OAKLAND COUNTY MICHIGAN

CAFETERIA PLAN

NATURAL SELECT PLAN DOCUMENT

As Adopted Effective: January 1, 1994

Amended & Restated: February 1, 2005

April 1, 2009 January 1, 2012 January 1, 2015

Intentionally Left Blank

Table of Contents

PREAMBLE ................................................................................................................................... 4

ARTICLE I - DEFINITIONS ....................................................................................................... 5 1.01 Affiliated Employer ............................................................................................. 5 1.02 After-Tax Contributions ..................................................................................... 5 1.03 Anniversary Date ................................................................................................. 5 1.04 Benefit Plan Option(s) ......................................................................................... 5 1.05 Board of Directors ............................................................................................... 5 1.06 Change in Status .................................................................................................. 5 1.07 Code ...................................................................................................................... 5 1.08 Compensation ....................................................................................................... 5 1.09 Dependent ............................................................................................................. 5 1.10 Dependent Care Spending Account ................................................................... 5 1.11 Earned Income ..................................................................................................... 6 1.12 Effective Date ....................................................................................................... 6 1.13 Eligible Employment Related Expenses ............................................................. 6 1.14 Eligible Medical Expenses ................................................................................... 6 1.15 Employee............................................................................................................... 6 1.16 Employer............................................................................................................... 7 1.18 Flexible Spending Account(s).............................................................................. 7 1.19 Health Care Spending Account .......................................................................... 7 1.20 Highly Compensated Individual ......................................................................... 7 1.21 Key Employee ....................................................................................................... 7 1.22 Non-elective Contribution(s) ............................................................................... 7 1.23 Participant ............................................................................................................ 7 1.24 Plan ........................................................................................................................ 8 1.25 Plan Administrator .............................................................................................. 8 1.26 Plan Year .............................................................................................................. 8 1.27 Pretax Contribution(s) ........................................................................................ 8 1.28 Qualified Benefit .................................................................................................. 8 1.29 Qualified Reservist Distribution ......................................................................... 8 1.08B Qualifying Individual ......................................................................................... 8 1.30 Qualifying Services .............................................................................................. 8 1.31 Salary Reduction Agreement .............................................................................. 9 1.32 Spouse ................................................................................................................... 9 1.33 Summary Plan Description ................................................................................. 9 1.34 Student .................................................................................................................. 9

ARTICLE II -- ELIGIBILITY AND PARTICIPATION ........................................................ 10 2.01 Eligibility to Participate .................................................................................... 10 2.02 Termination of Participation ............................................................................ 10 2.03 Eligibility to Participate in Flexible Spending Accounts ................................ 10 2.04 Qualifying Leave Under Family Leave Act ..................................................... 10 2.05 Non-FMLA Leave .............................................................................................. 10

ARTICLE III -- ELECTIONS .................................................................................................... 11 3.01 Election of Contributions .................................................................................. 11 3.02 Initial Election Period ........................................................................................ 11 3.03 Annual Election Period ..................................................................................... 11 3.04 Change of Elections ........................................................................................... 12 3.05 Impact of Termination of Employment on Election ....................................... 12

-i-

ARTICLE IV -- PREMIUM PAYMENTS AND CREDITS AND DEBITS TO ACCOUNTS .................................................................................................................... 13 4.01 Source of Benefit Funding ................................................................................. 13 4.02 Reduction of Certain Elections to Prevent Discrimination ............................ 13

ARTICLE V -- BENEFITS ......................................................................................................... 14 5.01 Qualified Benefits ............................................................................................... 14 5.02 Cash Benefit........................................................................................................ 14

ARTICLE VI -- REIMBURSEMENTS ..................................................................................... 15 6.01 Health Care Spending Account Reimbursement ............................................ 15 6.02 Dependent Care Spending Account Reimbursement ..................................... 16 6.03 Receiving Reimbursement ................................................................................ 16 6.04 Substantiation of Expenses ............................................................................... 16 6.05 Repayment of Excess Reimbursements ........................................................... 16 6.06 Reimbursement Following Cessation of Participation ................................... 16 6.07 Coordination of Benefits Under the Health Care Spending Account ........... 17 6.08 Disbursement Reports ....................................................................................... 17 6.09 Timing of Reimbursements ............................................................................... 17 6.10 Statements........................................................................................................... 17 6.11 Post-Mortem Payments ..................................................................................... 17 6.12 Non-Alienation of Benefits ................................................................................ 17 6.13 Mental or Physical Incompetency .................................................................... 17 6.14 Inability to Locate Payee ................................................................................... 17 6.15 Tax Effects of Reimbursements and Qualified Reservist

Distributions ....................................................................................................... 18 6.16 Forfeiture of Unclaimed Reimbursement Account Benefits .......................... 18

ARTICLE VII -- PLAN ADMINISTRATION ......................................................................... 19 7.01 Allocation of Authority ...................................................................................... 19 7.02 Provision for Third Party Adminstrators ........................................................ 19 7.03 Fiduciary Liability ............................................................................................. 19 7.04 Compensation of Plan Administrator .............................................................. 20 7.05 Bonding ............................................................................................................... 20 7.06 Payment of Administrative Expenses ............................................................... 20 7.07 Funding Policy .................................................................................................... 20

ARTICLE VIII -- FUNDING AGENT ...................................................................................... 21

ARTICLE IX -- CLAIMS PROCEDURES ............................................................................... 22

ARTICLE X -- AMENDMENT OR TERMINATION OF PLAN .......................................... 23 10.01 Permanency ........................................................................................................ 23 10.02 Employer's Right to Amend .............................................................................. 23 10.03 Employer's Right to Terminate ........................................................................ 23 10.04 Determination of Effective Date of Amendment or Termination .................. 23

ARTICLE XI -- GENERAL PROVISIONS .............................................................................. 24 11.01 Not an Employment Contract ........................................................................... 24 11.02 Applicable Laws ................................................................................................. 24 11.03 Requirement for Proper Forms ........................................................................ 24 11.04 Multiple Functions ............................................................................................. 24 11.05 Tax Effects .......................................................................................................... 24 11.06 Gender and Number .......................................................................................... 24 11.07 Headings ............................................................................................................. 24 11.08 Incorporation by Reference .............................................................................. 24

- ii -

11.09 Severability ......................................................................................................... 24 11.10 Effect of Mistake ................................................................................................ 24

ARTICLE XII -- CONTINUATION COVERAGE UNDER COBRA ................................... 26

ARTICLE XIII – HIPAA PRIVACY AND SECURITY ......................................................... 27 13.01 Scope and Purpose ............................................................................................. 27 13.02 Effective Date ..................................................................................................... 27 13.03 Use and Disclosure of PHI ................................................................................. 27 13.04 Conditions Imposed on Employer .................................................................... 27 13.05 Designated Employees Who May Receive PHI ............................................... 28 13.06 Restrictions on Employee with Access to PHI ................................................. 28 13.07 Policies and Procedures ..................................................................................... 28 13.08 Organized Health Care Arrangement ............................................................. 28 13.09 Privacy Official .................................................................................................. 28 13.10 Noncompliance ................................................................................................... 29 13.11 Definitions ........................................................................................................... 29 13.12 Interpretation and Limited Applicability ........................................................ 29 13.13 Services Performed for the Employer .............................................................. 29 13.14 Security of Electronic PHI ................................................................................ 30

- iii -

PREAMBLE Effective January 1, 1994 and as Amended and Restated on January 1, 2015, Oakland County Michigan 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 § 125. The Health Care Spending Account (“HCSA”), is intended to qualify as a Code § 105 self-insured medical expense reimbursement plan, and that the benefits provided under the HCSA be eligible for exclusion from the Participant’s income for federal income tax purposes under Code § 105(b). The Dependent Care Spending Account (“DCSA”), is intended to qualify as a Code § 129 dependent care assistance plan and that the benefits provided under the DCSA be eligible for exclusion from the Participant’s income for federal income tax purposes under Code § 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.

- 4 -

OAKLAND COUNTY MICHIGAN 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 414(b), (c), or (m). 1.02 “After-tax Contribution(s)” means amounts withheld from an Employee’s Compensation

pursuant to a Salary Reduction Agreement or Election Form 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 Natural Select 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 Natural Select 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 Natural Select 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 (including any applicable Benefit Plan Option(s) and the Health Care Spending Account), a Dependent is defined as set forth in Code Section 105(b) effective January 1, 2011 including any child as defined in Code Section 152(f)(1) of the Participant who as of the end of the taxable year has not attained age twenty-seven (27)); and for Dependent Care Spending Account purposes (if offered under the Plan), a Dependent also means an individual described in Code Section 21(e)(5) (e.g., Dependent of the parent with custody for the greatest portion of the year).

1.10 “Dependent Care Spending Account” shall have the meaning assigned to it by Section 6.02 of

the Plan.

- 5 -

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 § 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 NSPD. 1.13 “Eligible Employment-Related Expenses” means those expenses that would be considered to

be Employment-Related Expenses under Code § 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 §

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 HCSA as set forth in the NSPD, incurred by the Employee, or the Employee’s Spouse or Dependents, after the date of the Employee’s participation in the HCSA and during the Plan Year to the extent that the expense satisfies the conditions set forth in the Natural Select Plan Description and are for medical care as defined by Code § 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 § 213(d):

i) Expenses for qualified long term care services (as defined in Code § 7702B); and ii) Expenses for health insurance premiums; and iii) Effective January 1, 2011, expenses for a medicine or drug unless such medicine or drug is

a prescribed drug (determined without regard to whether such drug is available without a prescription) or is insulin.

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 § 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.

- 6 -

1.16 “Employer” means Oakland County Michigan 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 Oakland County Michigan. 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 Natural Select Plan Description.

1.17 “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 Natural Select 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).

1.18 “Health Care Spending Account” shall have the meaning assigned to it by Section 6.01 of the

Plan. 1.19 “Highly Compensated Individual” means an individual defined under Code § 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 § 125(b)(2),

as amended. 1.21 “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 Natural Select 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 Natural Select 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 Natural Select Plan Description or enrollment material.

1.22 “Participant” means an Employee who becomes a Participant pursuant to Article II.

- 7 -

1.23 “Plan” means this Cafeteria Plan as set forth herein. 1.24 “Plan Administrator” means the person(s) or Committee identified in the Natural Select 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.

1.25 “Plan Year” shall be the period of coverage set forth in the Natural Select Plan Description. 1.26 “Pretax Contribution(s)” means any amount withheld from the Employee’s Compensation

pursuant to a Salary Reduction Agreement or Election Form 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 § 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 (e.g., any group-term life insurance coverage that is includable in gross income by virtue of exceeding the dollar limitation on nontaxable coverage under Code § 79). Notwithstanding the previous sentence, long-term care insurance is not a “Qualified Benefit.”

1.28 “Qualified Reservist Distribution” means a distribution to an individual of all or a portion of

the balance in such individual’s Health Care Spending Account if: (i) while a Participant, such individual was, by reason of being a member of a reserve

component (as defined in section 101 of title 37, United States Code), ordered or called to active duty for a period of 180 days or more, or for an indefinite period, and

(ii) such distribution is made during the period beginning on the date of such order or call and ending on the last date that reimbursements could otherwise be made under the Health Care Spending Account for the Plan Year which includes the date of such order or call.

1.29 "Qualifying Individual" means an individual defined as a “Qualifying Individual” in the

Natural Select 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 (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.

- 8 -

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 Pretax Contributions (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 or Election Form may be maintained on an electronic database in accordance with all applicable federal and/or state laws.

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 “Natural Select Plan Description” or “NSPD” means the Cafeteria Plan NSPD and all

appendices incorporated into and made a part of the NSPD that is adopted by the Employer and associated to this Plan Document, and as amended from time to time. The NSPD and appendices are incorporated hereto by reference.

1.34 “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.

- 9 -

ARTICLE II ELIGIBILITY AND PARTICIPATION

2.01 Eligibility to Participate. Each Employee who satisfies the eligibility requirements set forth in

the NSPD shall be eligible to participate in this Plan as of the Eligibility Date set forth in the NSPD. 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 NSPD. 2.03 Eligibility to Participate in Flexible Spending Accounts. Each Employee who satisfies the

eligibility requirements set forth in the NSPD shall be eligible to participate in the Flexible Spending Accounts, if adopted by the Employer, on the applicable Eligibility Date set forth in the NSPD.

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 HCSA 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 NSPD and will be administered in accordance with the regulations issued under Code § 125 and in accordance with the FMLA.

2.05 Non-FMLA 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 NSPD 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 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.

- 10 -

ARTICLE III ELECTIONS

3.01 Election of Contributions. A Participant may elect any combination of Pretax Contributions (to

the extent set forth in the enrollment material) to fund any Benefit Plan Option available under the Plan, provided that only Qualified Benefits 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 NSPD or enrollment material, may allow the Participants to allocate his allotted share of Non-elective Contributions among the various Benefit Plan Options in a manner set forth in the NSPD or enrollment material.

3.02 Initial Election Period.

(a) Currently Full time Eligible Employees. An Employee who is eligible, according to Oakland County Merit System Rule 22, to become a Participant in this Plan as of the Effective Date must complete, sign and file a Salary Reduction Agreement or Election Form with the Plan Administrator (or its designated Third Party Administrator as set forth on the Salary Reduction Agreement or Election Form) 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 made by the Participant on this initial Salary Reduction Agreement or Election Form shall be effective, subject to Sections 3.04 and 3.05, for the Plan Year beginning on the Effective Date.

(b) New Full time Employees and Employees Who Have Not Yet Satisfied the Plan’s Waiting Period. An Employee who becomes eligible, according to Oakland County Merit System Rule 22, to become a Participant in this Plan after the Effective Date must complete, sign and file a Salary Reduction Agreement or Election Form with the Plan Administrator (or its designated Third Party Administrator as set forth on the Salary Reduction Agreement or Election Form) during the initial Election Period set forth in the NSPD or the enrollment material. Participation will commence under this Plan as set forth in the NSPD. 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 or Election Form 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 NSPD or the enrollment material. An Election is made during the Annual Election Period in the manner

- 11 -

set forth in the NSPD. The consequences of failing to make an election during the Annual Election Period will be set forth in the NSPD.

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 NSPD 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 NSPD 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 (e.g., 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 are set forth in the NSPD. Election changes for the purpose of Marriage will be retroactively effective with the date of the marriage (retroactive Pretax contributions are not collected.)

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 or Election Form. 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 NSPD.

- 12 -

ARTICLE IV PREMIUM PAYMENTS AND CREDITS AND 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 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 Contributions (as elected by the Employee on the Salary Reduction Agreement or Election Form 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 coverage 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 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 Reduction 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.

- 13 -

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 NSPD.

5.02 Cash Benefit. To the extent that a Participant does not elect to have the maximum amount of his

Compensation contributed as a Pretax 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 NSPD or the enrollment material.

- 14 -

ARTICLE VI REIMBURSEMENTS

6.01 Health Care Spending Account Reimbursement. Each Participant’s HCSA 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 or Election Form 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 HCSA (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 be related to the amount that a Participant has had credited to his HCSA. In no event will the amount of health care reimbursements in any Plan Year exceed the annual amount specified for the Plan Year in the Salary Reduction Agreement or Election Form for health care reimbursement. Any amount credited to the HCSA 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 NSPD, or has not been used to make a Qualified Reservist Distribution as set forth in the NSPD. 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 HCSA shall be set forth in the NSPD. The Employer may establish a minimum annual reimbursement amount as set forth in the NSPD.

The Employer has established 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 Medical 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 has established a Run out Period following the end of the Grace Period. All amounts allocated to the HCSA that are not used to reimburse Eligible Medical Expenses incurred during the Plan Year and/or the Grace Period or to make a Qualified Reservist Distribution shall be forfeited. The Employer will make Qualified Reservist Distributions to the extent that the Participant satisfies all election requirements established in accordance with applicable law and the Employer’s internal policies and procedures. Requests for a Qualified Reservist Distribution must be made on or after the date of the order or call to duty but before the last day of the Plan Year (or grace period, if applicable) during which the order or call to duty occurred. The Employer must receive a copy of the order or call to active duty prior to making a Qualified Reservist Distribution. A Qualified Reservist Distribution shall be made within a reasonable period of time after receiving a request and processing any claims submitted prior to the Qualified Reservist Distribution request, but in no event shall such period be more than sixty (60) days. The amount of the Qualified Reservist Distribution shall be equal to contributions to the HCSA as of the date of the QRD request minus reimbursements received. Notwithstanding any other provision of this Plan, an individual who has selected a Qualified Reservist Distribution shall be considered to have made such election as an alternative to COBRA or USERRA coverage continuation for the HCSA (except as may otherwise be required by applicable law).

- 15 -

6.02 Dependent Care Spending Account Reimbursement. Each Participant’s DCSA 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 dependent care reimbursements disbursed to the Participant in accordance 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 carried over into following months within the same Plan year, to be paid out as the DCSA balance becomes adequate. In no event will the amount of dependent care reimbursements exceed the amount credited to the DCSA. Any amount allocated to the DCSA 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 (Claim-It-By) Period set forth in the NSPD. 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 DCSA shall be set forth in the NSPD. The Employer may establish a minimum annual reimbursement amount as set forth in the NSPD.

6.03 Receiving Reimbursement. 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.

6.04 Substantiation of Expenses. Each Participant must submit an expense for reimbursement in

accordance with the terms of the NSPD and provide the required substantiation set forth in the NSPD 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. Similarly, if, as of the end of the period for making a Qualified Reservist Distribution, it is determined that a Participant has received a distribution under this Plan that exceeds the amount allowable for a Qualified Reservist Distribution for the applicable Plan Year as required by Section 6.01 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 HCSA 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 NSPD. Unless a COBRA election is made as set forth in the NSPD, Participants shall not be entitled to receive reimbursement for Eligible Medical Expenses incurred after employment ceases under this Section. Participants in the DCSA may submit claims for reimbursement for Eligible Employment-Related Expenses incurred during the Plan Year and before the date of participation in the DCSA ceases so long as the claim is submitted prior to the end of the run out period set forth in the NSPD. If provided under the

- 16 -

DCSA, however, and as set forth in the NSPD, Participants may submit claims for reimbursement for Eligible Employment-Related Expenses incurred during the Plan Year at any time until the last day of the run out period after the end of the Plan Year for which the election had been in effect, and to receive reimbursement hereunder. Any unused reimbursement benefits at the expiration of the Plan Year (as set forth in the NSPD) for the HCSA or DCSA shall be treated in accordance with Section 6.01.

6.07 Coordination of Benefits Under the Health Care Spending Account. The HCSA is intended

to pay benefits solely for otherwise unreimbursed medical expenses (subject to Qualified Reservist Distributions, if adopted by the Employer). 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 HCSA and/or DCSA.

6.11 Post-Mortem Payments. Any benefit payable under the HCSA or DCSA 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 determined, 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 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.

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.

- 17 -

6.15 Tax Effects of Reimbursements and Qualified Reservist Distributions. Neither the Employer, nor the Plan Administrator makes any warranty or other representation as to whether any reimbursements or Qualified Reservist Distributions 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 § 105 or a self-dependent care assistance plan under Code § 129.

6.16 Forfeiture of Unclaimed Reimbursement Account Benefits. Any HCSA or DCSA

reimbursement benefit payments that are unclaimed (e.g., un-cashed 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.

- 18 -

ARTICLE VII PLAN ADMINISTRATION

7.01 Allocation of Authority. The 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 NSPD 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 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, 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 may or 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 NSPD;

(f) 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 provisions.

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 NSPD as a Third Party Administrator. Unless otherwise provided in the service agreement, obligations under this Plan shall remain the obligation of the Employer.

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.

- 19 -

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.

- 20 -

ARTICLE VIII FUNDING AGENT

The Plan shall be funded with amounts withheld from Compensation pursuant to Salary Reduction Agreements or Election Forms, 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.

- 21 -

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 NSPD. The Plan’s claim review procedures set forth in the NSPD shall only apply to issues germane to the pretax benefits available under this Plan (e.g., 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.

- 22 -

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 benefits.

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. 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. Restatements of the Plan and/or administrative updates may be made by the Plan Administrator.

10.03 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 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.

- 23 -

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 NSPD, to the extent not preempted.

11.03 Requirement for Proper Forms. All communications 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.

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 § 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 NSPD for this Plan contains many of the actual terms and conditions of this Plan. To that end, the NSPD 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. 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

- 24 -

to be made to a Participant or other person, the 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 Plan. Such action by the Plan Administrator may include withholding of any amounts due the Plan or the Employer from Compensation paid by the Employer.

- 25 -

ARTICLE XII CONTINUATION COVERAGE UNDER COBRA

The NSPD includes COBRA continuation of coverage provisions that shall be applicable to the HCSA, if offered under the Plan, to the extent the plan sponsor is subject to COBRA (as it amended the Code and the Public Health Service Act).

- 26 -

ARTICLE XIII HIPAA PRIVACY AND SECURITY

13.01 Scope and Purpose. The HCSA (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 (“HIPAA”). 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 HIPAA, 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 the 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

received 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. § 164.524;

- 27 -

g) To make available PHI for amendment and incorporate any amendments to PHI in accordance with 45 C.F.R. § 164.526;

h) To make available the information required to provide an accounting of disclosure in

accordance with 45 C.F.R. § 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. §

164.504(f)(2)(iii) and described in this Article XIII. 13.05 Designated Employees Who May Receive PHI. In accordance with the Privacy Rules, only

certain Employees who perform Plan administrative functions may be given access to PHI. 13.06 Restrictions on Employee with Access to PHI. The Employees who have access to PHI 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. For further information refer to Oakland County’s Notice of Privacy Practices (as issued effective August 1, 2013) and available on the www.ocbenefits.com website.

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. § 160.103) provided by the Employer.

13.09 Privacy Official. The Plan Administrator will be responsible for the Plan’s compliance with

HIPAA, and may contract with or otherwise utilize the services of attorneys, accountants, brokers, consultant, or other third party experts as the Plan Administrator deems necessary or advisable. In addition, and notwithstanding any provision of this Plan to the contrary, the Plan Administrator 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 XIII;

b) Transmitting the certification to any third parties as may be necessary to permit them to disclose PHI to Employer;

- 28 -

c) Establishing and implementing policies and procedures with respect to PHI that are designed to ensure compliance by the Plan with the requirements of HIPAA;

d) Establishing and overseeing proper training of the Plan, or Employer personnel who will have access to Protected Health Information;

e) Any other duty or responsibility that the Plan Administrator deems necessary or appropriate to comply with the provisions of HIPAA and the purposes of this Article XIII.

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. § 160.103. “Privacy Notice” means the notice of the Plan’s privacy practices distributed to Plan participants in accordance with 45 C.F.R. § 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 Information or PHI” means individually identifiable health information as defined in 45 C.F.R. § 160.103.

13.12 Interpretation and Limited Applicability. This Article XIII serves the sole purpose of

complying with the requirements of HIPAA and shall be interpreted and construed in a manner to effectuate 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 nature 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 HIPAA, 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.

- 29 -

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 HIPAA.

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.

The Plan Administrator will be responsible for the Plan’s compliance with the security provisions of HIPAA. The Plan Administrator may contract with or otherwise utilize the services of attorneys, accountants, brokers, consultants, or other third party experts as the Plan Administrator deems necessary or advisable. In addition, and notwithstanding any provision of this Plan to the contrary, the Plan Administrator 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 HIPAA;

(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 Plan Administrator deems necessary or appropriate to comply with the security provisions of HIPAA and the purposes of this Article VIII.

- 30 -

OAKLAND COUNTY MICHIGAN

CAFETERIA PLAN

NATURAL SELECT PLAN DESCRIPTION

As Adopted Effective: January 1, 1994

Amended & Restated: February 1, 2005

April 1, 2009 January 1, 2012

September 26, 2012 January 1, 2015

Intentionally Left Blank

OAKLAND COUNTY MICHIGAN FLEXIBLE BENEFITS PLAN

NATURAL SELECT PLAN DESCRIPTION

TABLE OF CONTENTS

CAFETERIA PLAN COMPONENT DESCRIPTION............................................................................ 2

Q-1. What is the purpose of the Cafeteria Plan? ............................................................................. 2 Q-2. Who can participate in the Cafeteria Plan? ............................................................................. 2 Q-3. How do I become a Participant? ............................................................................................. 2 Q-4. When does my participation in the Cafeteria Plan end? ......................................................... 3 Q-5. What are tax advantages and disadvantages of participating in the Cafeteria Plan? .............. 3 Q-6. What are the election periods for entering the Cafeteria Plan? .............................................. 3 Q-7. Under what circumstances can I change my election during the Plan Year? ......................... 5 Q-8. How is my Benefit Plan Option coverage paid for under this Cafeteria Plan? ....................... 5 Q-9. What happens to my participation under the Cafeteria Plan if I take a leave of absence? ..... 6 Q-10. How long will the Cafeteria Plan remain in effect?................................................................ 7 Q-11. What happens if my request for a benefit under this Cafeteria Plan is denied? ..................... 7

HEALTH CARE SPENDING ACCOUNT COMPONENT DESCRIPTION ....................................... 8

Q-1. Who can participate in the Health Care Spending Account? .................................................. 8 Q-2. How do I become a Participant? ............................................................................................. 8 Q-3. What is my Health Care Spending Account? ......................................................................... 9 Q-4. When does my coverage under the Health Care Spending Account end? .............................. 9 Q-5. Can I ever change my Health Care Spending Account election? ........................................... 9 Q-6. What happens to my Health Care Spending Account if I take an approved leave of

absence? ................................................................................................................................ 10 Q-7. What is the maximum annual Health Care Spending Account amount that I may elect

under the Health Care Spending Account, and how much will it cost? ............................... 10 Q-8. How are Health Care Spending Account benefits paid for under this Plan? ........................ 10 Q-9. What amounts will be available for Health Care Spending Account Reimbursement at

any particular time during the Plan Year? ............................................................................ 10 Q-10. How do I receive reimbursement under the Health Care Spending Account? ..................... 11 Q-11. What is an “Eligible Medical Expense?” .............................................................................. 11 Q-12. When must the expenses be incurred in order to receive reimbursement? ........................... 12 Q-13. What if the “Eligible Medical Expenses” I incur during the Plan Year are less than the

annual amount I have elected for the Health Care Spending Account Reimbursement? ..... 13 Q-14. What happens if a Claim for Benefits under the Health Care Spending Account is

denied? .................................................................................................................................. 14 Q-15. What happens to unclaimed Health Care Spending Account Reimbursements? ................. 15 Q-16. What is COBRA Continuation Coverage? ........................................................................... 15 Q-17. Will my health information be kept confidential? ................................................................ 17 Q-18. How long will the Health Care Spending Account remain in effect? .................................. 17

DEPENDENT CARE SPENDING ACCOUNT COMPONENT DESCRIPTION ............................. 18

i

Q-1. Who can participate in the Dependent Care Spending Account? ......................................... 18 Q-2. How do I become a Participant? ........................................................................................... 18 Q-3. What is my “Dependent Care Spending Account?” ............................................................. 18 Q-4. When does my coverage under the Dependent Care Spending Account end? ..................... 18 Q-5. Can I ever change my Dependent Care Spending Account election? .................................. 19 Q-6. What happens to my Dependent Care Spending Account if I take an unpaid leave of

absence? ................................................................................................................................ 19 Q-7. What is the maximum annual Dependent Care Spending Account Reimbursement that I

may elect under the Dependent Care Spending Account? .................................................... 19 Q-8. How do I pay for Dependent Care Spending Account Reimbursements? ............................ 19 Q-10. How do I receive reimbursement under the Dependent Care Spending Account? ............... 21 Q-11. When must the expenses be incurred in order to receive reimbursement? ........................... 21 Q-12. What if the “Eligible Employment-Related Expenses” I incur during the Plan Year are

less than the annual amount of coverage I have elected for Dependent Care Spending Account Reimbursement? ..................................................................................................... 22

Q-13. Will I be taxed on the Dependent Care Spending Account benefits I receive? .................... 22 Q-14. If I participate in the Dependent Care Spending Account, will I still be able to claim the

household and dependent care credit on my federal income tax return? .............................. 22 Q-15. What is the household and dependent care credit? ............................................................... 22 Q-16. What happens to unclaimed Dependent Care Spending Account Reimbursements? ........... 23 Q-17. What happens if my claim for reimbursement under the Dependent Care Spending

Account is denied?................................................................................................................ 23 Q-18. How long will the Dependent Care Spending Account remain in effect? ............................ 23 Q-19. Can I receive reimbursement following cessation of participation? ..................................... 23

PLAN INFORMATION DESCRIPTION ............................................................................................... 24

A. Employer/Plan Sponsor Information .................................................................................... 24 B. Cafeteria Plan Component Information ................................................................................ 25 C. Health Care Spending Account Component Information ..................................................... 26 D. Dependent Care Spending Account Component Information .............................................. 27 E. Medical Coverage ................................................................................................................. 27 F. Dental Coverage ................................................................................................................... 28 G. Vision Coverage ................................................................................................................... 29 H. Life Insurance ....................................................................................................................... 29 I. Accidental Death and Dismemberment ................................................................................ 29

APPENDIX I – CLAIMS REVIEW PROCEDURE .............................................................................. 31

APPENDIX II – TAX ADVANTAGES EXAMPLE .............................................................................. 33

APPENDIX III – ELECTION CHANGE CHART ................................................................................ 34

APPENDIX IV – NEW EMPLOYEE HEALTH PLAN ELIGIBILITY SCHEDULE ...................... 50

ii

OAKLAND COUNTY MICHIGAN FLEXIBLE BENEFITS PLAN

NATURAL SELECT PLAN DESCRIPTION (“NSPD”) Oakland County Michigan (the “Employer”) is pleased to sponsor an employee benefit program known as a “Flexible Benefits Plan” (the “Plan”) for you and your fellow employees. It is so-called because it lets you choose from several different employee benefit plans (which we refer to as “Benefit Plan Options”) according to your individual needs, and allows you to use pretax dollars to pay for them by entering into a salary reduction arrangement with the Employer. This Plan helps you because the benefits you elect are nontaxable (e.g., you save social security and income taxes on the amount of your salary reduction). This Plan has three components:

i. A Cafeteria Plan Component. The Cafeteria Plan Component allows you to pay your share of certain underlying welfare benefit plans (called “Benefit Plan Options”) with Pretax Contributions.

ii. The Health Care Spending Account (“HCSA”). The HCSA allows you to elect to use a specified amount of Pretax Contributions to be used for reimbursement of Eligible Medical Expenses. The HCSA is intended to qualify as a Code Section 105 self-insured medical reimbursement Plan.

iii. The Dependent Care Spending Account (“DCSA”). The DCSA allows you to elect to use a specified amount of Pretax Contributions to be used for reimbursement of Eligible Employment-Related Expenses. The DCSA is intended to qualify as a Code Section 129 dependent care assistance plan.

Each of the three components is summarized in this document. Information relating to the Plan that is specific to your Employer is described in the Plan Information Description. For example, you can find the identity of the Third Party Administrator, the Employer, and the Plan Administrator in the Plan Information Description as well as the Plan Number and any applicable contact information. Each description and the attached Appendices constitute the Natural Select Plan Description for the Cafeteria Plan. The NSPD (collectively, the Natural Select Plan Description or “NSPD”) describes the basic features of the Plan, how it operates, and how you can get the maximum advantage from it. The Plan is also established pursuant to a plan document into which this NSPD has been incorporated. However, if there is a conflict between the official plan document and the NSPD, the plan document will govern. Certain terms in this Description are capitalized. Capitalized terms reflect important terms that are specifically defined in this Description or in the Plan Document into which this Description is incorporated. You should pay special attention to these terms as they play an important role in defining your rights and responsibilities under this Plan. Participation in the Plan does not give any Participant the right to be retained in the employment of his or her Employer or any other right not specified in the Plan. If you have any questions regarding your rights and responsibilities under the Plan, you may also contact the Plan Administrator (who is identified in the Plan Information Description).

1

OAKLAND COUNTY MICHIGAN FLEXIBLE BENEFITS PLAN

NATURAL SELECT PLAN DESCRIPTION

Cafeteria Plan Component Description

Q-1. What is the purpose of the Cafeteria Plan?

The purpose of the Cafeteria Plan is to allow eligible Employees to pay for certain benefit plans called “Benefit Plan Options” with pretax dollars called “Pretax Contributions.” The Benefit Plan Options to which you may contribute with Pretax Contributions under this Cafeteria Plan are described in the Plan Information Description. Pretax Contributions are described in more detail below.

Q-2. Who can participate in the Cafeteria Plan?

Each full time Employee of the Employer (or an Affiliated Employer listed in the Plan Information Description) who (i) satisfies the Cafeteria Plan Eligibility Requirements and (ii) is also eligible to participate in any of the Benefit Plan Options, according to Oakland County Merit System Rule 22, will be eligible to participate in this Cafeteria Plan. If you meet these requirements, you may become a Participant on the Cafeteria Plan Eligibility Date. The Cafeteria Plan Eligibility Requirements and Eligibility Date are described in the Plan Information Description. Those Employees who actually participate in the Cafeteria Plan are called “Participants.” The terms of eligibility of this Cafeteria Plan do not override the terms of eligibility of each of the Benefit Plan Options. In other words, if you are eligible to participate in this Cafeteria Plan, it does not necessarily mean you are eligible to participate in the Benefit Plan Options. For the details regarding eligibility provisions, benefit amounts, and premium schedules for each of the Benefit Plan Options, please refer to the plan description of each of the Benefit Plan Options. If you do not have a description for each of the Benefit Plan Options, you should contact the Plan Administrator for information on how to obtain a copy. You may only pay for the coverage of yourself and your tax dependents; however, for health plan purposes and the Health Care Spending Account, a Dependent is any child of yours who as of the end of the taxable year has not attained age twenty-seven (27), even if he/she is married or not a tax dependent.

Q-3. How do I become a Participant?

If you have otherwise satisfied the Cafeteria Plan Eligibility Requirements, you become a Participant by signing an individual Salary Reduction Agreement (sometimes referred to as an “Election Form”) on which you agree to pay for the Benefit Plan Options that you choose with Pretax Contributions. You will be provided with a Salary Reduction Agreement or Election Form on or before your Cafeteria Plan Eligibility Date. You must complete the form and submit it to the Plan Administrator or its designated Third Party Administrator (as indicated on or with the Salary Reduction Agreement), during one of the election periods described in Q-6 below. You may also enroll during the year if you previously elected not to participate and you experience a change described below that allows you to become a Participant during the year. If that occurs, you must complete an Election Change Form during the Election Change

2

Period described in Q-7 below. In no event can you become a Participant in this Cafeteria Plan prior to the date you complete and properly submit the Salary Reduction Agreement to the appropriate person(s). In some cases, the Employer may require you to pay your share of the Benefit Plan Option coverage that you elect with Pretax Contributions. If that is the case, your election to participate in the Benefit Plan Options(s) will constitute an election under this Cafeteria Plan. Enrollment may also be accomplished via telephone, voice response technology, electronic communication, web or online enrollment systems, or any other method prescribed by the Plan Administrator.

Q-4. When does my participation in the Cafeteria Plan end?

Your coverage under the Cafeteria Plan ends on the earliest of the following to occur:

a. The date that you make an election not to participate in accordance with this Cafeteria Plan Component Description;

b. The date you no longer satisfy the Eligibility Requirements of this Cafeteria Plan or all of the Benefit Plan Options;

c. The date that you terminate employment with the Employer; or d. The date that the Cafeteria Plan is either 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 Cafeteria Plan will automatically cease, and you will not be able to make any more Pretax Contributions under the Cafeteria Plan except as otherwise provided pursuant to Employer policy or individual arrangement (e.g., a severance arrangement where the former Employee is permitted to continue paying for a Benefit Plan Option out of severance pay on a pretax basis). If you are rehired within the same Plan Year and are eligible for the Cafeteria Plan (or you become eligible again), you may make new elections, if you are rehired or become eligible again more than 30 days after you terminated employment or lost eligibility (subject to any limitations imposed by the Benefit Plan Option(s)). If you are rehired or again become eligible within 30 days or less of your termination date, your Cafeteria Plan elections that were in effect when you terminated employment or stopped being eligible will be reinstated and remain in effect for the remainder of the Plan Year (unless you are allowed to change your election in accordance with the terms of the Plan).

Q-5. What are tax advantages and disadvantages of participating in the Cafeteria Plan?

You save both federal income tax and FICA (Social Security) taxes by participating in the Cafeteria Plan. There is an example in Appendix II that illustrates the tax savings you might experience as a result of participating in the Cafeteria Plan.

Participation in the Cafeteria Plan will reduce the amount of your taxable compensation. Accordingly, there could be a decrease in your Social Security benefits

Q-6. What are the election periods for entering the Cafeteria Plan?

The Cafeteria Plan basically has three election periods: (i) the “Initial Election Period,” (ii) the “Annual Election Period,” and (iii) the “Election Change Period,” which is the period following the date you have

3

a Change in Status Event. The following is a description of the Initial Election Period and the Annual Election Period.

Q-6a. What is the Initial Election Period?

If you want to participate in the Cafeteria Plan when you are first hired, you must enroll during the “Initial Election Period” described in the enrollment materials you will receive. If you make an election during the Initial Election Period, your participation in this Cafeteria Plan will begin on the later of your Eligibility Date or the first pay period coinciding with or next following the date that your election is received by the Plan Administrator (or it’s designated Third Party Administrator). The effective date of coverage under the Benefit Plan Options will be effective on the date established in the governing documents of the Benefit Plan Options. The election that you make during the Initial Election Period is effective for the remainder of the Plan Year and generally cannot be changed during the Plan Year unless you have a Change in Status Event described in Q-7 below.

If you do not make an election during the Initial Election Period, you will be deemed to have elected not to participate in this Cafeteria Plan for the remainder of the Plan Year. Failure to make an election under this Cafeteria Plan generally results in no coverage under the Benefit Plan Options; however, the Employer may provide coverage under certain Benefit Plan Options automatically. These automatic benefits are called “Default Benefits.” Any Default Benefit provided by your Employer will be identified in the enrollment materials. In addition, your share of the contributions for such Default Benefits may be automatically withdrawn from your pay on a pretax basis. You will be notified in the enrollment materials whether there will be a corresponding Pretax Contribution for such default benefits.

Q-6b. What is the Annual Election Period?

The Cafeteria Plan also has an “Annual Election Period” during which you may enroll if you did not enroll during the Initial Election Period or change your elections for the next Plan Year. The Annual Election Period will be identified in the enrollment materials distributed to you prior to the Annual Election Period. The election that you make during the Annual Election Period is effective the first day of the next Plan Year and cannot be changed during the entire Plan Year unless you have a Change in Status Event described in Q-7 below.

If you fail to make a change during the Annual Election Period, you are deemed to have elected to continue participation in the Cafeteria Plan with the same Benefit Plan Option elections that you had on the last day of the Plan Year in which the Annual Election period occurred (adjusted to reflect any increase/decrease in applicable premium/contributions). This is called an “Evergreen Election.” During the Annual Election Period in order for dependents (including spouse) to remain on your medical, dental and/or vision coverage, you MUST verify their continuing eligibility for the next Plan Year. Failure to do so will result in the removal of your dependents from coverage for the next Plan Year.

The Plan Year is generally a 12-month period (the initial or last Plan Year of the Plan could be an exception). The beginning and ending dates of the Plan Year are described in the Plan Information Description.

4

Q-7. Under what circumstances can I change my election during the Plan Year?

Generally, you cannot change your election under this Cafeteria Plan during the Plan Year. There are, however, a few exceptions.

First, your election will automatically terminate if you terminate employment or lose eligibility under this Cafeteria Plan or under all of the Benefit Plan Options that you have chosen.

Second, you may voluntarily change your election during the Plan Year if you satisfy the following conditions (prescribed by federal law):

a. You experience a “Change of Status Event” that affects your eligibility under this Cafeteria Plan and/or Benefit Plan Option; or

b. You experience a significant Cost or Coverage Change; and

c. You complete and submit a written Election Change Form within the Election Change Period described in the Plan Information Description.

d. You revoke a cafeteria plan election for group coverage due to a reduction in hours.

e. You revoke a cafeteria plan election and purchase a Marketplace Qualified Health Plan.

Change in Status Events and Cost or Coverage Changes recognized by this Cafeteria Plan, and the rules surrounding election changes in the event you experience a Change in Status Event or Cost or Coverage Change are described in Appendix III - Election Change Chart.

Third, an election under this Cafeteria Plan 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 Cafeteria Plan from becoming discriminatory within the meaning of the applicable federal income tax law.

If coverage under a Benefit Plan Option ends, the corresponding Pretax Contributions for that coverage will automatically end. No election is needed to stop the contributions.

Q-8. How is my Benefit Plan Option coverage paid for under this Cafeteria Plan?

You will pay for any Benefit Plan Option coverage that you elect with Pretax Contributions. When you elect to participate both in a Benefit Plan Option and this Cafeteria Plan, an amount equal to your share of the annual cost of those Benefit Plan Options that you choose divided by the applicable number of pay periods you have during that Plan Year is deducted from each paycheck after your election date. If you have chosen to use Pretax Contributions (or it is a Plan requirement), the deduction is made before any applicable federal and/or state taxes are withheld. An Employer may choose to pay for a share of the cost of the Benefit Plan Options you choose with Non-elective Employer Contributions. The amount of Non-elective Employer Contributions that is applied by the Employer towards the cost of the Benefit Plan Option(s) for each Participant and/or level of coverage is subject to the sole discretion of the Employer and it may be adjusted upward or downward in the Employer’s sole discretion. The Non-elective Employer 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

5

the Employer deems relevant. In no event will any Non-elective Employer Contribution be disbursed to you in the form of additional taxable compensation except as otherwise provided in the enrollment material or the Plan Information Description.

Q-9. What happens to my participation under the Cafeteria Plan if I take a leave of absence?

The following is a general description of the rules regarding participation in the Cafeteria Plan (and the Benefit Plan Options) during a leave of absence. The specific election changes that you can make under this Cafeteria Plan following a leave of absence are described in the Election Change Chart and the rules regarding coverage under the Benefit Plan Options during a leave of absence will be described in the Benefit Plan Option descriptions. If there is a conflict between the Election Change Chart/Benefit Plan Option Descriptions and this Q-9, the Election Change Chart or Benefit Plan Option description, whichever is applicable, will control.

a. If you go on a qualifying unpaid leave under the Family and Medical Leave Act of 1993 (FMLA), the Employer will continue to maintain your Benefit Plan Options that provide health coverage on the same terms and conditions as though you were still active to the extent required by FMLA (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 health coverage for Participants while they are on paid

leave (provided Participants on non-FMLA 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 Pretax 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 may pay your share of the contributions by making 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 or you may be required to pay to continue your group health coverage using post-tax contributions during the 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 and will be applied uniformly to all Participants. 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 Plan Administrator. The Election Change Chart will let you know whether you are able to drop your coverage or whether you are required to continue coverage during the leave.

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 Cafeteria Plan and the Benefit Plan Option upon return from such leave on the same basis as you were participating in the plans prior to the leave, or as otherwise required by the FMLA. Your coverage under the Benefit Plan Options providing health coverage will be reinstated once you have completed the required enrollment form and have met the New Employee Health Plan Eligibility waiting period

6

e. If you are commencing or returning from unpaid FMLA leave, your election under this Cafeteria

Plan for Benefit Plan Options providing non-health benefits shall be treated in the same manner that elections for non-health Benefit Plan Options are treated with respect to Participants commencing and returning from unpaid non-FMLA leave.

f. If you go on an unpaid non-FMLA leave of absence (e.g., personal leave, sick leave,

administrative leave, etc.) that does not affect eligibility in this Cafeteria Plan or a Benefit Plan Option offered under this Cafeteria Plan you must pay the required contributions if you do not work (or receive compensation through the use of leave banks) one day in any given month.

Q-10. How long will the Cafeteria Plan remain in effect?

Although the Employer expects to maintain the Plan indefinitely, it has the right to modify or terminate the Plan or any of its component programs at any time for any reason. Plan amendments and terminations will be conducted in accordance with the terms of the Plan document.

Q-11. What happens if my request for a benefit under this Cafeteria Plan is denied?

You will have the right to a full and fair review process. You should refer to Appendix I for a detailed description of the Claims Procedures under this Cafeteria Plan.

7

OAKLAND COUNTY MICHIGAN FLEXIBLE BENEFITS PLAN

NATURAL SELECT PLAN DESCRIPTION

Health Care Spending Account Component Description

Q-1. Who can participate in the Health Care Spending Account?

Each Employee who satisfies the HCSA Eligibility Requirements is eligible to participate on the HCSA Eligibility Date. The HCSA Eligibility Requirements and Eligibility Date are described in the Plan Information Description.

Q-2. How do I become a Participant?

If you have otherwise satisfied the HCSA Eligibility Requirements, you become a Participant in the HCSA by electing Health Care Savings Account benefits during the Initial or Annual Election Periods as described in the Cafeteria Plan Component Description). Your participation in the HCSA will be effective on the date that you make an election or on your HCSA Eligibility Date, whichever is later. See the Plan Information Description for your Employer’s Plan specifics. If you have made an election to participate and you want to change your election amount during the next Plan Year, you must make the changes to your election during the Annual Election Period. Otherwise, your election amount will remain the same during the next Plan Year. You may also become a Participant if you experience a Change in Status Event or Cost or Coverage Change that permits you to enroll mid-year (See Q-7 of the Cafeteria Plan Component Description for more details regarding mid-year election changes and the effective date of those changes). Once you become a Participant, your "Eligible Dependents" also become covered. For purposes of the HCSA, Eligible Dependents are the following:

(i) Your legal Spouse (as determined by state law to the extent consistent with the federal

Defense of Marriage Act) and (ii) Any other individuals who would qualify as a tax Dependent and any child of yours who as of

the end of the taxable year has not attained age twenty-seven (27).

If the Plan Administrator receives a National Medical Support Order (NMSO) relating to the HCSA, the HCSA will provide the health benefit coverage specified in the order to the person or persons (“alternate recipients”) named in the order to the extent the NMSO does not require coverage the HCSA does not otherwise provide. “Alternate recipients” include any child of the Participant who the Plan is required to cover pursuant to a NMSO. A “medical support order” is a legal judgment, decree or order relating to medical support. A medical support order is a NMSO to the extent it satisfies certain conditions required by law. Before providing any coverage to an alternate recipient, the Plan Administrator must determine whether the medical support order is a NMSO. If the Plan Administrator receives a medical support order relating to your HCSA, it will notify you in writing, and after receiving the order, it will inform you of its determination of whether or not the order is qualified.

8

Q-3. What is my Health Care Spending Account?

If you elect to participate in the HCSA, the Employer will establish a “Health Care Spending Account” to keep a record of the reimbursements you are entitled to, as well as the contributions you elected to withhold for such benefits during the Plan Year. No actual account is established; it is merely a bookkeeping account. Benefits under the HCSA are paid as needed from the Employer’s general assets except as otherwise set forth in the Plan Information Description.

Q-4. When does my coverage under the Health Care Spending Account end?

Your coverage under the HCSA ends on the earlier of the following to occur. See the Plan Information Description for your Employer’s Plan specifics.

a. The date you elect not to participate in accordance with the Cafeteria Plan Component Description;

b. The date you no longer satisfy the HCSA Eligibility Requirements; c. The date you terminate employment; or d. The date the Plan is terminated or you or the class of eligible Employees of which you are a

member are specifically excluded from the Plan. You may be entitled to elect Continuation Coverage (as described in Q-16 below) under the HCSA once your coverage ends because you terminate employment or experience a reduction in hours of employment.

Coverage for your Eligible Dependents ends on earliest of the following to occur:

a. The date your coverage ends; b. The date that your Dependents cease to be eligible Dependents (e.g., you and your Spouse

divorce); or c. The date the Plan is terminated or amended to exclude the individual or the class of Dependents

of which the individual is a member from coverage under the HCSA. You and/or your covered Dependents may be entitled to continue coverage if coverage is lost for certain reasons. The Continuation of Coverage provisions are described in more detail below.

Q-5. Can I ever change my Health Care Spending Account election?

You can change your election under the HCSA in the following situations:

a. For any reason during the Annual Election Period. You can change your election during the Annual Election Period for any reason. The election change will be effective the first day of the Plan Year following the end of the Annual Election Period.

b. Following a Change in Status Event. You may change your HCSA election during the Plan Year only if you experience an applicable Change in Status Event. See Q-7 of the Cafeteria Plan Component Description for more information on election changes. NOTE: You may not make HCSA election changes as a result of any Cost or Coverage Changes.

9

Q-6. What happens to my Health Care Spending Account if I take an approved leave of absence?

Refer to the Cafeteria Plan Component Description and the Election Change Chart to determine what, if any, specific changes you can make during a leave of absence. If your HCSA coverage ceases during an FMLA leave, you may, upon returning from FMLA leave, elect to be reinstated in the HCSA at either:

a. The same coverage level in effect before the FMLA leave (with increased contributions for the remaining period of coverage); or

b. At the same coverage level that is reduced pro-rata for the period of FMLA leave during which you did not make any contributions.

Under either scenario, expenses incurred during the period that your HCSA coverage was not in effect are not eligible for reimbursement under this HCSA.

Q-7. What is the maximum annual Health Care Spending Account amount that I may elect under the Health Care Spending Account, and how much will it cost?

You may elect any annual reimbursement amount subject to the maximum annual HCSA amount and the minimum reimbursement amount described in the Plan Information Description. You will be required to pay the annual contribution equal to the coverage level you have chosen reduced by any Non-elective Employer Contributions allocated to your HCSA. Any change in your HCSA election also will change the maximum available reimbursement for the period of coverage after the election. Such maximum available reimbursements will be determined on a prospective basis only by a method determined by the Plan Administrator that is in accordance with applicable law. The Plan Administrator (or its designated Third Party Administrator) will notify you of the applicable method when you make your election change.

Q-8. How are Health Care Spending Account benefits paid for under this Plan?

When you complete the Salary Reduction Agreement or Election Form, you specify the amount of HCSA reimbursement you wish to pay for with Pretax Contributions and/or Non-elective Employer Contributions, to the extent available. Your enrollment materials will indicate if Non-elective Employer Contributions are available for HCSA coverage. Thereafter, each paycheck will be reduced by an amount equal to pro-rata share of the annual contribution, reduced by any Non-elective Employer Contributions allocated to your HCSA.

Q-9. What amounts will be available for Health Care Spending Account Reimbursement at any particular time during the Plan Year?

So long as coverage is effective, the full, annual amount of Health Care Spending Account reimbursement you have elected, reduced by the amount of previous HCSA reimbursements received during the Plan Year, will be available at any time during the Plan Year, without regard to how much you have contributed.

10

Q-10. How do I receive reimbursement under the Health Care Spending Account?

Under this HCSA, you have several reimbursement options. You can complete and submit a written claim form for reimbursement (“Pay Me Back Claim Form”), you can request payment directly to your provider (“Pay My Provider”). Claims may be submitted automatically from your health plan provider to pay the expense. The following is a description of how all the options work. Pay Me Back Claim: When you incur an Eligible Medical Expense, you file a claim with the Plan's Third Party Administrator by completing and submitting a Pay Me Back Claim Form. You may obtain a Pay Me Back Claim Form at www.wageworks.com. Simply enter your user name and password, or select First Time User to complete the online registration process to access your account online. You must include with your Pay Me Back Claim Form a written statement from an independent third party (e.g., a receipt, EOB, etc.) associated with each expense that indicates the following:

a. The nature of the expense (e.g., what type of service or treatment was provided). If the expense is for an over-the-counter drug, the receipt must indicate the Rx number or, the name of the drug and a copy of the prescription recognized under applicable state law;

b. The date the expense was incurred; and c. The amount of the expense.

The Third Party Administrator will process the claim once it receives the Pay Me Back Claim Form from you. Reimbursement for expenses that are determined to be Eligible Medical Expenses will be made as soon as possible after receiving the claim and processing it. If the expense is determined to not be an “Eligible Medical Expense,” you will receive notification of this determination. You must submit all claims for reimbursement for Eligible Medical Expenses during the Plan Year in which they were incurred or during the Claim-It-By or Run-Out Period. The Run-Out Period is described in the Plan Information Description. Pay My Provider: You can request that payment be made directly from your HCSA or DCSA and sent directly to your provider. Automatic Rollover Claims: If offered by your Employer, a claim can be submitted on your behalf by your health plan provider, based on eligible out-of-pocket expenses related to health care claims processed by that health plan provider.

Q-11. What is an “Eligible Medical Expense?”

An “Eligible Medical Expense” means an expense that has been incurred by you and/or your eligible Dependents that satisfies the following conditions:

a. The expense is for “medical care” as defined by Code Section 213(d); and b. The expense has not been reimbursed by any other sources, and you will not seek reimbursement

for the expense from any other source.

The Code generally defines “medical care” as any amounts incurred to diagnose, treat, or prevent a specific medical condition or for purposes of affecting any function or structure of the body. Not every health-related expense you or your eligible Dependents incur constitutes an expense for “medical care.” For example, an expense is not for “medical care,” as that term is defined by the Code, if it is merely for

11

the beneficial health of you and/or your eligible Dependents (e.g., vitamins or nutritional supplements that are not taken to treat a specific medical condition) or for cosmetic purposes, unless necessary to correct a deformity arising from illness, injury, or birth defect. You may, in the discretion of the Third Party Administrator/Plan Administrator, be required to provide additional documentation from a health care provider showing that you have a medical condition and/or the particular item is necessary to treat a medical condition. Expenses for cosmetic purposes are also not reimbursable unless they are necessary to correct an abnormality caused by illness, injury, or birth defect. In addition, certain expenses that might otherwise constitute “medical care” as defined by the Code are not reimbursable under any Health Care Spending Account (per Treasury regulations):

a. Health insurance premiums; b. Expenses incurred for qualified long-term care services; c. Effective January 1, 2011, expenses for a medicine or drug unless such medicine or drug is a

prescribed drug (determined without regard to whether such drug is available without a prescription) or is insulin; and

d. Any other expenses that are specifically excluded by the Employer. For a list of Eligible Medical Expenses, go to www.wageworks.com and enter your user name and password.

Q-12. When must the expenses be incurred in order to receive reimbursement?

Eligible Medical Expenses must be incurred during the Plan Year and while you are a Participant in the Plan. “Incurred” means that the service or treatment giving rise to the expense has been provided. If you pay for an expense before you are provided the service or treatment, the expense may not be reimbursed until you have been provided the service or treatment. Except as provided below, you may not be reimbursed for any expenses arising before the HCSA becomes effective, before your Salary Reduction Agreement or Election Form becomes effective, or for any expenses incurred after the close of the Plan Year, or, after a separation from service or loss of eligibility (except for expenses incurred during an applicable COBRA continuation period). Your Employer has established a “Grace Period” for the HCSA offered under the Flexible Benefits Plan that follows the end of the Plan Year during which amounts you have allocated to the HCSA that is unused at the end of the Plan Year may be used to reimburse Eligible Medical Expenses incurred during the Grace Period. The Grace Period will begin on the first day of the Plan Year following the effective date and will end two (2) months and fifteen (15) days later. For example, if the Plan Year ends December 31, 2014, the Grace Period begins January 1, 2015 and ends March 15, 2015. In order to take advantage of the Grace Period, you must be:

• A Participant in the HCSA on the last day of the Plan Year to which the Grace Period relates, or • A Qualified Beneficiary who is receiving COBRA coverage under the HCSA on the last day of

the Plan Year to which the Grace Period relates.

12

The following additional rules will apply to the Grace Period:

• Eligible Medical Expenses incurred during a Grace Period and approved for reimbursement will be paid first from available amounts that were remaining at the end of the Plan Year to which the Grace Period relates and then from any amounts that are available to reimburse expenses incurred during the current Plan Year.

For example, assume that $200 remains in the HCSA sub-account at the end of the 2014 Plan Year and further assume that you have elected to allocate $2,400 to the HCSA for the 2015 Plan Year. If you submit for reimbursement an Eligible Medical Expense of $500 that was incurred on the January 15, 2015, $200 of your claim will be paid out of the unused amounts remaining in the HCSA from the 2014 Plan Year and the remaining $300 will be paid out of amounts allocated to your HCSA for 2015.

• Expenses incurred during a Grace Period must be submitted before the end of the Run-Out Period

described in this NSPD. This is the same Run-Out Period for expenses incurred during the Plan Year to which the Grace Period relates. Any unused amounts from the end of a Plan Year to which the Grace Period relates that are not used to reimburse Eligible Medical Expenses incurred either during the Plan Year to which the Grace Period relates or during the Grace Period will be forfeited if not submitted for reimbursement before the end of the Run-Out Period.

• You may not use HCSA amounts to reimburse Eligible Employment Related Expenses.

Q-13. What if the “Eligible Medical Expenses” I incur during the Plan Year are less than the annual amount I have elected for the Health Care Spending Account Reimbursement?

You will not be entitled to receive any direct or indirect payment of any amount that represents the difference between the actual Eligible Medical Expenses you have incurred and the annual coverage level you have elected. Any amount allocated to a HCSA shall be forfeited by the Participant and restored to the Employer if it has not been applied to provide reimbursement for Eligible Medical Expenses incurred during the Plan Year that are submitted for reimbursement within the Run-Out Period described in the Plan Information Description. Amounts so forfeited shall be used to offset administrative expenses and future costs, and/or applied in a manner that is consistent with applicable rules and regulations (per the Plan Administrator’s sole discretion). The sole exception to this rule is the “Qualified Reservist Distribution,” described below. What is a “Qualified Reservist Distribution?” Effective January 1, 2012, the Employer has established a “Qualified Reservist Distribution” for the HCSA. If you are called or ordered to active duty, you may be eligible for a “Qualified Reservist Distribution” from your HCSA. This means that you may be able to request a distribution of the remaining balance, if any, in your HCSA in the event that you are called or ordered to active military duty.

13

In order to be eligible for a Qualified Reservist Distribution, you must:

o be a member of a “reserve component” (as defined in section 101 of title 37 of the United States Code), which means a member of the Army National Guard; the Reserve for the U.S. Army, Navy, Marine Corps, Air Force, or Coast Guard; Air National Guard of the United States; or the Reserve Corps of the Public Health Service;

o be called or ordered to active military duty for (i) 180 days or more or (ii) for an indefinite period; o provide a copy of your order or call to active duty; and o be a Participant in the HCSA on the date you are called or ordered to duty.

If you believe you are eligible for a Qualified Reservist Distribution, you must contact the Administrator to request a distribution request form as soon as possible. A request for a Qualified Reservist Distribution must be made in writing on the form provided by the Administrator. You must submit a copy of your order or call to active duty along with your request. Requests for a Qualified Reservist Distribution must be made on or after the date of the order or call to duty but before the last day of the Plan Year (or grace period, if applicable) during which the order or call to duty occurred. You will receive your Qualified Reservist Distribution within a reasonable period of time, but no later than sixty (60) days after your request has been received. A Qualified Reservist Distribution will be: Made based on all salary reduction amounts credited to your HCSA for the applicable Plan Year that have not been applied to provide HCSA Reimbursements submitted before the Qualified Reservist Distribution request is submitted. Claims incurred and submitted but not yet reimbursed at the time the Qualified Reservist Distribution Request is received will be treated like any other claim submitted for reimbursement under the Health Care Savings Account. Notwithstanding anything to the contrary, if you elect to receive a Qualified Reservist Distribution, you will forfeit any right to reimbursement for medical expenses incurred after the date of the QRD. The Plan Administrator will determine what this amount is on a uniform basis, consistent with applicable law and IRS interpretations. Notwithstanding any other provision of this Plan, an individual who has selected a Qualified Reservist Distribution shall be considered to have made such election as an alternative to COBRA or USERRA coverage continuation for the HCSA (except as may otherwise be required by applicable law). Unlike your reimbursements from your HCSA for Eligible Medical Expenses, the amount of your Qualified Reservist Distribution is taxed as income and will be reported as income on your W-2. Qualified Reservist Distributions do not apply to amounts in your DCSA.

Q-14. What happens if a Claim for Benefits under the Health Care Spending Account is denied?

You will have the right to a full and fair review process. You should refer to Appendix I for a detailed description of the Claims Procedures under this Plan.

14

Q-15. What happens to unclaimed Health Care Spending Account Reimbursements?

Any HCSA reimbursement benefit payments that are unclaimed (e.g., un-cashed benefit checks) by the close of the Plan Year following the Plan Year in which the Eligible Medical Expense was incurred shall be forfeited.

Q-16. What is COBRA Continuation Coverage?

Federal law requires most private and governmental employers sponsoring group health plans to offer employees and their families the opportunity for a temporary extension of health care coverage (called “Continuation Coverage”) at group rates in certain instances where coverage under the plans would otherwise end. These rules apply to this HCSA, unless the Employer sponsoring the HCSA is not subject to these rules (e.g., the employer is a “small-employer” or the HCSA is a church plan). The Plan Administrator can tell you whether the Employer is subject to federal COBRA continuation rules (thus subject to the following rules). These rules are intended to summarize the continuation rights set forth under federal law. If federal law changes, only the rights provided under applicable federal law will apply. To the extent that any greater rights are set forth herein, they shall not apply. When Coverage May Be Continued Only “Qualified Beneficiaries” are eligible to elect Continuation Coverage if they lose coverage as a result of a “Qualifying Event.” A “Qualified Beneficiary” is the Participant, covered Spouse and/or covered Dependent child at the time of the Qualifying Event. A Qualified Beneficiary has the right to continue coverage if he or she loses coverage as a result of certain Qualifying Events. The table below describes the qualifying events that may entitle a Qualified Beneficiary to continuation coverage:

Covered Employee

Covered Spouse

Covered Dependent

1. Covered Employee’s termination of employment or reduction in hours of employment

2. Divorce or Legal Separation 3. Child ceasing to be an eligible

Dependent

4. Death of the covered Employee There are special rules pertaining to Health Care Spending Accounts that determine when COBRA is extended. COBRA continuation coverage is only extended when year-to-date deposits exceed year-to-date claims paid. Type of Continuation Coverage If you choose Continuation Coverage, you may continue the level of coverage you had in effect immediately preceding the Qualifying Event. However, if Plan benefits are modified for similarly situated active Employees, then they will be modified for you and other Qualified Beneficiaries as well. After electing COBRA coverage, you will be eligible to make a change in your benefit election with respect to

15

the HCSA upon the occurrence of any event that permits a similarly situated active Employee to make a benefit election change during a Plan Year. If you do not choose Continuation Coverage, your coverage under the HCSA will end with the date you would otherwise lose coverage. Notice Requirements You or your covered Dependents (including your Spouse) must notify the COBRA Administrator identified in the Plan Information Description in writing of a divorce, legal separation, or a child losing Dependent status under the Plan within 60 days of the later of the date of the event or the date on which coverage is lost because of the event. Your written notice must identify the Qualifying Event, the date of the Qualifying Event, and the Qualified Beneficiaries impacted by the qualifying event. When the COBRA Administrator is notified that one of these events has occurred, the Plan Administrator will in turn notify you that you have the right to choose Continuation Coverage by sending you the appropriate election forms. Notice to an Employee's Spouse is treated as notice to any covered Dependents who reside with the Spouse. You may be required to provide additional supporting documentation. An Employee or covered Dependent is responsible for notifying the COBRA Administrator if he or she becomes covered under another group health plan. Election Procedures and Deadlines Each Qualified Beneficiary is entitled to make a separate election for continuation coverage under the Plan if they are not otherwise covered as a result of another Qualified Beneficiary’s election. In order to elect Continuation Coverage, you must complete the Election Form(s) within 60 days from the date you would lose coverage for one of the reasons described above or the date you are sent notice of your right to elect Continuation Coverage, whichever is later and send it to the COBRA Administrator identified in the Plan Information Description. Failure to return the election form within the 60-day period will be considered a waiver of your Continuation Coverage rights. Cost You will have to pay the entire cost of your Continuation Coverage. The cost of your Continuation Coverage will not exceed 102% of the applicable premium for the period of Continuation Coverage. The first contribution after electing Continuation Coverage will be due 45 days after you make your election. Subsequent contributions are due the first day of each month; however, you have a 30-day grace period following the due date in which to make your contribution. Failure to make contributions within this time period will result in automatic termination of your Continuation Coverage. When Continuation Coverage Ends The maximum period for which coverage may be continued is the end of the Plan Year in which the Qualifying Event occurs. However, in certain situations, the maximum duration of coverage may be 18 or 36 months from the Qualifying Event (depending on the type of qualifying event and the level of Non-elective Contributions provided by the Employer). You will be notified of the applicable maximum

16

duration of Continuation Coverage when you have a Qualifying Event. Regardless of the maximum period, Continuation Coverage may end earlier for any of the following reasons:

a. If the contribution for your Continuation Coverage is not paid on time or it is significantly insufficient (Note: if your payment is insufficient by the lesser of 10% of the required premium, or $50, you will be given 30 days to cure the shortfall);

b. If you become covered under another group health plan and are not actually subject to a pre-existing condition exclusion limitation;

c. If you become entitled to Medicare; or d. If the Employer no longer provides group health coverage to any of its Employees.

Q-17. Will my health information be kept confidential?

Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), group health plans such as the HCSA and the Third Party Administrators are required to take steps to ensure that certain “protected health information” is kept confidential. You may receive a separate notice that outlines the Employer’s health privacy policies.

Q-18. How long will the Health Care Spending Account remain in effect?

Although the Employer expects to maintain the Plan indefinitely, it has the right to modify or terminate the Plan or any of its Component Programs at any time and for any reason.

17

OAKLAND COUNTY MICHIGAN FLEXIBLE BENEFITS PLAN

NATURAL SELECT PLAN DESCRIPTION

Dependent Care Spending Account Component Description

Q-1. Who can participate in the Dependent Care Spending Account?

Each Employee who satisfies the DCSA Eligibility Requirements is eligible to participate in the DCSA on the DCSA Eligibility Date. The DCSA Eligibility Requirements and Eligibility Date are described in the Plan Information Description.

Q-2. How do I become a Participant?

If you have otherwise satisfied the DCSA Eligibility Requirements, you become a Participant in the DCSA by electing Dependent Care Reimbursement benefits during the Initial or Annual Election Periods described in Q-6 of the Cafeteria Plan Component Description. Your participation in the DCSA will be effective on the date that you make the election or your DCSA Eligibility date, whichever is later. See the Plan Information Description for your Employer’s Plan specifics. If you have made an election to participate and you want to participate during the next Plan Year, you are not required to make an election during the Annual Election Period. You may also become a Participant if you experience a Change in Status Event or Cost or Coverage Change that permits you to enroll mid-year (See Q-7 of the Cafeteria Plan Component Description for more details regarding mid-year election changes and the effective date of those changes).

Q-3. What is my “Dependent Care Spending Account?”

If you elect to participate in the DCSA, the Employer will establish a “Dependent Care Spending Account” to keep a record of the reimbursements you are entitled to, as well as the contributions you elected to withhold for such benefits during the Plan Year. No actual account is established; it is merely a bookkeeping account.

Q-4. When does my coverage under the Dependent Care Spending Account end?

Your coverage under the DCSA ends on the earlier of the following to occur. See the Plan Information Description for your Employer’s Plan specifics.

a. The date you elect not to participate in accordance with the Cafeteria Plan Component Description;

b. The date you no longer satisfy the DCSA Eligibility Requirements; c. The date the Plan is terminated or you or the class of eligible Employees of which you are a

member are specifically excluded from the Plan.

18

Q-5. Can I ever change my Dependent Care Spending Account election?

You can change your election under the DCSA in the following situations:

a. For any reason during the Annual Election Period. You can change your election during the Annual Election Period for any reason. The election change will be effective the first day of the Plan Year following the end of the Annual Election Period.

b. Following a Change in Status Event or Cost or Coverage Change. You may change your DCSA election during the Plan Year only if you experience an applicable Change in Status Event or there is a significant Cost or Coverage change. See Q-7 of the Cafeteria Plan Component Description for more information on election changes.

Q-6. What happens to my Dependent Care Spending Account if I take an unpaid leave of absence?

Refer to the Cafeteria Plan Component Description and the Election Change Chart to determine what, if any specific changes you can make during a leave of absence.

Q-7. What is the maximum annual Dependent Care Spending Account Reimbursement that I may elect under the Dependent Care Spending Account?

The annual amount cannot exceed the maximum DCSA reimbursement amount specified in Internal Revenue Code Section 129. Currently, the maximum amount under Oakland County’s Plan is $4,992 per calendar year if you (for 2015 the maximum amount is $4,995):

a. Are married and file a joint return; b. Are married, but your Spouse maintains a separate residence for the last 6 months of the calendar

year, you file a separate tax return, and you furnish more than one-half the cost of maintaining those Dependents for whom you are eligible to receive tax-free reimbursements under the DCSA; or

c. Are single. If you are married and reside together, but file a separate federal income tax return, the maximum Dependent Care Spending Account Reimbursement that you may elect is $2,500. In addition, the amount of reimbursement that you receive on a tax-free basis during the Plan Year cannot exceed the lesser of the earned income (as defined in Code Section 32) or your Spouse earned income. Your Spouse will be deemed to have earned income of $250 if you have one Qualifying Individual and $500 if you have two or more Qualifying Individuals (described below), for each month in which your Spouse is:

a. Physically or mentally incapable of caring for himself or herself; or b. A full-time student (as defined by Code Section 21).

Q-8. How do I pay for Dependent Care Spending Account Reimbursements?

When you complete the Salary Reduction Agreement or Election Form, you specify the amount of DCSA Reimbursement you wish to pay for with Pretax Contributions to the extent available. Your enrollment

19

material will indicate if Non-elective Contributions are available for DCSA coverage. Thereafter, each paycheck will be reduced by an amount equal to a pro-rata share of the annual contribution.

Q-9. What is an “Eligible Employment-Related Expense” for which I can claim a reimbursement?

You may be reimbursed for work-related dependent care expenses (“Eligible Employment-Related Expenses”). Generally, an expense must meet all of the following conditions for it to be an Eligible Employment Related Expense:

a. The expense is incurred for services rendered after the date of your election to receive DCSA reimbursement benefits and during the calendar year to which it applies.

b. Each individual for whom you incur the expense is a "Qualifying Individual.” A Qualifying Individual is:

(i) An individual age 12 or under who is a "qualifying child" of the Employee as defined in Code Section 152(a)(1). Generally speaking, a "qualifying child" is a child (including a brother, sister, step sibling) of the Employee or a descendant of such child (e.g. a niece, nephew, grandchild) who shares the same principal place of abode with you for more than half the year and does not provide over half of his/her support.

(ii) A Spouse or other tax Dependent (as defined in Code Section 152) who is physically or

mentally incapable of caring for himself or herself and who has the same principal place of abode as you for more than half of the year.

Note: There is a special rule for children of divorced parents. If you are divorced, the child

is a qualifying individual of the “custodial” parent (as defined in Code Section 152);

c. The expense is incurred for the care of a Qualifying Individual (as described above), or for related household services, and is incurred to enable you (and your Spouse, if applicable) to be gainfully employed. Expenses for overnight stays or overnight camps are not eligible. Tuition expenses for kindergarten (or above) do not qualify.

d. If the expense is incurred for services outside your household and such expenses are incurred for the care of a Qualifying Individual who is age 13 or older, such Dependent must regularly spend at least 8 hours per day in your home.

e. If the expense is 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 complies with all applicable state and local laws and regulations.

f. The expense is not paid or payable to a “child” (as defined in Code Section 152(f)(1)) of yours who is under age 19 the entire year in which the expense is incurred or an individual for whom you or your Spouse is entitled to a personal tax exemption as a Dependent.

g. You must supply the taxpayer identification number for each dependent care service provider to the IRS with your annual tax return by completing IRS Form 2441.

You are encouraged to consult your personal tax advisor or IRS Publication 17 “Your Federal Income Tax” for further guidance as to what is or is not an Eligible Employment-Related Expense if you have any doubts. In order to exclude from income the amounts you receive as reimbursement for dependent care

20

expenses, you are generally required to provide the name, address, and taxpayer identification number of the dependent care service provider on your federal income tax return.

Q-10. How do I receive reimbursement under the Dependent Care Spending Account?

Under this DCSA, you have two reimbursement options. You can complete and submit a written Claim Form for reimbursement (“Pay Me Back Claim”). Alternatively, you can request payment directly to your provider (“Pay My Provider”). The following is a description of how both options work. When you incur an Eligible Employment-Related Expense, you file a claim with the Plan's Third Party Administrator by completing and submitting a Pay Me Back Claim Form. You may obtain a Pay Me Back Claim Form at www.wageworks.com. Simply enter your user name and password, or select First Time User to complete the online registration process to access your account online. You must include with your Pay Me Back Claim Form a written statement from an independent third party (e.g., a receipt, etc.) associated with each expense that indicates the following:

a. The date(s) the expense was incurred; b. The nature of the expense (e.g., what type of service was provided); and c. The amount of the expense.

The Third Party Administrator will process the claim once it receives the Pay Me Back Claim Form from you. Reimbursement for expenses that are determined to be Eligible Employment-Related Expenses will be made as soon as possible after receiving the claim and processing it. If the expense is determined to not be an “Eligible Employment-Related Expense,” you will receive notification of this determination. You must submit all claims for reimbursement for Eligible Employment-Related Expenses during the Plan Year in which they were incurred or during the Claim-It-By or Run-Out Period. The Run-Out Period is described in the Plan Information Description. If your claim was for an amount that was more than your current DCSA balance, the excess part of the claim will be carried over into following months, to be paid out as your balance becomes adequate. You must incur the expense in order to receive payment. “Incurred” means the service has been provided without regard to whether you have paid for the service. Payments for advance services are not reimbursable because they have not yet been incurred. For example, Employee A pays the monthly day care fee on January 1 and then submits a copy of the receipt on January 3. The expense for the entire month is not reimbursable until the services for that month have been performed. In addition, you must certify with each claim that you have not been reimbursed for the expense(s) from any other source and you will not seek reimbursement from any other source.

Q-11. When must the expenses be incurred in order to receive reimbursement?

Eligible Employment-Related Expenses must be incurred during the Plan Year. You may not be reimbursed for any expense arising before the DCSA become effective, before your Salary Reduction Agreement or Election Form becomes effective, or for any expenses incurred after the close of the Plan Year and unless noted otherwise in the Plan Information Description, after your participation the DCSA ends.

21

Q-12. What if the “Eligible Employment-Related Expenses” I incur during the Plan Year are less than the annual amount of coverage I have elected for Dependent Care Spending Account Reimbursement?

You will not be entitled to receive any direct or indirect payment of any amount that represents the difference between the actual Eligible Employment-Related Expenses you have incurred, on the one hand, and the annual DCSA reimbursement you have elected and paid for, on the other. Any amount credited to a DCSA shall be forfeited by the Participant and restored to the Employer if it has not been applied to provide the elected reimbursement for any Plan Year by the end of the Claim-It-By or Run-Out Period following the end of the Plan Year for which the election was effective. Amounts so forfeited shall be used to offset reasonable administrative expenses and future costs and/or otherwise permitted under applicable law.

Q-13. Will I be taxed on the Dependent Care Spending Account benefits I receive?

You will not normally be taxed on your DCSA reimbursements so long as your family aggregate DCSA reimbursement (under this DCSA and/or another employer’s DCSA) does not exceed the maximum annual reimbursement limits described above. However, to qualify for tax-free treatment, you will be required to list the names and taxpayer identification numbers on your annual tax return of any persons who provided you with dependent care services during the calendar year for which you have claimed a tax-free reimbursement.

Q-14. If I participate in the Dependent Care Spending Account, will I still be able to claim the household and dependent care credit on my federal income tax return?

You may not claim any other tax benefit for the tax-free amounts received by you under this DCSA, although the balance of your Eligible Employment-Related Expenses may be eligible for the dependent care credit.

Q-15. What is the household and dependent care credit?

The household and dependent care credit is an allowance for a percentage of your annual, Eligible Employment-Related Expenses as a credit against your federal income tax liability under the U.S. Tax Code. In determining what the tax credit would be, you may take into account $3,000 of such expenses for one Qualifying Individual, or $6,000 for two or more Qualifying Individuals. Depending on your adjusted gross income (AGI), the percentage could be as much as 35% of your Eligible Employment-Related Expenses (to a maximum credit amount of $1,050 for one Qualifying Individual or $2,100 for two or more Qualifying Individuals), to a minimum of 20% of such expenses. The maximum 35% rate must be reduced by 1% (but not below 20%) for each $2,000 portion (or any fraction of $2,000) of your adjusted gross incomes over $15,000 for taxable years beginning after 2002 and before 2013. Illustration: Assume you have one Qualifying Individual for whom you have incurred Eligible Employment-Related Expenses of $3,600, and that your adjusted gross income is $21,000. Since only one Qualifying Individual is involved, the credit will be calculated by applying the appropriate percentage to the first $3,000 of the expenses. The percentage is, in turn, arrived at by subtracting one percentage point from 35% for each $2,000 of your adjusted gross income over $15,000. The calculation is: 35% -- [$21,000 – 15,000)/$2,000 x 1% = 32%. Thus, your tax credit would be $3,000 x 32% = $960. If you had

22

incurred the same expenses for two or more Qualifying Individuals, your credit would have been $3,600 x 32% = $1,152, because the entire expense would have been taken into account, not just the first $3,000.

Q-16. What happens to unclaimed Dependent Care Spending Account Reimbursements?

Any DCSA reimbursements that are unclaimed (e.g., un-cashed benefit checks) by the close of the Plan Year following the Plan Year in which the Eligible Employment-Related Expense was incurred shall be forfeited.

Q-17. What happens if my claim for reimbursement under the Dependent Care Spending Account is denied?

You will have the right to a full and fair review process. You should refer to Appendix I for a detailed description of the Claims Procedures under this Plan.

Q-18. How long will the Dependent Care Spending Account 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.

Q-19. Can I receive reimbursement following cessation of participation?

Participants may submit claims for reimbursement for Eligible Employment-Related Expenses incurred during the Plan Year at any time until the last day of the run out period after the end of the Plan Year for which the election had been in effect, and to receive reimbursement for qualified expenses.

23

PLAN INFORMATION DESCRIPTION TO THE OAKLAND COUNTY MICHIGAN PLAN

NATURAL SELECT PLAN DESCRIPTION This Appendix provides information specific to the Oakland County Michigan Cafeteria Plan.

A. Employer/Plan Sponsor Information

1. Name, address and phone number of Plan Sponsor:

Oakland County Michigan Human Resources – Employee Benefits 2100 Pontiac Lake Road, Bldg. 41 West

Waterford, MI 48328 248-452-9189

2. Name, address and phone number of Plan

Administrator: The Plan Administrator shall have 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 omissions in the Plan and the NSPD issued in connection with the Plan.

Oakland County Michigan Human Resources – Employee Benefits 2100 Pontiac Lake Road, Bldg. 41 West

Waterford, MI 48328 248-452-9189

3. Federal Tax Identification 38-6004876

4. Controlling Law: Michigan

5. Plan Number: 501

6. Initial Effective Date: This is the date that the Plan was first established.

January 1, 1994

7. Amended and Restated Date: February 1, 2005 April 1, 2009

January 1, 2012 September 26, 2012

January 1, 2015 8. Initial Plan Year: January 1 through December 31

9. All subsequent Plan Years (If different from 8) --

10. Affiliated Employers participating in the Plan: N/A

11. Third Party Administrator: WageWorks, Inc.

1100 Park Place 4th Floor

San Mateo, CA 94403

24

B. Cafeteria Plan Component Information

(a) Cafeteria Plan Eligibility Requirements and Eligibility Date. See Page 49.

The Employee’s commencement of participation in the Plan is conditioned on the Employee properly completing and submitting a Salary Reduction Agreement or Election Form as summarized in this NSPD. Eligibility for coverage under any given Benefit Plan Option shall be determined not by this Plan but by the terms of that Benefit Plan Option.

(b) Cafeteria Plan Annual Election Rules. With respect to Benefit Plan Option elections, including

the HCSA and DCSA elections, failure to make an election during the Annual Election Period will result in the following deemed election(s):

The Employee will be deemed to have elected to continue his Benefit Plan Option

elections in effect as of the end of the Plan Year in which the Annual Election Period took place, unless Employee notifies the company in writing of a qualifying status change or at any time before the end of the Plan Year for the following Plan Year. This is called an “Evergreen Election.” During the Annual Election Period in order for dependents (including spouse) to remain on your medical, dental and/or vision coverage, you MUST verify their continuing eligibility for the next Plan Year. Failure to do so will result in the removal of your dependents from coverage for the next Plan Year.

(c) Change of Election Period. If you experience a Change in Status Event or Cost or Coverage

Change as described in the Cafeteria Plan Component Description and in the Election Change Chart, you may make the permitted election changes described in the Election Change Chart by submitting an Election Change Form within 30 days after the date of the event to the Employer. If you are participating in an insured arrangement that provides a longer Election Change Period, the Election Change Period described in the insurance policy will apply.

(d) Benefits Plan Options: The Employer elects to offer to eligible Employees the following

Benefit Plan Option(s) subject to the terms and conditions of the Plan and the terms and conditions of the Benefit Plan Options. These Benefit Plan Option(s) are specifically incorporated herein by reference.

The maximum Pretax Contributions a Participant can contribute via the Salary Reduction Agreement is the aggregate cost of the applicable Benefit Plan Options selected. It is intended that such Pretax Contribution amounts will, for tax purposes, constitute an Employer contribution, but may constitute Employee contributions for state insurance law purposes.

1. Health Care Spending Account 2. Dependent Care Spending Account 3. Medical Coverage 4. Dental Coverage 5. Vision Coverage 6. Life Insurance

25

7. Accident Death and Dismemberment Insurance

C. Health Care Spending Account Component Information

(a) HCSA Eligibility Requirements and Eligibility Date.

(i) Newly hired or newly eligible Participants may enroll in the middle of the Plan Year. (ii) Newly hired or newly eligible Participants must wait 30-60 days before they can be

covered under this Plan (See Chart). (iii) Newly hired or newly eligible Participants are required to satisfy the new hire waiting

period to enroll during open enrollment. (iv) Following the waiting period or enrollment date (whichever is later), new hire coverage

becomes effective: a. First of the month following satisfaction of waiting period and requesting enrollment.

(b) Annual Health Care Spending Account Amount. The maximum annual HCSA reimbursement

each year may not exceed the lesser of the HCSA reimbursement amount elected for that year or $2,496. The minimum annual amount that may be elected under the HCSA is $104. For 2015, the maximum annual amount is $2,484 and the minimum annual amount is $108.

(c) Coverage Effective Date for Qualified Changes. Coverage following a qualified life change

will begin on any day of the month following your request for new enrollment or change in enrollment.

(d) Coverage End Date for Qualified Changes. If coverage is revoked following a qualified life

change, coverage will end on any day of the month following the request to revoke coverage. (e) Coverage End Date Under the Health Care Spending Account. Coverage will end

immediately upon cessation of participation under the HCSA.

(f) Run-Out Period (Claim-It-By Date). The Claim-It-By Date/Run-Out Period is the deadline date in which expenses incurred during a coverage period must be submitted to be eligible for reimbursement. Claims must be received by this date to be eligible for reimbursement from the Plan.

a. The Mid-Year Run-Out Period for terminated Employees ends at the end of the

month following 4 months after the Plan Year end date.

b. The End-of-Plan Run-Out Period for an Employee who is covered through the end of the Plan Year ends at the end of the month following 4 months after the Plan Year end date.

(g) Grace Period. The Grace Period is the two month and 15 day period after the end of the Plan Year for which Eligible Medical Expenses can continue to be incurred should a balance remain in the account as of the last day of the Plan Year. Each Plan Year the Grace Period will begin January 1 and end March 15. All expenses incurred during the Grace Period with the intent to

26

use up any monies from the previous Plan Year, must be submitted within the End-of-Plan Run-Out Period.

(h) COBRA Administrator. The COBRA Administrator for the HCSA is Oakland County

Michigan, 2100 Pontiac Lake Road, Bldg. 41 West, Waterford, MI 48328 Attn: Human Resources – Employee Benefits

(i) Method of Funding. HCSA benefits are paid from the Employer’s general assets.

D. Dependent Care Spending Account Component Information

(a) DCSA Eligibility Requirements and Eligibility Date.

(i) Newly hired or newly eligible Participants may enroll in the middle of the Plan Year. (ii) Newly hired or newly eligible Participants must wait 30-60 days before they can be covered

under this Plan (See Chart). (iii) Newly hired or newly eligible Participants are required to satisfy the new hire waiting period

to enroll during open enrollment. (iv) Following the waiting period or enrollment date (whichever is later), new hire coverage

becomes effective: a. First of the month following satisfaction of waiting period and requesting enrollment.

(b) Annual Dependent Care Spending Account Amount. The maximum annual DCSA

reimbursement each calendar year may not exceed the lesser of the DCSA reimbursement amount elected for that year or $4,992 (or $2,500 for married filling separate returns). The minimum annual amount that may be elected under the DCSA is $104. For 2015, the maximum annual amount is $4,995 and the minimum annual amount is $108.

(c) Coverage End Date Under the Dependent Care Spending Account. Coverage will end at the

end of the plan year in which coverage ceases under the DCSA.

(d) Run-Out Period (Claim-It-By Date). The Claim-It-By Date/Run-Out Period is the deadline date in which expenses incurred during a coverage period must be submitted to be eligible for reimbursement. Claims must be received by this date to be eligible for reimbursement from the Plan.

a. The Mid-Year Run-Out Period for terminated Employees ends at the end of the

month following 4 months after the Plan Year end date.

b. The End-of-Plan Run-Out Period for Employees who are covered through the end of the Plan Year ends at the end of the month following 4 months after the Plan Year End date.

(e) Method of Funding. DCSA benefits are paid from the Employer’s general assets.

E. Medical Coverage

(a) Medical Coverage Eligibility Requirements and Eligibility Date.

27

(i) Newly hired or newly eligible Participants may enroll in the middle of the Plan Year. (ii) Newly hired or newly eligible Participants must wait 30-60 days before they can be covered

under this Plan (See Chart). (iii) Newly hired or newly eligible Participants are required to satisfy the new hire waiting period

to enroll during open enrollment. (iv) Following the waiting period or enrollment date (whichever is later), new hire coverage

becomes effective: a. First of the month following satisfaction of waiting period and requesting enrollment.

(b) Coverage Effective Date for Qualified Changes. Coverage following a qualified life

change will begin on any day of the month following your request for new enrollment or change in enrollment.

(c) Coverage End Date for Qualified Changes. If coverage is revoked following a qualified life change, coverage will end on any day of the month following the request to revoke coverage.

(d) Coverage End Date Under Medical Coverage. Coverage will end at the end of the month in

which the employee terminates employment.

(e) COBRA Administrator. The COBRA Administrator for the Medical Coverage is Oakland County Michigan, 2100 Pontiac Lake Road, Bldg. 41 West, Waterford, MI 48328 Attn: Human Resources – Employee Benefits

F. Dental Coverage

(a) Dental Coverage Eligibility Requirements and Eligibility Date. (i) Newly hired or newly eligible Participants may enroll in the middle of the Plan Year. (ii) Newly hired or newly eligible Participants must wait 30-60 days before they can be covered

under this Plan (See Chart). (iii) Newly hired or newly eligible Participants are required to satisfy the new hire waiting period

to enroll during open enrollment. (iv) Following the waiting period or enrollment date (whichever is later), new hire coverage

becomes effective: a. First of the month following satisfaction of waiting period and requesting enrollment.

(b) Coverage Effective Date for Qualified Changes. Coverage following a qualified life

change will begin on any day of the month following your request for new enrollment or change in enrollment.

(c) Coverage End Date for Qualified Changes. If coverage is revoked following a qualified life change, coverage will end on any day of the month following the request to revoke coverage.

(d) Coverage End Date Under Dental Coverage. Coverage will end at the end of the month in

which the employee terminates employment.

28

(e) COBRA Administrator. The COBRA Administrator for the Dental Coverage is Oakland County Michigan, 2100 Pontiac Lake Road, Bldg. 41 West, Waterford, MI 48328 Attn: Human Resources – Employee Benefits

G. Vision Coverage

(a) Vision Coverage Eligibility Requirements and Eligibility Date.

(i) Newly hired or newly eligible Participants may enroll in the middle of the Plan Year. (ii) Newly hired or newly eligible Participants must wait 30-60 days before they can be covered

under this Plan (See Chart). (iii) Newly hired or newly eligible Participants are required to satisfy the new hire waiting period

to enroll during open enrollment. (iv) Following the waiting period or enrollment date (whichever is later), new hire coverage

becomes effective: a. First of the month following satisfaction of waiting period and requesting enrollment.

(b) Coverage Effective Date for Qualified Changes. Coverage following a qualified life

change will begin on any day of the month following your request for new enrollment or change in enrollment.

(c) Coverage End Date for Qualified Changes. If coverage is revoked following a qualified life change, coverage will end on any day of the month following the request to revoke coverage.

(d) Coverage End Date Under Vision Coverage. Coverage will end at the end of the month in

which the employee terminates employment.

(e) COBRA Administrator. The COBRA Administrator for the Medical Coverage is Oakland County Michigan, 2100 Pontiac Lake Road, Bldg. 41 West, Waterford, MI 48328 Attn: Human Resources – Employee Benefits

H. Life Insurance

(a) Life Insurance Eligibility Requirements and Eligibility Date. i. Newly hired or newly eligible Participants may enroll in the middle of the Plan Year.

ii. Newly hired or newly eligible Participants will be covered under this Plan the first day of the following month in which they were newly hired or newly eligible.

(b) Coverage End Date Under Life Insurance. Coverage will end on the last day of the month in

which the employee terminates employment or becomes ineligible for Life Insurance.

I. Accidental Death and Dismemberment

(a) Accidental Death and Dismemberment Eligibility Requirements and Eligibility Date. i. Newly hired or newly eligible Participants may enroll in the middle of the Plan Year.

ii. Newly hired or newly eligible Participants will be covered under this Plan the first day of the following month in which they were newly hired or newly eligible.

29

(b) Coverage End Date Under Accidental Death and Dismemberment. Coverage will end on the

last day of the month in which the employee terminates employment or becomes ineligible for Life Insurance.

30

APPENDIX I – CLAIMS REVIEW PROCEDURE The Plan has established the following claims review procedure in the event you are denied a benefit under this Plan. The procedure set forth below does not apply to benefit claims filed under the Benefit Plan Options other than the Health Care Spending Account and Dependent Care Spending Account. Step 1: Notice of denial is received from Third Party Administrator. If your claim is denied, you will receive written notice from the Third Party Administrator that your claim is denied as soon as reasonably possible, but no later than 30 days after receipt of the claim. For reasons beyond the control of the Third Party Administrator, the Third Party Administrator may take up to an additional 15 days to review your claim. You will be provided written notice of the need for additional time prior to the end of the 30-day period. If the reason for the additional time is that you need to provide additional information, you will have 45 days from the notice of the extension to obtain that information. The time period during which the Third Party Administrator must make a decision will be suspended until the earlier of the date that you provide the information or the end of the 45-day period. Step 2: Review your notice carefully. Once you have received your notice from the Third Party Administrator, review it carefully. The notice will contain:

a. The reason(s) for the denial and the Plan provisions on which the denial is based; b. A description of any additional information necessary for you to perfect your claim, why the

information is necessary, and your time limit for submitting the information; c. A description of the Plan’s appeal procedures and the time limits applicable to such procedures;

and d. A right to request all documentation relevant to your claim.

Step 3: If you disagree with the decision, file an appeal. If you do not agree with the decision of the Third Party Administrator, you may file a written appeal. Your appeal must be received within 180 days of the date you received notice that your claim was denied. You should submit all information identified in the notice of denial as necessary to perfect your claim and any additional information that you believe would support your claim to: WageWorks Claims Appeal Board, P.O. Box 991, Mequon, WI 53092-0991 or fax to 877-220-3248. The Appeal Review Process is documented at www.wageworks.com/hcdcappeals.pdf. Step 4: Second notice of denial is received from Third Party Administrator. If the claim is again denied, you will be notified in writing by the Third Party Administrator as soon as possible but no later than 30 days after receipt of the appeal. Step 5: Review your notice carefully. You should take the same action that you take in Step 2 described above. The notice will contain the same type of information that is provided in the first notice of denial provided by the Third Party Administrator. Step 6: If you still disagree with the Third Party Administrator’s decision, file a second level appeal with the Plan Administrator. If you still do not agree with the Third Party Administrator’s decision and you wish to appeal, you must file a written appeal with the Plan Administrator within the time period set forth in the first level appeal denial notice from the Third Party Administrator. You should gather any additional information that is identified in the notice as necessary to perfect your claim and any other information that you believe will support your claim.

31

If the Plan Administrator denies your second level appeal, you will receive notice within 30 days after the Plan Administrator receives your claim. The notice will contain the same type of information that was referenced in Step 1 above. Important Information Other important information regarding your appeals:

a. Health Care Spending Account Only: Each level of appeal will be independent from the previous level (i.e., the same person(s) or subordinates of the same person(s) involved in a prior level of appeal will not be involved in the appeal);

b. On each level of appeal, the Third Party Administrator will review relevant information that you submit even if it is new information; and

c. You cannot file suit in federal court until you have exhausted these appeals procedures.

32

APPENDIX II – TAX ADVANTAGES EXAMPLE As indicated in the NSPD, participating in the Plan can actually increase your take home pay. Consider the following example: You are married and have one child. The Employer pays for 80% of your medical insurance premiums, but only 40% for your family. You pay $2,400 in premiums ($400 for your share of the Employee-only premium, plus $2,000 for family coverage under the Employer's major medical insurance plan). You earn $50,000 and your Spouse (a student) earns no income. You file a joint tax return. If you participate in

the Cafeteria Plan If you do not

participate in the Cafeteria Plan

1. Gross Income $50,000 $50,000 2. Salary Reductions for Premiums $2,400 (pretax) $0 3. Adjusted Gross Income $47,600 $50,000 4. Standard Deduction ($9,700) ($9,700) 5. Exemptions ($9,300) ($9,300) 6. Taxable Income $28,600 $31,000 7. Federal Income Tax (Line 6 x applicable tax schedule)

($3,590) ($3,904)

8. FICA Tax (7.65% x Line 3 Amount ($3,641) ($3,825) 9. After-tax Contributions ($0) ($2400) 10. Pay After Taxes and Contributions $40,365 $39,821 11. Take Home Pay Difference $544

33

APPENDIX III – ELECTION CHANGE CHART The following is a description of the election changes that are permitted under this Plan. However, please note that election changes that are permitted under this Plan may not be permitted under the Benefit Plan Option (e.g., the insurance carrier may not allow a change). If a change is not permitted under a Benefit Plan Option, no election change is permitted under the Plan. Likewise, a Benefit Plan Option may allow an election change that is not permitted by this Plan. In that case, your pretax reduction may not be changed even though a coverage change is permitted. First, we describe the general rules regarding election changes that are established by the IRS. Then, you should look to the chart to determine under what circumstances you are permitted to make an election under this Plan and the scope of the changes you may make. 1. Change in Status. Election changes may be allowed if a Participant or a Participant’s Spouse or

Dependent experiences one of the Change in Status Events set forth in the chart. The election change must be on account of and correspond with the Change in Status Event as determined by the Plan Administrator (or it’s designated Third Party Administrator). With the exception of enrollment resulting from birth, placement for adoption or adoption, all election changes are prospective (generally the first of the month following the date you make a new election with the Third Party Administrator but it may be earlier depending on the Employer’s internal policies or procedures). As a general rule, a desired election change will be found to be consistent with a Change in Status Event if the event the Change in Status 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:

• Loss of Dependent Eligibility. For accident and health benefits (e.g., health, dental and vision

coverage), a special rule governs which types of election changes are consistent with the Change in Status. For a Change in Status involving a divorce, annulment or legal separation, the death of a Spouse or Dependent, or a Dependent ceasing to satisfy the eligibility requirements for coverage, an election to cancel accident or health benefits for any individual other than the Spouse involved in the divorce, annulment, or legal separation, the deceased Spouse or Dependent, or the 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. Contact the Third Party Administrator for more information.

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-dependent coverage, or family coverage. Before the plan year, Mike elects family coverage for himself, his wife Sharon, and their child. Mike and 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 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

34

change to employee-plus-one-dependent coverage would be consistent with this Change in Status.

• Gain of Coverage Eligibility Under Another Employer’s Plan. For a Change in Status in which a Participant or his or her Spouse or Dependent gain eligibility for coverage under another employer’s cafeteria plan or benefit plan as a result of a change in marital status or a change in the Participant’s, the Participant’s Spouse’s, or the Participant’s Dependent’s employment status, an 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 Spending Account Benefits. With respect to the Dependent Care Spending Account benefit, an election change is permitted 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) the election change is on account of and corresponds with a Change in Status that affects the eligibility of Dependent Care Spending Account 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 spending account 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 consistent with this Change in Status.

• Group Term Life Insurance, Disability Income, or Dismemberment Benefits (if offered under the

Plan. See the list of Benefit Plan Options offered under the Plan). For group term life insurance, disability income and accidental death and dismemberment benefits only if a Participant experiences any Change in Status (as described above), an election to either increase or decrease coverage is permitted.

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 coverage (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 decrease his group-term life insurance coverage would each be consistent with this Change in Status.

2. Special Enrollment Rights. If a Participant, Participant’s Spouse and/or Dependent are entitled to

special enrollment rights under a Benefit Plan Option that is a group health plan, an election change to correspond with the special enrollment right is permitted. Thus, for example, if an otherwise eligible Employee declined enrollment in medical coverage for the Employee or the Employee’s eligible Dependents because of outside medical coverage and eligibility for such coverage is subsequently lost due to certain reasons (e.g., due to legal separation, divorce, death, termination of employment, reduction in hours, or exhaustion of COBRA period), the Employee may be able to elect medical coverage under the Plan for the Employee and his or her eligible Dependents who lost such coverage. Furthermore, if an otherwise eligible Employee gains a new Dependent as a result of

35

marriage, birth, adoption, or placement for adoption, the Employee may also be able to enroll the Employee, the Employee’s Spouse, and the Employee’s newly acquired Dependent, provided that a request for enrollment is made within the Change of Election 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 summary description for an explanation of special enrollment rights.

Effective April 1, 2009, if an otherwise eligible Employee (1) loses coverage under a Medicaid Plan under Title XIX of the Social Security Act; (2) loses coverage under State Children’s Health Insurance Program (SCHIP) under Title XXI of the Social Security Act; or (3) becomes eligible for group health plan premium assistance under Medicaid or SCHIP, the Employee is entitled to special enrollment rights under a Benefit Plan Option that is a group health plan, and an election change to correspond with the special enrollment right is permitted. Thus, for example, if an otherwise eligible Employee declined enrollment in medical coverage for the Employee or the Employee’s eligible Dependents because of medical coverage under Medicaid or SCHIP and eligibility for such coverage is subsequently lost, the Employee may be able to elect medical coverage under a Benefit Option for the Employee and his or her eligible Dependents who lost such coverage. Furthermore, if an otherwise eligible Employee and/or Dependent gains eligibility for group health plan premium assistance from SCHIP or Medicaid, the Employee may also be able to enroll the Employee, and the Employee’s Dependent, provided that a request for enrollment is made within the 60 days from the date of the loss of other coverage or eligibility for 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 a Dependent child (including a foster child who is your tax Dependent) to be covered under this Plan, an election change to provide coverage for the Dependent child identified in the order is permissible. 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 a Participant or the Participant’s Dependents become

entitled to Medicare or Medicaid, an election to cancel that person’s accident or health coverage is permitted. Similarly, if a Participant or Participant’s Dependents who have been entitled to Medicare or Medicaid loses eligibility for such, you may elect to begin or increase that person’s accident or health coverage.

5. Change in Cost. If the cost of a Benefit Plan Option significantly increases, a Participant may

choose either to make an increase in contributions, revoke the election and receive coverage under another Benefit Plan Option that provides similar coverage, or drop coverage altogether if no similar coverage exists. If the cost of a Benefit Plan Option significantly decreases, a Participant who elected to participate in another Benefit Plan Option may revoke the election and elect to receive coverage provided under the Benefit Plan Option that decreased in cost. In addition, otherwise eligible Employees who elected not to participate in the Plan may elect to participate in the Benefit Plan Option that decreased in cost. For insignificant increases or decreases in the cost of Benefit Plan Options, however, Pretax Contributions will automatically be adjusted to reflect the minor change in

36

cost. The Plan 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 Health Care Spending Account.)

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 coverage under a Benefit Plan Option is significantly curtailed, a Participant

may elect to revoke his or her election and elect coverage under another Benefit Plan Option that provides similar coverage. If the significant curtailment amounts to a complete loss of coverage, a Participant 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, a Participant may revoke his or her 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, a Participant 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 applicable Treasury regulations; or (b) the Plan Year for this Plan is different from the Plan Year of the other employer plan. Finally, a Participant may change his or her election to add coverage under this Plan for the Participant, the Participant’s Spouse or Dependents 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 Health Care Spending Account.)

The following is a chart reflecting the election changes that may be made under the Plan with respect to each Benefit Plan Option. In addition, election changes that are permitted under this Plan are subject to any limitations imposed by the Benefit Plan Options. If an election change is permitted by this Plan but not by the Benefit Plan Option, no election change under this Plan is permitted.

37

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

I. Change in Status A. Change in Employee’s Legal Marital Status

1. Gain Spouse (marriage)

Employee may enroll or increase election for newly eligible Spouse and Dependent children (Note: Under IRS “tag-along” interpretation, new and preexisting Dependents may be enrolled); coverage option (e.g., HMO to PPO) change may be made; Employee may revoke or decrease Employee’s or Dependent’s coverage only when such coverage becomes effective or is increased under the Spouse’s plan. Also, see HIPAA special enrollment rule below.

Same as previous column (Note: HIPAA special enrollment rights likely do not apply).

Employee may enroll or increase election for newly eligible Spouse or Dependents, or likely decrease election if Employee or Dependents become an eligible Dependent under new Spouse’s health plan (Note: HIPAA special enrollment rights likely do not apply).

Employee may enroll or increase to accommodate newly eligible Dependents or decrease or cease coverage if new Spouse is not employed or makes a DCSA coverage election under Spouse’s plan.

Employee may enroll, increase, decrease, or cease coverage even when eligibility is not impacted.

2. Lose Spouse (divorce, legal separation, annulment, death of Spouse) (See loss of Dependent eligibility below for discussion of Dependent eligibility loss following divorce, separation, etc.)

Employee may revoke election only for Spouse; coverage option (e.g., HMO to PPO) change may be made; Employee may elect coverage for self or Dependents who lose eligibility under Spouse’s plan if such individual loses eligibility as a result of the divorce, legal separation, annulment, or death. (Note: Under IRS “tag-along” interpretation, any Dependents may be enrolled so long as at least one Dependent has lost coverage under the Spouse’s plan.)

Same as previous column (Note: HIPAA special enrollment rights likely do not apply).

Employee may decrease election for former Spouse who loses eligibility (Note: HIPAA special enrollment rights likely do not apply). Employee may enroll or increase election where coverage lost under Spouse’s health plan.

Employee may enroll or increase to accommodate newly eligible Dependents (e.g., due to death of spouse) or decrease or cease coverage if eligibility is lost (e.g., because Dependent now resides with ex- Spouse).

Employee may enroll, increase, decrease, or cease coverage even when eligibility is not impacted.

38

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

B. Change in the Number of Employee’s Dependents 1. Gain Dependent (birth, adoption)

Employee may enroll or increase coverage for newly-eligible Dependent (and any other Dependents who were not previously covered under IRS “tag-along” rule); coverage option (e.g., HMO to PPO) change may be made; Employee may revoke or decrease Employee’s or Dependent’s coverage if Employee becomes eligible under Spouse’s plan. Also, see HIPAA special enrollment rule below.

Same as previous column (Note: HIPAA special enrollment rights likely do not apply).

Same as previous column (Note: HIPAA special enrollment rights likely do not apply).

Employee may enroll or increase to accommodate newly eligible Dependents (and any other Dependents who were not previously covered under IRS “tag-along” rule).

Employee may enroll, increase, decrease, or cease coverage even when eligibility is not impacted.

2. Lose Dependent (death)

Employee may drop coverage only for the Dependent who loses eligibility; coverage option (e.g., HMO to PPO) change may be made.

Same as previous column.

Employee may decrease or cease election for Dependent who loses eligibility.

Employee may decrease election for Dependent who loses eligibility.

Employee may enroll, increase, decrease, or cease coverage even when eligibility is not impacted.

C. Change in Employment Status of Employee, Spouse, or Dependent That Affects Eligibility

1. Commencement of Employment by Employee, Spouse, or Dependent (or Other Change in Employment Status) That Triggers Eligibility

a. Commencement of Employment by Employee or Other Change in Employment Status (e.g., PT to FT, hourly to salaried, etc.) Triggering Eligibility Under Component Plan

Provided eligibility was gained for this coverage, Employee may add coverage for Employee, Spouse or Dependents and coverage option (e.g., HMO to PPO) change may be made.

Same as previous column.

Same as previous column.

Same as previous column.

Employee may enroll, increase, decrease, or cease coverage even when eligibility is not impacted.

b. Commencement of Employment by Spouse or Dependent or Other Employment Event Triggering Eligibility Under Their Employer’s Plan

Employee may revoke or decrease election as to Employee’s, Spouse’s, or Dependent’s coverage if Employee, Spouse or Dependent is added to Spouse’s or Dependent’s coverage; coverage option (e.g., HMO to PPO) change may be made.

Same as previous column.

Employee may apparently decrease or cease HCSA election if gains eligibility for health coverage under Spouse’s or Dependent’s plan.

Employee may make or increase election to reflect new eligibility (e.g., if Spouse previously did not work). Employee may revoke election as to Dependent’s coverage if Dependent is added to Spouse’s plan.

Employee may enroll, increase, decrease or cease coverage even when Spouse’s or Dependent’s eligibility is not impacted.

39

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

2. Termination of Employment by Employee, Spouse, or Dependent (or Other Change in Employment-Status) That Causes Loss of Eligibility

a. Termination of Employee’s Employment or Other Change in Employment Status (e.g., unpaid leave, FT to PT, strike, salaried to hourly, etc.) Resulting in a Loss of Eligibility

Employee may revoke or decrease election for Employee, Spouse or Dependents who lose eligibility under the plan. In addition, other previously eligible Dependents may also be enrolled under “tag-along” rule. Coverage option (HMO to PPO) change may be made.

Same as previous column.

Same as previous column.

Employee may revoke or decrease election to reflect loss of eligibility.

Employee may enroll, increase, decrease or cease coverage even when eligibility is not affected.

i. Termination and Rehire Within 30 Days

Prior elections at termination are reinstated unless another event has occurred that allows a change (as an alternative, Employer may prohibit participation until next plan year).

Same as previous column.

Same as previous column.

Same as previous column.

Same as previous column.

ii. Termination and Rehire After 30 Days

Employee may make new elections.

Same as previous column.

Same as previous column.

Same as previous column.

Same as previous column.

b. Termination of Spouse’s or Dependent’s Employment (or other change in employment status resulting in a loss of eligibility under their Employer’s plan)

Employee may enroll or increase election for Employee, Spouse or Dependents who lose eligibility under Spouse’s or Dependent’s Employer’s Plan. In addition, other previously eligible Dependents may also be enrolled under “tag-along” rule. Coverage option (e.g., HMO to PPO) change may be made; See HIPAA special enrollment rule below.

Same as previous column (Note: HIPAA special enrollment rights likely do not apply).

Employee may enroll or increase HCSA election if Spouse or Dependent loses eligibility for health coverage (Note: HIPAA special enrollment rights likely do not apply).

Employee may enroll or increase if Spouse or Dependent loses eligibility for DCSA. Employee may decrease or cease DCSA election if Spouse’s loss of employment renders Dependents ineligible.

Employee may enroll, increase, decrease or cease even when eligibility is not affected.

40

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

D. Event Causing Employee’s Dependent to Satisfy or Cease to Satisfy Eligibility Requirements (Also see discussion of gain/loss of eligibility under Dependent or Spouse’s Employer’s plan)

1. Event by Which Dependent Satisfies Eligibility Requirements Under Employer’s Plan (attaining a specified age, becoming single, becoming a student, etc.)

Employee may enroll or increase election for affected Dependent. In addition, Employee may apparently add previously eligible (but not enrolled) Dependents under “tag-along” rule; coverage option (e.g., HMO to PPO) change may be made.

Same as previous column.

Employee may increase election or enroll only if Dependent gains eligibility under HCSA.

Employee may increase election or enroll to take into account expenses of affected Dependent.

Employee may enroll, increase, decrease or cease even when eligibility is not affected.

2. Event by Which Dependent Ceases to Satisfy Eligibility Requirements Under Employer’s Plan (attaining a specified age, getting married, ceasing to be a student, etc.)

Employee may decrease or revoke election only for affected Dependent. Coverage option (e.g., HMO to PPO) change may be made.

Same as previous column.

Employee may decrease election to take into account ineligibility of expenses of affected Dependent, but only if eligibility is lost.

Employee may decrease or drop election to take into account expenses of affected Dependent.

Employee may enroll, increase, decrease or cease coverage even when eligibility is not affected.

E. Change in Place of Residence of Employee, Spouse, or Dependent

1. Move Triggers Eligibility

Employee may enroll or increase election for newly eligible Employee, Spouse, or Dependent. Also, other previously eligible Dependents may be re-enrolled under “tag-along” rule; coverage option (e.g., HMO to PPO) change may be made.

Same as previous column.

No change allowed, even if underlying health coverage change occurs.

N/A. Dependent care eligibility is not generally affected by place of residence (but see change in coverage below).

Employee may increase or decrease even if Spouse’s or Dependent’s eligibility is not affected.

2. Move Causes Loss of Eligibility (e.g., Employee or Dependent moves outside HMO service area)

Employee may revoke election or make new election if the change in residence affects the Employee’s, Spouse’s or Dependent’s eligibility for coverage option.

Same as previous column.

No change allowed, even if underlying health coverage change occurs.

N/A. Dependent care eligibility is not generally affected by place of residence (but see change in coverage below).

Employee may enroll, increase, decrease or cease even when eligibility is not affected.

41

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

II. Cost Changes With Automatic Increase/Decrease in Elective Contributions (including Employer-motivated changes and changes in Employee contribution rates)

Plan may automatically increase or decrease (on a reasonable and consistent basis) affected Employees’ elective contributions under the plan, so long as the terms of the plan require Employees to make such corresponding changes.

Same as previous column.

No change permitted.

Application is unclear. Presumably, plan may automatically increase or decrease (on a reasonable and consistent basis) affected Employees’ elective contributions under the plan, so long as the terms of the plan require Employees to make such corresponding changes.

Same as Major Medical column.

III. Significant Cost Changes Significant Cost

Increase: Affected Employee may increase election correspondingly OR revoke election and elect coverage under another benefit plan option providing similar coverage. If no option providing similar coverage is available, Employee may revoke election. Significant Cost Decrease: Employees may elect coverage (even if had not participated before) with decreased cost, and may drop election for similar coverage option. Though unclear, it appears that tag-along concepts may apply.

Same as previous column.

No change permitted.

Same as Major Medical column for significant cost increase, except no change can be made when the cost change is imposed by a Dependent care provider who is a relative of the Employee.

Same as Major Medical column.

42

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

IV. Significant Coverage Curtailment (With or Without Loss of Coverage) Without Loss of

Coverage: Affected participant may revoke election for curtailed coverage and make new prospective election for coverage under another benefit plan option which provides similar coverage. With Loss of Coverage: Affected participant may revoke election for curtailed coverage and make new prospective election for coverage under another benefit plan option which provides similar coverage OR drop coverage if no similar benefit plan option is available.

Same as previous column.

No change permitted.

Election change may apparently be made whenever there is a change in provider or a change in hours of Dependent care.

Same as Major Medical column.

V. Addition or Significant Improvement of Benefit Plan Option

Eligible employees (whether currently participating or not) may revoke their existing election and elect the newly added (or newly improved) option. Though unclear, it appears that tag-along concepts may apply.

Same as previous column.

No change permitted.

Eligible employees (whether currently participating or not) may revoke their existing election and elect the newly added (or newly improved) option.

Same as previous column.

43

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

VI. Change in Coverage Under Other Employer’s Cafeteria Plan or Qualified Benefits Plan (In order for election changes to be permitted under this exception, the election change must be on account of and correspond with the change in coverage

under the other Employer’s cafeteria plan or qualified benefits plan. In addition, either (1) the plan of the other Employer must permit elections specified under the applicable regulations and an election must actually be made under such plan; or (2) the Employee’s cafeteria plan must permit elections for a period of coverage different from that under the other Employer plan (“election lock” rule).

A. Other Employer’s Plan Increases Coverage Employee may

decrease or revoke election for Employee, Spouse, or Dependents if Employee, Spouse, or Dependents have elected or received corresponding increased coverage under other employer’s plan.

Same as previous column.

No change permitted.

Employee may decrease or revoke election for Employee, Spouse, or Dependents if Employee, Spouse, or Dependents have elected or received corresponding increased coverage under other employer’s plan

Same as previous column.

B. Other Employer’s Plan Decreases or Ceases Coverage Employee may enroll

or increase election for Employee, Spouse, or Dependents if Employee, Spouse, or Dependents have elected or received corresponding decreased coverage under other employer’s plan.

Same as previous column.

No change permitted.

Employee may increase election for Employee, Spouse, or Dependents if Employee, Spouse, or Dependents have elected or received corresponding decreased coverage under other Employer’s plan.

Same as previous column.

C. Open Enrollment Under Plan of Other Employer

Corresponding changes can be made under Employer’s plan.

Corresponding changes can be made under Employer’s plan.

No change permitted.

Corresponding changes can be made under Employer’s plan.

Corresponding changes can be made under Employer’s plan.

44

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

VII. FMLA Leave (Employees can fund this coverage by (1) pre-paying their contribution obligations on a pre-tax basis (so long as the leave does not straddle two plan

years); (2) making contributions on a month-by-month basis (pre-tax if they are receiving salary continuation payments); or (3) catching up on their contributions upon returning from the leave.)

A. Employee’s Commencement of FMLA Leave

Employee can make same elections as employee on non-FMLA leave. In addition, an employer must allow an Employee on unpaid FMLA leave either to revoke coverage or to continue coverage but allow Employee to discontinue payment of his or her share of the contribution during the leave (the Employer may recover the Employee’s share of contributions when the Employee returns to work). FMLA also allows an Employer to require that Employees on paid FMLA leave continue coverage if Employees on non-FMLA paid leave are required to continue coverage.

Same as previous column.

Same as previous column.

Employee may revoke election and make another election as provided under FMLA.

Same as previous column.

B. Employee’s Return from FMLA Leave

Employee may make a new election if coverage terminated while on FMLA leave. In addition, an Employer may require an Employee to be reinstated in his or her election upon return from leave if Employees who return from a non-FMLA paid leave are required to be reinstated in their elections.

Same as previous column.

Same as previous column. Note that, upon return, an Employee whose coverage has lapsed has the right to resume coverage at prior coverage level (and make up unpaid premiums) or at a level reduced prorate for the missed contributions.

Employee may make a new election if coverage terminated while on FMLA leave. In addition, an Employer may require an Employee to be reinstated in his or her election upon return from leave if Employees who return from a non-FMLA leave are required to be reinstated in their elections.

Same as previous column.

45

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

IX. HIPAA Special Enrollment Rights (See related exception for addition of new Dependents)

A. Special Enrollment for Loss of Other Health Coverage

Employee may elect coverage for Employee, Spouse, or Dependent who has lost other coverage (COBRA coverage exhausted or terminated, no longer eligible for non-COBRA coverage or Employer contributions for non-COBRA coverage terminated, etc.) Though unclear, it appears that tag-along concepts may apply.

No change permitted, unless plan is subject to HIPAA.

No change permitted, unless HCSA is subject to HIPAA.

No change permitted. No change permitted.

B. Special Enrollment for Acquisition of New Dependent by Birth, Marriage, Adoption, or Placement for Adoption. (If newborn or newly adopted child is enrolled under HIPAA’s special rules, child’s coverage may be retroactive to date of birth, adoption, or placement for adoption; Employee may change salary reduction election to pay for extra cost of child’s coverage retroactive to date of birth, adoption, or placement for adoption. For marriage, coverage is effective prospectively.)

Employee may elect coverage for Employee, Spouse, or Dependent. Example provides that election of coverage may also extend to previously eligible (but not yet enrolled) Dependents.

No change permitted, unless plan is subject to HIPAA.

No change permitted, unless HCSA is subject to HIPAA.

No change permitted.

No change permitted.

C. Special Enrollment for Loss of Medicaid under Title XIX of the Social Security Act, State Children’s Health Insurance under Title XXI of the Social Security Act, or eligibility for group health plan premium assistance.

(If newborn or newly adopted child is enrolled under HIPAA’s special rules, child’s coverage may be retroactive to date of birth, adoption, or placement for adoption; Employee may change salary reduction election to pay for extra cost of child’s coverage retroactive to date of birth, adoption, or placement for adoption.)

Employee may elect coverage for Employee, or Dependent. Unclear, but appears election of coverage may also extend to previously eligible (but not yet enrolled) Dependents.

No change permitted, unless plan is subject to HIPAA.

No change permitted, unless plan is subject to HIPAA.

No change permitted. No change permitted.

46

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

X. COBRA Events

Employee may increase pre-tax contributions under Employer’s plan for coverage if COBRA event (or similar state law continuation coverage event) occurs with respect to the Employee, Spouse, or Dependents with respect to which the COBRA qualifying event occurred (such as a loss of eligibility for regular coverage due to loss of Dependent status or a reduction in hours, etc.) and if applicable, the individual still qualifies as a tax Dependent of Employee.

Same as previous column.

No change permitted.

No change permitted. No change permitted.

XI. Judgment, Decree, or Order

A. Order That Requires Coverage for the Child Under Employee’s Plan

Employee may change election to provide coverage for the child. Though unclear, it appears that tag-along concepts may apply.

Same as previous column.

Same as previous column.

No change permitted. No change permitted.

B. Order That Requires Spouse, Former Spouse, or Other Individual to Provide Coverage for the Child

Employee may change election to cancel coverage for the child.

Same as previous column.

Same as previous column.

No change permitted. No change permitted.

47

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

XII. Medicare or Medicaid

A. Employee, Spouse, or Dependent Enrolled in Employer’s Accident or Health Plan Becomes Entitled to Medicare or Medicaid. (Other than coverage solely for pediatric vaccines)

Employee may elect to cancel or reduce coverage for Employee, Spouse, or Dependent, as applicable.

Unlikely that Employee can elect to drop dental or vision coverage; presumably, Employee must retain coverage.

Employee may apparently decrease or revoke election or increase election if HCSA is dropped due to Medicare/Medicaid and prior Employer coverage was more comprehensive.

No change permitted. No change permitted.

B. Employee, Spouse, or Dependent Loses Eligibility for Medicare or Medicaid. (Other than coverage solely for pediatric vaccines)

Employee may elect to commence or increase coverage for Employee, Spouse, or Dependent, as applicable. Though unclear, it appears that tag-along concepts may apply.

Unlikely that Employee can elect to add dental or vision coverage; presumably, Employee cannot.

Employee may apparently increase or decrease or revoke election where Employer plan elected due to loss of eligibility for Medicare/Medicaid is more comprehensive than Medicare/Medicaid

No change permitted. No change permitted.

XII. Revocation of Cafeteria Plan Election

A. Due to Reduction in Hours. (To revoke a cafeteria plan election for group coverage due to a reduction in hours the following conditions must be met:)

Group health plan is not a flexible spending account (FSA) and provides minimum essential coverage; there is a change in the employee’s status such that the employee will reasonably be expected to average less than 30 hours of service per week, even if that reduction does not result in the employee ceasing to be eligible under the group health plan; and; the

Employee may elect to cancel or reduce coverage for Employee, Spouse, or Dependent, as applicable.

No change permitted.

No change permitted.

No change permitted. No change permitted.

48

Change in Status Event Major Medical Dental and Vision Health Care Spending Account

(HCSA)

Dependent Care Spending Account

(DCSA)

Employee Group Life, AD&D and

Disability Coverage

revocation of coverage corresponds to enrollment of employee and applicable dependents in aother plan that provides minimum essential coverage with the new coverage effective no longer than the first day of the second month following the month the original coverage is revoked.

B. Purchase a Marketplace Qualified Health Plan. (To revoke a cafeteria plan election group group coverage and purchase a Marketplace Qualified Health Plan the following conditions must be met:)

Group health plan is not a health FSA and provides minimum essential coverage; the employee is eligible for a special enrollment period or seeks to enroll in a Marketplace QHP during the annual open enrollment period; and the revocation of coverage corresponds to the intended enrollment of the employee and applicable dependents in a Marketplace QHP with new coverage that is effective beginning no later than the day immediately following the last day of the original coverage that is revoked.

Employee may elect to cancel or reduce coverage for Employee, Spouse, or Dependent, as applicable.

No change permitted.

No change permitted.

No change permitted. No change permitted.

49

APPENDIX IV – NEW EMPLOYEE HEALTH PLAN ELIGIBILITY SCHEDULE

New full-time eligible employees become eligible for enrollment as shown in the following chart. If you do not turn in a Health Plan Enrollment Form within 14 days from the date of hire, you will receive a standard benefits package (ASR Health Benefits PPO3, Standard Vision, and Standard Dental for yourself only). The following chart shows the effective dates for Medical, Dental and Vision coverages and, if elected, the reimbursement account(s) for yourself and any eligible dependents that you include on your enrollment form.

DATE OF HIRE ELIGIBLE FOR

FROM THROUGH HEALTH COVERAGE & REIMBURSEMENT ACCOUNTS

JANUARY 1 JANUARY 31 MARCH 1

FEBRUARY 1 FEBRUARY 28 OR 29 APRIL 1

MARCH 1 MARCH 31 MAY 1

APRIL 1 APRIL 30 JUNE 1

MAY 1 MAY 31 JULY 1

JUNE 1 JUNE 30 AUGUST 1

JULY 1 JULY 31 SEPTEMBER 1

AUGUST 1 AUGUST 31 OCTOBER 1

SEPTEMBER 1 SEPTEMBER 30 NOVEMBER 1

OCTOBER 1 OCTOBER 31 DECEMBER 1

NOVEMBER 1 NOVEMBER 30 JANUARY 1

DECEMBER 1 DECEMBER 31 FEBRUARY 1

50