4.13 SR 05-06-2024 - Laserfiche WebLink

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© 2012 Hitesman & Wold, P.A. City of Elk River Flexible Benefits Plan 23 ARTICLE IX. GROUP MEDICAL BENEFITS 9.1 Purpose. The purpose of this Article is to provide for the pre-tax payment opportunity for Group Medical Benefits under this Plan as an Optional Benefit. The Employer provides Group Medical Benefits through one or more “plans” within the meaning of Sections 105 and 106 of the Code. 9.2 Separate Written Plan. For purposes of Sections 105 and 106 of the Code, this Article shall constitute a separate written plan providing for the reimbursement or direct payment of Insurance Premium expenses. To the extent necessary, other provisions of the Plan are incorporated by reference. 9.3 Definitions. (a) Dependent means an individual (e.g., Spouse, child, etc.) who qualifies as a “dependent” under the terms and conditions of the applicable plan document governing the Group Medical Benefits. (b) Group Medical Benefits means the medical coverage made available by the Employer through this Article to which the Insurance Premiums relate. It does not include individual insurance contracts. (c) HMO means a health maintenance organization authorized to do business in the state in which it operates with which an agreement has been entered for the purpose of providing benefits under the Plan. (d) Highly Compensated Individual means an individual who is highly compensated as defined in Section 105(h)(5) of the Code. (e) Insurance Contract means (1) any insurance contract secured from an insurance company or HMO authorized to do business in the state in which such contract is issued, which has been obtained for the purpose of providing benefits under this portion of the Plan; or (2) a self-insured plan administered by a third party. (f) Insurance Premiums means the amount that must be paid on a periodic basis in return for coverage under the Insurance Contract. 9.4 Terms, Conditions and Limitations. The Employer shall secure the necessary Insurance Contracts, as identified in Exhibit A. Coverage shall begin, benefits shall be provided, and coverage shall terminate in accordance with the applicable Insurance Contracts. Such Insurance Contracts, are expressly incorporated into and made part of this Plan. 9.5 Payments. The Plan Administrator shall make Insurance Premium payments for the Group Medical Benefits on behalf of the Participant in an amount necessary to provide the benefit applicable to the Participant under this portion of the Plan for the applicable Plan Year. Such payments shall be made from Employer Contributions, if any, provided by the Employer under the Plan and, if necessary, contributions made in accordance with the salary reduction arrangement and other arrangements applicable to the Participant under the terms of the Plan. The appropriate portions shall depend on the coverage elected by the Participant. The Plan Administrator shall also make such payments on behalf of the Participant’s Dependents who are enrolled in the Group Medical Benefits. To the extent a Dependent is provided coverage under the Group Medical Benefits and that Dependent is not the Participant’s Spouse or Tax Dependent, the tax consequence of such coverage shall be addressed as described in Section 4.2. 9.6 Nondiscrimination. To the extent the Group Medical Benefits are subject to Section 105(h) of the Code or Section 2716 of the Public Health Services Act, they shall not discriminate in favor of Page 116 of 254