What does the Beniversal FSA provide? Visit

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1 Flexible Spending Accounts (FSAs) What does the Beniversal FSA provide? Tax-free money for medical and dependent care expenses Convenient access to account funds through the Beniversal Prepaid MasterCard On-the-go account access with the BRiMobile app Streamlined online account support through BRiWeb Friendly and knowledgable participant services representatives to assist with your questions Visit

2 What is a Flexible Spending Account? A Flexible Spending Account (FSA) is an IRS-approved account that allows you to pay for eligible medical and dependent care expenses on a tax-free basis. How does the tax savings work? When you enroll in your employer sponsored Flexible Spending Account, your contributions are not subject to Federal, FICA and most state taxes. This means you bring home more money in your paycheck! Tax Savings Example Annual Income $50,000 Anticipated Medical Expenses $2,500 Without Plan With Plan Federal Income Tax Paid $12,500 $11,875 State Income Tax Paid $3,000 $2,850 FICA $3,825 $3,634 Total Taxes Paid $19,325 $18,359 Disposable Income $30,675 $31,640 Annual Tax Savings $966 The figures above are for illustration purposes only. Actual savings and tax rates may vary. Calculate your personalized tax savings at Who can participate? In order to participate in the plan, you need to meet the eligibility requirements set by your employer. If you or your spouse is reporting contributions to an HSA, generally you will not be eligible to participate in a Medical FSA. Please contact your employer or refer to your plan documentation for more details and eligibility requirements. How do elections work? Prior to the start of a plan year or when you become eligible, you will make an annual election for medical and/or dependent care expenses separately (as applicable). Elections do not carry over from year to year. Check with your employer about the maximum (and any applicable minimum) amounts you can set aside in a Medical FSA and Dependent Care FSA. Generally, once you have enrolled in the plan, you cannot change your elections during that plan year unless you have a certain qualifying event (e.g. marriage, death, change in employment status, etc.) that may allow a change in your plan year election amounts. More information is also available in your plan documentation. When can I access FSA funds? Services must be provided during the plan year designated in your plan documentation and you cannot access FSA funds until the service is provided. The IRS allows one exception for orthodontia expenses. Refer to your plan documentation regarding any unused funds at the end of the plan year.

3 What are eligible medical expenses? This list is intended to be used as a quick reference of potentially eligible medical expenses and does not guarantee that an expense will be eligible. Please see your plan documents to verify what expenses are reimbursable under your plan. This list is not intended to be an all encompassing list and may be updated from time to time. Eligible expenses for Flexible Spending Accounts (FSAs) are governed by Section 213(d) of the Internal Revenue Code. In addition to the list below, there are over 150 additional items or expense types that are considered potentially eligible. These may require prescriptions or a letter of medical necessity when submitting a reimbursement request. Acupuncture Alcoholism treatment Allergy treatments (if prescribed) Ambulance Arthritis gloves Artificial limbs Artificial teeth Asthma devices and medicines (if prescribed) Bandages Body scans Braille books and magazines Breast pumps Breast reconstruction surgery following mastectomy Cancer screenings Carpal tunnel wrist supports Chiropractors Circumcision Co-insurance amounts Co-payments Couseling, when used to treat diagnosed medical condition CPAP (continuous positive airway pressure) devices Crutches Dental sealants Dental services and procedures Dentures and denture adhesives Diabetic supplies Diagnostic items/services Drug addiction treatment Drug overdose, treatment of Durable medical equipment Eye examinations, eyeglasses, equipment, and materials First aid kits Flu shots Fluoridation services Gauze pads Guide dog Hearing aids Hospital services Immunizations Insulin Laboratory fees Lactation consultant Laser eye surgery, Lasik Liquid adhesive for small cuts Lodging at a hospital or similar institution Mastectomy-related special bras Medical alert bracelet or necklace Medical information plan charges Medical monitoring and testing devices (e.g. blood-sugar test kits and test strips) Medical practitioner s fee for online or telephone consultation Medical records charges Midwife Norplant insertion or removal Obstetrical expenses Occlusal guards to prevent teeth grinding Operations / Surgeries Optometrist Organ donors Orthodontia Orthopedic shoe inserts Osteopath fees Ovulation monitor Oxygen Physical exams Physical therapy Pregnancy test kits Prescription drugs and medicines, for the purpose of medical care (not general health or cosmetic purposes) Preventive care screenings Prosthesis Psychiatric care Radial keratotomy Reading glasses Rehydration solution Rubbing alcohol Screening tests Sleep-deprivation treatment Speech therapy Stop-smoking programs Telephone equipment or television for hearing-impaired persons Thermometers Transplants Transportation expenses for person to receive medical care, may include car mileage or alternative transportation costs Vaccines Vision correction procedures Walkers Wheelchair X-ray fees Eligible Over-the-Counter Medical Supplies Adult incontinence products (e.g. Depends) Birth control products (e.g. prophylactics) (if allowed by your plan) Contact lens solution Denture adhesives First aid supplies (e.g. band-aids) Health monitors (e.g. blood pressure, cholesterol, HIV, thermometers) Hearing aid batteries Heat wraps (e.g. ThermaCare) Heating pads, hot water bottles Insulin & diabetic supplies Medicine dropper/spoon Motion sickness devices Supports/braces (e.g. ankle, knee, wrist, therapeutic glove) Eligible Over-the-Counter Drugs & Medicines (require a prescription) Acne medications Allergy and sinus medications (e.g. Benadryl, Claritin, Sudafed) Anti-fungal medications (e.g. Lotramin AF) Anti-itch medications (e.g. Caladryl) Cold sore medications Cough, cold & flu remedies Decongestants Diaper rash ointments Ear wax removal drops First aid creams Gastrointestinal aids (e.g. antacids, anti-diarrhea medicines, non-fiber laxatives, nausea medications) Lactose intolerance pills Motion sickness pills Nasal sprays for congestion (e.g. Afrin) Pain relievers (e.g. aspirin, Excedrin, Tylenol, Advil, Motrin) Sleeping aids Smoking cessation medications (e.g. nicotine gum or patches) Suppositories Toothache relievers (e.g. Orajel) Wart remover medications Yeast infection creams (e.g. Monistat) Once your account is open, you will have access to a detailed eligible expense look up table. Simply log in to your account at and select Eligible Health Care Expense Table under the FSA/HRA tab.

4 FSA Expense & Tax Savings Estimate Worksheet Medical FSA Estimate: Estimate your eligible out-of-pocket medical expenses. Out-of-pocket expenses include services for you, your spouse and eligible dependents. General Expenses $ Office visits / doctor s fees (actual cost if deductible applies or total co-payments) $ Immunizations / Vaccines $ Laboratory fees / X-rays $ Over-the-counter drugs and medicines (prescription required) $ Over-the-counter medical supplies $ Prescription Drugs $ SUBTOTAL Hospitalization & Specialist Expenses $ Emergency Room $ Hospital Bills $ Specialists or alternative medicine (Acupuncture, chiropractor, physical therapy, specialists fees, etc.) $ Surgery $ OTHER MEDICAL EXPENSES NOT SPECIFIED $ SUBTOTAL Dental $ Cleanings / Dental Exams $ Fillings / Dental procedures $ Orthodontia $ X-rays $ SUBTOTAL Vision $ Corrective eye surgery & eye wear $ Eye exams $ Prescription glasses / contact lenses $ SUBTOTAL Hearing $ Hearing Aids $ Hearing Exams $ SUBTOTAL $ TOTAL MEDICAL FSA ESTIMATE Dependent Care FSA Estimate: Estimate your eligible out-of-pocket dependent care expenses. Dependent Care Expenses $ Adult Day Care $ Child Day Care / In-home Dependent Care $ Nursery School $ TOTAL DEPENDENT CARE FSA ESTIMATE Tax Savings Estimate: Estimate your total annual estimated tax savings. Amounts. A. ENTER TOTAL MEDICAL FSA ESTIMATE (See Plan Highlights for the maximum limits that may apply.) $ B. ENTER TOTAL DEPENDENT CARE FSA ESTIMATE (See Plan Highlights for the maximum limits that may apply.) $ C. TOTAL EXPENSES (Line A + Line B) $ D. TAX RATE (Enter percentage of your gross salary that you pay in Federal, State and Local Taxes. (If uncertain, use 30%.)) % E. FICA (includes Social Security and Medicare) % F. TOTAL TAX RATE (Line D + Line E) % G. ESTIMATED ANNUAL TAX SAVINGS (Line C x Line F) $

5 What do I need to know about FSAs? Medical FSA A Medical FSA can be used to pay for eligible medical expenses provided to you, your spouse or eligible dependents. Upon enrolling in a Medical FSA, you have access to your full plan year election amount. The tax-free amount you can set aside in a Medical FSA per plan year can be found in your Plan Highlights. Your Plan Highlights also contain other specifi c information about your employer sponsored plan. Expenses must be primarily to prevent, treat, diagnose or mitigate a physical or mental defect or illness. The eligibility of an expense is governed by the IRS. Common eligible expenses include: Co-payments, co-insurance and deductible expenses Dental care (e.g. exams, fillings, crowns) Vision care, eyeglasses, contact lenses Chiropractic care Prescription drugs and certain over-the-counter medical items Expenses cannot be for personal care, cosmetic or general health purposes. Some expenses are only eligible if certifi ed by a licensed medical provider as medically necessary. Expenses cannot be reimbursed from any other source (e.g. insurance). Refer to your Plan Highlights for details regarding how unused Medical FSA funds are treated. While you can use the Medical FSA for medical expenses for a spouse or dependent, you cannot use Medical FSA funds for dependent care expenses (e.g. child care) and vice-versa. Dependent Care FSA A Dependent Care FSA can be used to reimburse dependent care expenses (e.g. child care) for a qualifi ed person. These expenses enable you to be gainfully employed and, if married, enable your spouse to be gainfully employed, look for work or attend school full-time. The qualifi ed person must spend at least 8 hours per day in your home and is one of the following: Dependent child under the age of 13 and for whom you can claim a tax exemption. Spouse or dependent who is physically or mentally incapable of self-care, lives with you for more than half of the year, and for whom you can claim a tax exemption. The tax-free amount you can set aside per calendar year in a Dependent Care FSA can be found in your Plan Highlights. Common eligible expenses, include: Before/after school care Child Care / in-home dependent care Day care facility Nursery school Adult care Services provided for education, overnight camps or services provided by the child s parent or other dependent for income tax purposes are not eligible expenses. The amount available for reimbursement of dependent care expenses is limited to the cash balance in your Dependent Care FSA. Refer to your Plan Highlights for details regarding how unused Dependent Care FSA funds are treated. You cannot claim a federal tax credit for any expenses reimbursed through a Dependent Care FSA. Consult a tax professional to determine if it would be more to your advantage to elect a Dependent Care FSA or to use the federal tax credit. Use the FSA Expense & Tax Savings Estimate Worksheet included in the booklet to help you estimate how much you should elect.

6 How do I access my FSA? Log in to BRiWeb BRiWeb is your secure participant login for managing your accounts with Benefi t Resource. BRiWeb allows you to view balance and transaction information, submit claims, download plan documents and much more. To log in, go to tresource.com: 1. Click Participants under Secure Login. 2. Once on the Participant Login page, please enter: Company Code: Provided by your employer Login ID: Default Login ID selected and provided by your employer. You may change it upon initial login. Initial Password: 5 digit home zip code (You will be prompted to change the password upon initial login.) 3. BRiWeb will open to a Dashboard which provides a quick snapshot of your account(s) and profi le. To manage your FSA, select the FSA/HRA tab. To view a quick video demo of BRiWeb, visit BRI Resources at tresource.com. Download the BRiMobile app BRiMobile is your on-the-go account access to view balances and recent transactions, submit claims and send receipts. BRiMobile app is available for iphone, ipad and Android devices. Learn more at tresource.com/tools or download the app from the Apple App Store or Google Play. Contact Participant Services Participant Services is available to assist with your questions by phone, chat and . Representatives are available in English and Spanish. Phone: (800) , Monday - Friday, 8am - 8pm (Eastern Time) ParticipantServices@Benefi tresource.com Live Chat: Available through the participant login at tresource.com, Monday - Friday, 8am - 5pm (Eastern Time). For more information on these or other account information, please visit us at

7 How do I access my FSA? (Continued) Use the Beniversal Card (if offered) The Beniversal Prepaid MasterCard can be used at qualifi ed merchants providing medical products and services, such as: doctors, dentists, medical labs, hospitals, medical supply stores, vision centers and certain drugstores and retail merchants. (A list of drugstores and retail merchants is available at tresource.com). When using your card, always save your itemized receipts. With an FSA, the IRS requires Benefi t Resource to verify that 100% of transactions are for eligible expenses. Since some qualifi ed merchants also offer services/items that are not eligible, Benefi t Resource may contact you requesting additional documentation on a transaction. Requested receipts and documentation for card transactions can be submitted online at tresource.com, through the BRiMobile app or by fax/mail. Instructions will be provided in the request. Submit a Claim When not using the Beniversal Card or for Dependent Care expenses, you can submit a claim with your itemized receipt or supporting documentation. Claims can be submitted: Online at tresource.com Once logged in to your account, go to the FSA/HRA tab and select Submit Online Claim. Follow the on screen instructions. Through the BRiMobile app Download the BRiMobile app from the Apple App Store or Google Play. By faxing/mailing a claim form Claim forms can be downloaded and printed from tresource.com. Reimbursements are paid weekly. To receive your reimbursements by direct deposit, please log into tresource.com and set up your direct deposit account information. The Beniversal Card is issued by The Bancorp Bank pursuant to license by MasterCard International Incorporated. The Bancorp Bank; Member FDIC. MasterCard is a registered trademark of MasterCard International Incorporated Benefit Resource, Inc. All rights reserved.

8 FSA store THE FLEXIBLE SPENDING ACCOUNT SITE BR \ / Benefit Resource, Inc. Access FSA Store at henefitresource.com./fsaextras FSA Store is exclusively stocked with FSNHSA eligible products so there are no guessing games about what is and is not reimbursable by an FSA. The site also offers tools and resources to help you better understand and manage your funds. Eliminate eligibility guessing games. Estimate your annual FSA spending. Receive deadline reminders. Get answers to all your FSA questions! FIRST AID SUN CARE BABY CARE COLD & ALLERGY HOME HEALTH PAIN RELIEF EYE CARE FOOT CARE Get $5 Off Orders $35+ With Promo Code: Cannot be combined with other offers. 1 use per customer. BROE...

9 Frequently Asked Questions & Plan Highlights

10 Flexible Spending Account FAQs: General (1) What is a Flexible Spending Account (FSA)? A Flexible Spending Account (FSA) is part of the benefit plan offered to you by your employer and allows you to use tax-free dollars to pay for certain medical and/or dependent care expenses. There are two types of FSAs: a Medical FSA (for eligible medical services provided to you, your spouse or your eligible dependent) and a Dependent Care FSA (for eligible dependent care expenses). (2) Who is eligible to elect an FSA? Eligibility requirements for a Medical FSAand a Dependent Care FSA are indicated in your Plan Highlights. (3) Is there a maximum or minimum annual amount that I can elect for an FSA? Any applicable maximum/minimum amounts for your annual FSA elections are indicated in your Plan Highlights. (4) Can I elect a Medical FSA and a Dependent Care FSA? Yes. Participation in each FSA is completely voluntary - you can enroll in one, both or neither. To participate, you must make your election(s) prior to the beginning of each new plan year. (5) What is the advantage of enrolling in an FSA? Enrolling in an FSA allows you to make tax-free salary contributions to pay for eligible medical and dependent care expenses that are not covered or reimbursed by any other source. FSAs increase your take-home pay by reducing taxable income, making these out-of-pocket expenses more affordable! (6) What employee taxes are eliminated by contributing to a Medical or Dependent Care FSA? You will not pay federal income tax, Social Security tax and most state taxes (varies by state) on contributions to a Medical and/or Dependent Care FSA. (7) Since I will not pay Social Security taxes on money contributed to an FSA, will my Social Security benefits be lower when I retire or if I become disabled? Tax-free contributions may slightly reduce your Social Security benefits. However, the value of your tax savings with an FSA should more than offset the slight reduction in Social Security benefits in future years. (8) What dollar amount is available in my FSA? The amount available for a Medical FSA = the total amount you elected for the current plan year minus any prior payments and reimbursments. The amount available for a Dependent Care FSA = the total payroll deductions posted to your Account for the current plan year minus any prior payments and reimbursements. (9) How can I determine my account balance? There are several ways you can determine your account balance: Your account balance will be displayed on the Explanation of Benefits (EOB) issued with each reimbursement check/direct Deposit advice. Account information can be accessed 24/7: at and using the secure account inqui ry system via the BRiMobile app or mobile device users You may call Benefit Resource Participant Services T: (800) (8am - 8 pm Eastern Time, Monday - Friday). (10) Who is responsible for determining if an expense is eligible? Eligibility of expenses is dictated by the IRS and those guidelines are used by Benefit Resource. The services of an attorney are utilized if an additional opinion is needed or research is required to clarify the eligibility of an expense.

11 FAQs FSA GENERAL: Continued (11) Are expenses eligible if services are provided prior to my effective date in the plan? No. Services must be provided on or after your effective date. (12) Can money in a Medical FSA be used for a Dependent Care FSA? No. Money directed to one type of account can be used onjy for expenses relating to that account. This is true even if all the money in one account is not used and the other account runs short. (13) If I elect too much for my FSA during the plan year and cannot use it, what happens to the extra funds? Refer to your Plan Highlights regarding unused FSA funds. Any forfeited funds are returned to your employer, but the IRS has imposed strict regulations on the use of these funds (they cannot be refunded to the employees who forfeited them). Employees should be conservative when estimating the amount to elect for an FSA. (14) Can I change my FSA election during the plan year? Generally, your election cannot be changed during a plan year unless you experience a Qualified Status Change (QSC) as defined by the Internal Revenue Service. A change in election must be on account of a QSC event, so the election change must be made within the time frame required by your Employer after the QSC. For example, you may be permitted to prospectively change an election during a plan year when one of the following changes in status occurs that affects eligibility for coverage: Change in your legal marital status (e.g. marriage, legal separation, divorce, annulment, death ofa spouse). Change in number of tax dependents (e.g. birth, adoption, placement for adoption, death). Change in your dependent's eligibility for coverage due to the dependent's age, student status, marital status or similar circumstance (e.g. your child reaches age 13 so is no longer eligible for coverage under a Dependent Care FSA). Change in employment status of employee, spouse, or dependent that affects eligibility for the FSA. Change in residence or worksite of employee, spouse or dependent that affects eligibility for the FSA. Change in dependent care costs or coverage (e.g. change in your day care provider). If you, your spouse or an eligible dependent experiences a QSC event, you may change your FSA election(s) as long as the requested change is consistent with the event. For example:. If you have a new baby, you may increase your Medical FSA and/or Dependent Care FSA election(s) to accommodate the added medical and/or day care expenses for this new child.. If you have a new baby and your spouse terminates employment to stay home with the child, you may decrease your Dependent Care FSA election since you no longer have eligible day care expenses for that child. If you currently have eligible day care expenses for your pre-schooler, you may decrease your Dependent Care FSA election when the child starts school during the plan year since you would no longer have eligible day care expenses for that child. (15) Will my FSA election automatically continue after my current plan year ends? No. You must enroll again before the beginning of each new plan year. This gives you a chance to change your election each plan year as your circumstances change. (16) What happens if my employment terminates before the end of the plan year? Your Medical FSA will terminate as of the date your employment terminates. Eligible medical services provided prior to your date of termination will still be eligible for reimbursement, but services provided after the date of termination will not be eligible unless you are eligible for and elect to continue coverage under COBRA. See additional information in your SPD or Plan Document. Your Dependent Care FSA balance will continue to be available for reimbursement of eligible services provided at any time within your plan year. (17) If I terminate employment, can I receive a refund for the cash balance remaining in my FSA? No. IRS regulations do not allow this. The Employer maintains a Plan Document; if anything in this document conflicts with the Plan Document. then the Plan Document controls.

12 Beniversal Card FAQs (1) What is a Beniversal Card? The Beniversal Prepaid MasterCard allows you to use funds from your Medical Flexible Spending Account (FSA) and/or Health Reimbursement Account (HRA) to pay for eligible medical expenses at qualified merchants that accept Debit MasterCard. (2) When can I start using my Beniversal Card? Before using your card, you must: Activate and sign the card (follow the instructions received with your card). Wait to use the card on or after your effective date in the plan. (3) What dollar amount is available on my Beniversal Card after I activate it? The amount available for a Medical FSA = the total amount you elected for the current plan year minus any prior payments and reimbursements. Check your plan documents to determine if prior year funds are available on the card. The amount available for an HRA = the total funds posted to your current plan year account minus any prior payments and reimbursements. (4) Where can I use my Beniversal Card? Your card will only work at Qualified Merchants who accept Debit MasterCard. Qualified Merchants include medical providers such as: (5) (6) Chiropractors Doctors Dentists Hospitals Medical labs Medical supply stores Orthodontists Podiatrists Vision Centers IIAS merchants 90% merchants What is an IIAS merchant? An IIAS merchant has an Inventory Information Approval System (IIAS) that automatically identifies eligible medical expenses. Here s how it works: Have the sales clerk total your entire purchase. Use your Beniversal Card first, which will automatically pay for the eligible medical items. Use another form of payment for the remaining amount. A list of IIAS merchants is available at the Benefit Resource website at You usually will not need to submit a receipt to verify the eligibility of a purchase made at an IIAS merchant, but save your receipt just in case. What is a 90% merchant? A 90% merchant has registered with a national organization, certifying that 90% or more of its revenue is from the sale of eligible medical items. If a merchant has more than one location, each location must be registered. A list of 90% merchants is available at You usually will need to submit documentation to verify the eligibility of a purchase at a 90% merchant, so save your receipt. (7) What can I purchase with my Beniversal Card? Use your card to pay for medical expenses that are eligible under your plan. Check the plan information from your employer for additional details. Do not use your card for ineligible expenses, such as teeth whitening, health club memberships or cosmetic procedures. Expenses must be for you, your spouse or your eligible dependent(s), unless otherwise restricted under your employer s plan. General information about eligible expenses is available at (8) Can I use my card to purchase over-the-counter (OTC) items? If you have a General Medical FSA, eligible OTC medical items can be purchased with your Beniversal Card (see examples in the OTC Chart at For an HRA, check your Plan Highlights to see if any OTC expenses are eligible. (9) What if I order my prescription through an online or mail order program? When payment information is requested for a prescription service, you can simply provide your Beniversal Card number and related account details. (10) If asked, should I select Debit or Credit? Select CREDIT to sign for the purchase or DEBIT to enter a PIN. Information on how to request a PIN is included when you receive your card. There is no ATM or cash access associated with this card. (11) What should I do with my receipts? Save them! In fact, save all documentation related to medical expenses paid with your Beniversal Card. The documentation must include provider name, type of service, date of service and cost of service. (For prescriptions drugs, documentation must include the drug name). IRS regulations require all FSA/HRA transactions to be verified for eligibility. The technology built into your card provides a way to verify many card transactions automatically. When a card transaction cannot be verified automatically, the IRS requires that you submit followup documentation. Benefit Resource will contact you when this is necessary. This often happens if you use the card for the following: - Dental and vision expenses. - Expenses that are not co-payments under your employer-sponsored health insurance plan. - Expenses at a 90% merchant. (12) What if I lose these documents? See if your provider or insurance company can provide copies for you. An Explanation of Benefits (EOB) generally provides all the required information. If you cannot provide the required document(s) or if an expense is ineligible you may repay the expense or provide a substitute claim to offset it.

13 BENIVERSAL CARD FAQs: Continued If you take no action: - Your FSA and/or HRA may be suspended. - Your eligibility to participate in the plan may be suspended. - The amount of the expense may be deducted from your wages on an after-tax basis. Card purchases not verified as an eligible expense will be reported as taxable income, per IRS regulations. (13) Can I use the Beniversal Card to pay for a service before it is provided? No. IRS regulations require that a service be provided before using FSA or HRA funds. (The IRS allows an exception to this rule for orthodontia expenses. Use of FSA/HRA funds for orthodontia may be based either on date of service or payment due date.) (14) Can I use the Beniversal Card to pay a bill that has a Balance Due for an eligible service? Yes, as long as the payment is completed in the same plan year that the service was provided. However, if followup documentation is requested for the expense, itemized detail will need to be provided as explained above. (15) Can I use my card to pay for services that were provided prior to participating in the plan? No, IRS regulations do not allow this. The date of service determines whether the expense is eligible, not the date of payment. A service is only eligible if it is provided in your current plan year and after you begin participating in the plan. (16) What if a provider requires me to pay in full at the point-of-sale, even if part of the expense will be paid from another source? Do not use your Beniversal Card if any part of the expense will be reimbursed from another source (such as your health insurance carrier). Pay the required amount with some other means and then submit a claim to Benefit Resource for reimbursement of the eligible amount not reimbursed elsewhere. (17) What are some reasons my Beniversal Card might not work at the point-of-sale? Your card has not been activated. Your balance is less than the full expense. You attempted to purchase items that are not eligible under your plan. You attempted to use your card at a non-qualified merchant. The merchant is not registered in an eligible network. The merchant is having technical problems. The home address you gave the merchant did not match the address on file with your Beniversal Card. (18) What should I do if I cannot use my Beniversal Card at the point-of-sale? Use another form of payment for the eligible item(s) and then submit a completed claim with supporting documentation to Benefit Resource. You can do this in one of the following ways: (a) The BRiMobile app allows mobile device users to submit claims on-the-go. (b) Log in to the Benefit Resource website, under the FSA/HRA Plans tab, select Submit an Online Claim (if allowed by your plan). Complete your claim form, then either upload it to Benefit Resource or print it so you can fax or mail it to Benefit Resource. (c) Complete a paper claim form (available from the Benefit Resource website or your employer) and fax or mail it to Benefit Resource. (19) How do I know how much is in my account? Checking your account balance before using the card will help ensure you have sufficient funds to cover the entire amount of your eligible purchase. Account information is available 24/7 when you log in to or via the BRiMobile app for mobile device users. You can call the toll-free number on the back of your card, Monday - Friday, 8am - 8pm (Eastern Time). (20) What if an expense is more than the amount remaining in my account? If the merchant can do a split transaction, tell the clerk you wish to use the Beniversal Card for the exact amount left in your account and then pay for the remaining amount with another form of payment. If the merchant cannot do a split transaction, use another form of payment and submit a claim to Benefit Resource for reimbursement from the funds remaining in your account. (21) Do I need a new Beniversal Card each plan year? No. As long as you continue to participate in an FSA or HRA, you can continue using your card through the expiration date on the card. Your new Medical FSA election will be loaded on your card at the beginning of each new plan year. (Medical FSA funds from the prior plan year will no longer be available on the card after that plan year ends.) HRA funds will be available on your card per your HRA Plan Highlights. (22) What happens if I terminate employment or stop participating in the plan? Your card will be automatically cancelled when you stop working for the employer or stop participating in the plan. Claims for eligible expenses may be submitted for reimbursement per your Plan Highlights. (23) Where do I go for answers to my questions? Information is available 24/7 at The Benefit Resource Participant Services Department is available online via Live Chat (Monday - Friday, 8am - 5pm (Eastern Time) with participant login access) or by calling (800) , Monday - Friday, 8am - 8pm (Eastern Time). (24) What if I lose my card or need another one? To minimize unauthorized use of your card, be sure to report a lost card immediately by calling Benefit Resource at (800) You can request replacement cards at the same number. (There is a fee associated with card replacement. Fee details are available in your Cardholder Agreement. A third party may opt to pay this fee on your behalf. Check with your plan administrator.) The Employer maintains a Plan Document; if anything in this document conflicts with the Plan Document, then the Plan Document controls. The Beniversal Prepaid MasterCard is issued by The Bancorp Bank pursuant to license by MasterCard International Incorporated. The Bancorp Bank; Member FDIC. MasterCard is a registered trademark of MasterCard International Incorporated. Rev. 05/2016

14 FLEXIBLE BENEFIT PLAN with Beniversal MasterCard PLAN HIGHLIGHTS* A. General Plan Information 1. Employer name: Enloe Medical Center. 2. Plan name: Enloe Medical Center Flexible Benefit Plan. 3. Plan type: The Plan is a welfare plan designed to provide benefits permitted under Section 125 of the Internal Revenue Code (IRC). The Plan name and Plan number should be used in any formal correspondence relating to the Plan. 4. Eligibility requirements: Must be an employee of Enloe Medical Center who works at least 24 hours a week. If you or your spouse is reporting contributions to a Health Savings Account (HSA), you are not eligible for a Medical FSA. 5. The effective date on which you can begin participating in the Plan: On the first of the month once the eligibility requirements have been met. 6. Kinds of group insurance for which you can pay your share of premiums through the Plan: Medical, Dental and Vision Insurances. The Health Benefits that are offered under the Premium Payment Component are the Medical, Dental and Vision Plans. An Eligible Employee can elect: 7. To participate in the Premium Payment Component by electing to pay for his share of the premiums for Health Benefits Plan on a pre-tax Salary Reduction basis (Premium Payment Benefits); 8. To pay for his share of the premiums with after-tax deductions outside of this Plan; or 9. To Opt-Out of participation in Health Plan Benefits and receive a monthly credit of $50 in lieu of group health coverage and $7 in lieu o group dental coverage, subject to withholding for income and payroll taxes. NOTE: Employees who are covered on the Enloe medical plan as dependents of another Employee are not eligible to receive the Opt-Out credit. B. The Plan Year begins on January 1 and ends on December 31. C. Plan effective date: January 1, D. Plan number: 501. E. F. Employer ID number: Name, address, phone number of the Plan Administrator: 12. Agent for service of process: Enloe Medical Center. B. Flexible Spending Accounts (FSAs) 1. Types of FSAs Enloe Medical Center 1531 Esplanade Chico, CA (530) Medical FSA (a) Maximum amount you can set aside per Plan Year for reimbursement of eligible medical expenses as defined by IRC Section 213(d) except for insurance premiums: $2,650. (b) For active participants: Eligible services must be provided: ο after your effective date in the Plan and ο during the Plan Year. (c) If you become ineligible (including termination of employment) during the Plan Year: Eligible services must be provided: ο after your effective date in the Plan, ο during the Plan Year and ο prior to the date on which you become ineligible. The Beniversal Card may no longer be used to access Medical FSA funds. You may submit a claim for reimbursement of eligible expenses. Dependent Care FSA (a) Maximum amount you can set aside per calendar year for reimbursement of eligible dependent care services, as defined by IRC Section 21(b), is limited to the smallest of the following amounts: $5,000 if single or if married and filing jointly; $2,500 if married and filing separately. The earned income of the participant. The earned income of the participant s spouse. (b) For active participants: Eligible services must be provided: ο after your effective date in the Plan and ο during the Plan Year. * Please review your Summary Plan Description for details of IRS regulations. Eff.01/2018 The Employer maintains a Plan Document; if anything in this document conflicts with the Plan Document, then the Plan Document controls.

15 PLAN HIGHLIGHTS* : Continued (c) If you become ineligible (including termination of employment) during the Plan Year: Eligible services must be provided: ο after your effective date in the Plan and ο during the Plan Year in which you become ineligible. 2. Claims for FSAs Claim submission time frames (a) Claims must be received by Benefit Resource, Inc. before the end of the 60 day run-out after the Plan Year ends. (b) Claims denied during the run-out may be resubmitted, but must be received by Benefit Resource within 21 days after the run-out ends. (c) Eligible participants are allowed to rollover up to $500 of unused Medical FSA funds to the next Plan Year after the end of the time frame in (b) is completed for the current Plan Year. The minimum amount that can rollover must be greater than $10. (d) Any funds remaining in your Medical or Dependent Care FSA after this will be forfeited. Claim reimbursements (a) Complete your claim following all instructions. (b) Claims received with proper documentation will be processed within 5 business days. (c) Claim reimbursements are processed daily. (d) There is a minimum reimbursement amount of $15 (except during the run-out after the end of the Plan Year). (e) A claim should never be submitted for an expense that has been paid for with a Beniversal Card or reimbursed from any other source. 3. Beniversal Card for Medical FSA (a) (b) (c) (d) (e) (f) (g) The Beniversal Card allows you to access Medical FSA funds to pay for eligible medical services at qualified merchants. The card may only be used to pay for eligible medical services after they have been provided. The IRS allows one exception: eligibility of orthodontia expenses can be based on either date of payment, date of service or payment due date on coupons/statements. Payment of a current Plan Year medical service with the card must be completed before the Plan Year ends. Once a new Plan Year begins, only Medical FSA funds associated with the new Plan Year will be available on the card. You are advised to save all documentation related to medical expenses paid with your card, as IRS regulations require all transactions to be verified for eligibility. If a card transaction cannot be automatically verified, you will be contacted to submit documentation for that transaction. Medical expenses paid with the card should never be submitted for claim reimbursement. * Please review your Summary Plan Description for details of IRS regulations. Eff.01/2018 The Employer maintains a Plan Document; if anything in this document conflicts with the Plan Document, then the Plan Document controls.

16 Getting Started 1. Determine your election amount(s) for Medical FSA and Dependent Care FSA separately. Utilize the FSA Expense & Tax Savings Estimate Worksheet in this booklet or visit tresource.com to access the online calculators. TIPS: Be a little conservative in your estimates. Check your Plan Highlights to see what happens to funds that you do not use by the end of the plan year. Also, be sure to check with your employer or review your Plan Highlights for any minimum or maximum limits that may apply, along with any restrictions on eligible expenses. 2. Enroll in the FSA Your employer will provide you detailed instructions regarding how and when enrollment will need to be completed. If online enrollment is offered by your employer, go to tresource.com, click on Participants under Secure Login. To log in, enter: Company Code: Provided by your employer Login ID: Default Login ID selected and provided by your employer. You may change it upon initial login. Initial Password: 5 digit home zip code (You will be prompted to change the password upon initial login.) Once logged in, go to the FSA/HRA tab and select the enrollment link. Follow the on screen prompts to complete your enrollment. What do participants think of their Beniversal FSA? Everyone is very helpful and responsive. I ve used the Live Chat a few times- I love it!!!! The BRI staff have always been very helpful, courteous, and knowledgeable; and your website is very user-friendly. Keep it up! I m always pleased when I don t need to contact an organization for help or to sort out problems because it means the business is doing a lot of things right to avoid trouble in the first place. I recommend daily that my co-workers get this card! 3. Begin using your account. If you have enrolled in a Medical FSA for the fi rst time and the Beniversal Card is offered, it will arrive in a plain white envelope from Benefi t Resource. Once you receive your card, you will need to activate it by calling the number on the activation sticker. If you already have a Beniversal Card, you can continue to use the card through the expiration date. If you are not using a card or have dependent care expenses, you can begin submitting claims for reimbursement. Please check with your employer or refer to your Plan Highlights regarding any restrictions that may exist regarding eligible expenses and time frames for using funds and reimbursing eligible expenses. Questions? Visit us online at: Contact us: (800) , Monday - Friday, 8am - 8pm (Eastern Time), by at ParticipantServices@BenefitResource.com or with Live Chat via participant login at Monday - Friday, 8am - 5pm (Eastern Time) Rev. 08/2015 FSA Kenneth Drive Rochester NY Toll-free: (866) Fax: (585)