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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