4.13 SR 05-06-2024 - Laserfiche WebLink

Home Browse Search

© 2012 Hitesman & Wold, P.A. City of Elk River Flexible Benefits Plan 30 ARTICLE XIV. MEDICAL EXPENSE REIMBURSEMENT PLAN 14.1 Purpose. The purpose of this Article is to provide Participants with the opportunity to be reimbursed for certain eligible Medical Expenses as an Optional Benefit under the Plan. This Article is intended to qualify as a self-insured medical reimbursement plan under Section 105 of the Code so that payments received under this portion of the Plan are excludable from the gross income of the Participant under Section 105(b) of the Code. 14.2 Separate Written Plan. For purposes of Section 105 of the Code, this Article shall constitute a separate written plan providing for the reimbursement of certain Medical Expenses. To the extent necessary, other provisions of the Plan are incorporated by reference. 14.3 Definitions. (a) Claims Run-out Period means the period beginning on the first day following the close of the Grace Period and ending on thirty (30) days from the close of the Grace Period. (b) Dependent means an individual who is a Tax Dependent. (c) Highly Compensated Individual means an individual who is highly compensated as defined in Section 105(h)(5) of the Code. (d) Medical Expense means an expense incurred during the applicable Plan Year by a Participant, Spouse, or Dependent for medical care as defined in Section 213(d) of the Code, excluding premiums for health coverage and long-term care coverage. Medical care generally refers to the diagnosis, cure, treatment, or prevention of disease or for the purpose of affecting any structure or function of the body. Also included are reasonable transportation expenses for and essential to medical care. “Medical Expense” includes over-the-counter drugs and medicines, only to the extent allowed by Section 106(f) of the Code. (e) Medical Expense Reimbursement Account (“ME Account”) means the record keeping account established by the Plan Administrator for each Plan Year for each Participant from whom an Election to create such an account is received. 14.4 Medical Expense Account. The ME Account will be credited with the amount elected by the Participant at the beginning of the Plan Year. The election may consist of a salary reduction election and/or an election to allocate the Employer Contribution. A Participant’s ME Account will be decreased from time to time in the amount of payments made to the Participant for eligible Medical Expenses incurred during the Plan Year and Grace Period. 14.5 Claims Determination. Claim submission, determination, and appeals shall be handled in accordance with Article VI. 14.6 Incurred Expenses. To be reimbursable, an eligible Medical Expense must have been incurred after participation in this portion of the Plan began and during the Plan Year for which reimbursement is claimed or the Grace Period related to such Plan Year. An expense is “incurred” when the Participant is provided with the care which gives rise to the eligible Medical Expense, not when the service is billed or paid. Reimbursement shall not be made for future projected expenses. Notwithstanding the foregoing, pursuant to and in accordance with the Cafeteria Plan Regulations, the Plan may reimburse Medical Expenses for orthodontia care in advance. 14.7 Reimbursement of Expense. The Participant shall be reimbursed as specified in Section 6.7 from the Participant’s ME Account for eligible Medical Expenses incurred during the applicable Plan Year and Grace Period for which the Participant submits the documentation required under Page 123 of 254