2017 Consumer Driven Health Plan for Small Businesses

Posted on Posted in Affordable Care Act, Employee Benefits, Health Insurance, Small Business

Employee Benefit Plan with Voluntary Salary Reduction, Premium Payment, Health Flexible Savings Account, Health Savings Account, and Dependent Care Assistance Plan Components

The Freedom Benefits standard plans are redesigned for 2017. All plans can be customized. This is the table of contents for the 2017 consumer-driven health plan.

Table of Contents

ARTICLE I. Introduction

1.1 Establishment of Plan

1.2 Legal Status

ARTICLE II. Definitions

2.1 Definitions

ARTICLE III. Eligibility and Participation

3.1 Eligibility to Participate

3.2 Termination of Participation

3.3 Participation Following Termination of Employment or Loss of Eligibility

3.4 FMLA Leaves of Absence

3.5 Non-FMLA Leaves of Absence

ARTICLE IV. Method and Timing of Elections

4.1 Elections When First Eligible

4.2 Elections during Open Enrollment Period

4.3 Failure of Eligible Employee to File an Election Form Salary Reduction Agreement

4.4 Irrevocability of Elections

4.5 Default Elections

ARTICLE V. Benefits Offered and Method of Funding

5.1 Benefits Offered

5.2 Employer and Participant Contributions

5.3 Using Salary Reductions to Make Contributions

5.4 Funding This Plan

ARTICLE VI. Premium Payment Component

6.1 Benefits

6.2 Contributions for Cost of Coverage

6.3 Medical Insurance Benefits Provided Under the Medical Insurance Plan

6.4 Medical Insurance Benefits; COBRA

ARTICLE VII. Health FSA Component

7.1 Health FSA Benefits

7.2 Contributions for Cost of Coverage of Health FSA Benefits

7.3 Eligible Medical Care Expenses for Health FSA

7.4 Maximum and Minimum Benefits for Health FSA

7.5 Establishment of Health FSA Account

7.6 Forfeiture of Health FSA Accounts; Use-It-or-Lose-It Rule

7.7 Reimbursement Claims Procedure for Health FSA

7.8 Reimbursements from Health FSA after Termination of Participation; COBRA

7.9 Named Fiduciary for Health FSA

7.10 Coordination of Benefits with HSA, HRA, etc.

ARTICLE VIII. HSA Component

8.1 HSA Benefits

8.2 Contributions for Cost of Coverage for HSA; Maximum Limits

8.3 [Reserved]

8.4 Recording Contributions for HSA

8.5 Tax Treatment of HSA Contributions and Distributions

8.6 Trust/Custodial Agreement; HSA Not Intended to Be an ERISA Plan

ARTICLE IX. DCAP Component

9.1 DCAP Benefits

9.2 Contributions for Cost of Coverage for DCAP Benefits

9.3 Eligible Dependent Care Expenses

9.4 Maximum and Minimum Benefits for DCAP

9.5 Establishment of DCAP Account

9.6 Forfeiture of DCAP Accounts; Use-It-or-Lose-It Rule

9.7 Reimbursement Claims Procedure for DCAP

9.8 Reimbursements from DCAP After Termination of Participation

9.9 Report to DCAP Participants

ARTICLE X. HIPAA PROVISIONS FOR THE HEALTH FSA

10.1 Provision of Protected Health Information to Employer

10.2    Permitted Disclosure of Enrollment/Disenrollment Information

10.3    Permitted Uses and Disclosure of Summary Health Information

10.4    Permitted and Required Uses and Disclosure of PHI for Plan Administration Purposes

10.5    Conditions of Disclosure for Plan Administration Purposes

10.6    Adequate Separation between Plan and Employer

10.7    Certification of Plan Sponsor

ARTICLE XI. [Reserved.]

ARTICLE XII. Irrevocability of Elections; Exceptions

12.1    Irrevocability of Elections

12.2    Procedure for Making New Election If Exception to Irrevocability Applies

12.3    Change in Status Defined

12.4    Events Permitting Exception to Irrevocability Rule for All Benefits Other than HSA Benefits

12.5    Election Modifications for HSA Benefits May Be Changed Prospectively at Any Time

12.6    Election Modifications Required by Plan Administrator

ARTICLE XIII. Appeals Procedure

13.1    Procedure If Benefits Are Denied Under This Plan

13.2 Claims Procedures for Medical Insurance Benefits

ARTICLE XIV. Recordkeeping and Administration

14.1    Plan Administrator

14.2    Powers of the Plan Administrator

14.3    Reliance on Participant, Tables, etc.

14.4    Provision for Third-Party Plan Service Providers

14.5    Fiduciary Liability

14.6    Compensation of Plan Administrator

14.7    Bonding

14.8 Insurance Contracts

14.9 Inability to Locate Payee

14.10 Effect of Mistake

ARTICLE XV. General Provisions

15.1 Expenses

15.2 No Contract of Employment

15.3 Amendment and Termination

15.4 Governing Law

15.5 Code and ERISA Compliance

15.6 No Guarantee of Tax Consequences

15.7 Indemnification of Employer

15.8 Non-Assignability of Rights

15.9 Headings

15.10 Plan Provisions Controlling

15.11 Severability

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