severability. Should any part of this Plan subsequently be invalidated by a court of competent jurisdiction, the remainder thereof shall be given effect to. the maximum extent possible. 10.15 Effect of Mistake. In the event of a mistake as to the eligibility or participation of an Employee, the allocations made to the account of any Participant, or. the amount of distributIOns made or to be made to a Participant or other person, the Plart Administrator shall, to the extent it deems possible, cause to be allocated or cause to be withheld or accelerated, or otherwise make adjustment of, such amounts as will in jts judgment accord to such Participant or other person the credits to the account or distributions to which he is properly entitled under the Plan. Such action by the Administrator may include withholding of any amounts due the Plan or the Employer from Compensation paid by the Employer 10.16 Provisions Relating to Insurers. No insurer shall be required or permitted to issue an insurance policy or contract that is inconsistent with the purposes of this Plan, nor be bound to take any action not in accordance with the terms of any policy or contract with this Plan. The insurer shall not be deemed to be a party to this Plan, nor shall it be bound to interpret the construction or validity of the Plan. The jnsurer shall be protected from its good faith reliance on the written representations and instructions of the Trustee and the Plan Administrator, and shall not be responsible for the initial or continued qualified status of the Plan. 10.17 Forfeiture of Unclaimed Reimbursement Account Benefits. Any Reimbursement Account benefit payments that are unclaimed (e.g., uncashed benefit checks) by the close of the Plan Year following the Plan Year in which the Health or Dependent Care Expense was incurred shall be forieited. 10.18 HIPAA Privacy. To the extent a URM is offered under the Plan, the rights and obligations of an individual covered under the URM, the Employer and Plan, with respect to permitted uses and disclosures of a covered individual's protected health information, set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be summarized in the SPD. ARTICLE XI - CONTINUATION COVERAGE UNDER COBRA The SPD includes provisions that shall be applicable to the URM to the extent the URM is a "group health plan" as defined by Code 99 4980B and 5000(b}( 1) and the regulations promulgated thereunder and to the extent it is offered under the Pian. The intent of those provisions (as incorporated in this Article) is to extend continuation rights required by COBRA. 6-7~1 PLAN DOC RESOLUTION NO. 2009- RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CHULA VISTA ADOPTING THE CITY OF CHULA VISTA CAFETERIA BENEFITS PLAN FOR 2010 WHEREAS, the Internal Revenue Code requires that the Section 125 Cafeteria Benefits Plan offered by the City to its employees be in a written document and that the document be formally adopted by the City Council on or before the first day of the plan year; and WHEREAS, in June 1998, the City established its first Section 125 Cafeteria Benefits Plan; and WHEREAS, in compliance with Internal Revenue Code SI25(d) the City Council annually adopts a written plan document prior to the first day of the plan year; and WHEREAS, the first day of the City's plan year is January I, 2010; and WHEREAS, this Plan Document lays out how the City offers eligible employees the choice between cash and certain nontaxable benefits (such as health insurance), thereby allowing employees to pay for the benefits they choose on a pre-tax basis; and WHEREAS, the specific health plans offered and their structure are not part of this Cafeteria Plan Document; and WHEREAS, they are included in what is known as the Summary Plan Document that was given to eligible employees as part of their open enrollment materials to assist them in making their benetit choices; and WHEREAS, the plans offered and their structure are determined after our broker, Barney and Barney, extensively markets and negotiates with providers to provide coverage comparable to the prior year while keeping the increase in costs to the City and its benefited employees to a minimum; and WHEREAS, all employee groups are advised of the offers and the plan structures that will provide the least increase in premium costs; and WHEREAS, under current cafeteria plan regulations having an approved written plan IS critical; and WHEREAS, without a written plan or if the written plan does not comply with applicable requirements regarding content and timing of adoption, then the plan is not a cafeteria plan and employees' elections will be taxable; and WHEREAS, the City has timed its open enrollment period for 2010 to comply with these regulations and to meet provider cutoff deadlines for enrollment to ensure employees are covered without interruption; and 6-77 Resolution No. 2009- Page 2 WHEREAS, The City's Plan includes the following required information: description of available benefits, participation rules, election procedures, manner of contributions, maximum amount of contributions, the plan year, and the plans provisions for complying with flexible spending arrangements (FSAs). NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Chula Vista does hereby adopt the City ofChula Vista Cafeteria Benefits Plan for 2010. Presented by Approved as to form by ~~DC-A Kelley Bacon Director of Human Resources Bart C. Miesfeld City Attorney 6-78