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5.3. ERMUSR 02-09-2010
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5.3. ERMUSR 02-09-2010
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2/5/2010 4:08:14 PM
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City Government
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ERMUSR
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2/9/2010
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ARTICLE X <br />GROUP DENTAL BENEFITS <br />10.1 Purpose. The purpose of this Article is to provide for the pre-tax payment <br />opportunity for Group Dental Benefits under this Plan as an Optional Benefit. The <br />Employer provides Group Dental Benefits through one or more ~~plans" within the <br />meaning of Sections 105 and 106 of the Code. <br />10.2 Separate Written Plan. For purposes of Sections 105 and 106 of the Code, this <br />Article shall constitute a separate written plan providing for the reimbursement or <br />direct payment of Insurance Premium expenses. To the extent necessary, other <br />provisions of the Plan are incorporated by reference. <br />10.3 Definitions. <br />(a) Dependent means an individual (e.g., Spouse, child, domestic partner, etc.) <br />who qualifies as a "dependent" under the terms and conditions of the <br />applicable plan document governing the Group Dental Benefits. To the extent <br />a Dependent is provided coverage under the Group Dental Benefits and that <br />Dependent is not the Participant's Spouse or Tax Dependent, the tax <br />consequence of such coverage shall be addressed as described in Section 4.2. <br />(b) DMO means a dental maintenance organization authorized to do business in <br />the state in which an agreement has been entered for the purpose of <br />providing benefits under this portion of the Plan. <br />(c) Group Dental Benefits means the dental coverage made available by the <br />Employer through this Article to which the Insurance Premiums relate. It <br />does not include individual Insurance Contracts. <br />(d) Highly Compensated Individual means an individual who is highly <br />compensated as defined in Section 105(h)(5) of the Code. <br />(e) Insurance Contract means (1) any insurance contract secured from an <br />insurance company or DMO authorized to do business in the state in which <br />such contract is issued, which has been obtained for the purpose of providing <br />benefits under this portion of the Plan; or (2) aself-insured plan administered <br />by a third party. <br />(f) Insurance Premiums means the amount that must be paid on a periodic <br />basis in return for coverage under the Insurance Contract. <br />10.4 Terms, Conditions and Limitations. The Employer shall secure the necessary <br />Insurance Contracts, DMO agreements, or other dental benefit agreements from third <br />party providers, as identified in Exhibit A. Coverage shall begin, benefits shall be <br />provided, and coverage shall terminate in accordance with the applicable Insurance <br />Contracts, DMO agreements, other dental benefit agreements, and/or self-insured <br />plan documents. Such Insurance Contracts, agreements, and plan documents are <br />expressly incorporated into and made part of this Plan. <br />10.5 Payments. The Plan Administrator shall make Insurance Premium payments for the <br />Group Dental Benefits on behalf of the Participant in an amount necessary to provide <br />the benefit applicable to the Participant under this portion of the Plan for the <br />27 <br />
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