Sarasota County Government Health Care Flexible Spending Account Plan Document

Transcription

1 Sarasota County Government Health Care Flexible Spending Account Plan Document Introduction Sarasota County has established this Health Care Flexible Spending Account Plan (the "Plan") to meet the needs of those of its Employees who are Participants in the Plan. The purpose of this Plan is to provide for the medical protection for certain Participants, their spouses and their dependents. The Plan will provide benefits only for certain items of health care expenses which are not covered by any other type of employee benefit plan or individual insurance. The Plan is intended to qualify as a self-insured medical reimbursement plan as defined in Section 105 ofthe Internal Revenue Code. This is an amendment or restatement ofthe Health Care Flexible Spending Account Plan dated January 1, The Plan Sponsor, Plan Administrator, a benefits committee, and/or a third party claims administrator is hereby granted discretionary authority to determine eligibility for benefits and/or to construe the terms ofthe plan. Definitions a. Anticipated Contributions - means the total amount of contributions the participant is expected to make during the plan year. b. Benefit Administrator - means an individual appointed by the Commission or other governing body ofthe Employer. c. Coverage Period - means a period oftime during the Plan Year in which benefits are stable due to a regular contribution amount. d. Effective Date - Means the Effective Date stated in the Preamble. e. Eligibility Requirement means the requirement(s) for participation stated herein. f. Employer - means Sarasota County. g. Employee - means any person who is employed by the Employer for purposes of the Federal Insurance Contributions Act. h. Participant - means any Employee who has satisfied the eligibility requirements ofthe Plan and who elects to make contributions to the Plan and actually makes such contributions. i. Plan Administrator - means the Employer.

2 J. Plan Year - The initial Plan Year for this Plan Document is January 1, 2018 to December 31, Subsequent Plan Years shall be twelve ( 12) month periods beginning each January 1 and ending on the following December 31 st k. ODRO - means Qualified Domestic Relations Order. Eligibility The eligible Employee may elect to participate in the Plan upon completion of the Eligibility Requirements specified by the Employer in the Section 125 Plan in Section If the eligible Employee elects to participate in the Plan during open enrollment and makes the required contributions, coverage shall begin on the January 1 st immediately following the election. Ifthe election is made during open enrollment, or the first day of the month following 30 days of employment for mid-year elections. If the Eligible Employee elects to participate or change an election in the Plan during the Plan Year as allowed due to a qualifying event, coverage shall begin on the first day of the month following the election. Participation shall continue until the earlier ofthe last day of the Plan Year or the date coverage ceases. Each Employee who terminates employment with the Employer during a Plan Year that is later rehired and becomes eligible for this Plan during the same Plan Year shall be treated as a newlyeligible employee for the purposes ofelection rights. Termination of Eligibility The eligibility of a Participant will cease upon the earlier ofthe following: The date your eligibility ends; The date your employment ends; or The date this Plan is terminated Ifeligibility ceases during a Plan Year, the former Participant may not make a new election for the remainder of the Plan Year. 2

3 Participation in the Health Care Flexible Spending Account may be continued beyond the termination of eligibility as permitted under the Family Medical Leave Act (FMLA) as described in section 2.03 of the Cafeteria Plan or the Consolidated Omnibus Budget Reconciliation Act (COBRA). Continuation of Coverage Participants and qualified dependents may have a right to continue coverage under the provisions ofcobra through the end of the plan year in which coverage would otherwise cease. Benefits The Employer shall establish minimum and maximum annual Employee contributions for each Plan Year, subject to statutory limits. Such minimum and maximum annual Employee contributions shall be communicated to Employees during the annual enrollment period or upon eligibility, as applicable. The amount available for reimbursement shall be the Employee's Anticipated Contributions during the Plan Year minus the amount already reimbursed during the Plan Year via check, direct deposit, debit card transaction or other means. Not later than ninety (90) days following the date upon which the Participant submits appropriate claim information, the Employer shall reimburse the Participant up to the Anticipated Contribution for a given Coverage Period for all eligible expenses incurred by the Participant during the Plan Year and defined as reimbursable under Code Section 105 for himself and his spouse and/or his tax dependents, ifany. The Employer shall not reimburse the Participant for any amounts payable under any other employee benefit plan or policy or any individual insurance by which the Participant, his spouse, or dependents are covered. All such reimbursements are must comply with Code Section 213(d), however, the Employer may restrict or limit such coverage by means of administrative rules provided such rules are made known to Employees prior to the beginning ofeach Plan Year or the date of the Employee's eligibility, as applicable. The IRS and other government entities may further restrict or limit which expenses are eligible. The Plan Administrator shall have final discretion as to which expenses are eligible for reimbursement. 3

4 Qualified Domestic Relations Order A court with jurisdiction over the employee, spouse and/or dependents covered by this Plan may through the issuance of a QDRO may allocate all or a portion of the available benefits under this Plan for the exclusive benefit of any or all of such persons as long as the total of all benefits for a Participant, the Participant's spouse and the Participant's dependents does not exceed 100% ofthe Anticipated Contributions for the Plan Year. Eligible Expenses Expenses eligible for reimbursement for Participants not eligible to make contributions to a Health Savings Account plan include those incurred during the Benefit Period for the prevention, diagnosis, cure, mitigation, or treatment of disease, for the purpose of affecting any structure or function of the body, or for the treatment and cure of bodily injury resulting from accidents and for transportation primarily for and essential to medical care for himself, his spouse and his covered dependents, as defined in Code Section 105. Additionally, reimbursable expenses must be for medical, dental, vision or hearing care. Medical expenses covered by any Employer-sponsored medical insurance plan or paid by any other plan or insurance program are not eligible. Covered persons include the Participant and any individuals considered by the IRS as spouse or dependents for income tax purposes. The Participant may not be reimbursed for any amounts payable under any other employee benefit plan or policy or any individual insurance by which the Participant, his spouse, or dependents are covered. All reimbursements must comply with Code Section 213 and/or specific guidance issued by the IRS related to the Plan, however, the Employer may restrict or limit such coverage by means of administrative rules provided such rules are made known to Employees prior to the beginning of each Plan Year or the date of the Employee's eligibility, as applicable. Benefit Period The Participant shall be permitted to submit requests for reimbursement of eligible expenses incurred during the period beginning on the date participation begins within a given Plan Year and ending on the earlier of the date participation ends for that Plan Year or the end of the Plan Year. Additionally, plan participants have the option of rolling over up to $ of unused funds into the following plan year. Claims Procedure A Participant shall make a claim for Benefits by making a request in accordance with the Claim for Benefits section. If a claim is wholly or partially denied, notice of a decision shall be furnished to the Participant within a reasonable period oftime, not to exceed ninety (90) days after receipt ofthe claim by the Plan Administrator, unless special circumstances require an extension oftime for processing the claim. If an extension of time is required, written notice of the extension shall be furnished to the Participant prior to the termination ofthe initial ninety (90) day period. In no event shall the 4

5 extension exceed a period of ninety (120) days from the end ofthe initial period. The extension notice shall indicate the special circumstances requiring an extension oftime and the date on which the Plan Administrator expects to render a decision. The Plan Administrator shall, upon request, provide a Participant who is denied a claim for benefits written notice setting forth, in a manner calculated to be understood by the claimant, the following: a. a specific reason or reasons for the denial; b. specific reference to pertinent Plan provisions upon which the denial is based; c. a description ofany additional material or information necessary for the claimant to perfect the claim and an explanation ofwhy that material or information is necessary; d. an explanation ofthe Plan's claim review procedure. The purpose ofthe review procedure is to provide a procedure by which a Participant, under the Plan, may have reasonable opportunity to appeal a denial of a claim to the Plan Administrator for a full and fair review. To accomplish that purpose, the Participant, or his duly authorized representative may: a. request review upon written application; b. review pertinent Plan documents; and c. submit issues and comments in writing. A Participant or his duly authorized representative shall request a review by filing a written application for review with the Plan Administrator at any time within sixty (60) days after receipt ofwritten notice ofthe denial ofthe claim. Decision on review of a denied claim shall be made in the following manner: a. The decision on review shall be made by the Benefit Administrator, which may, at its discretion, hold a hearing on the denied claim. The Benefit Administrator shall make its decision not later than sixty (60) days after the Benefit Administrator receives the request for review, unless special circumstances require extension oftime for processing, in which case a decision shall be rendered as soon as possible, but not later than one hundred twenty (120) days after receipt ofthe request for review. If an extension oftime for review is required, written notice ofthe extension shall be furnished to the Participant prior to the commencement ofthe extension. b. The decision on review shall be in writing and shall include specific reasons for the decision, written in a manner calculated to be understood by the Participant, and specific references to the pertinent Plan provisions on which the decision is based. 5

6 c. In the event that the decision on review is not furnished within the time period set forth, the claim shall be deemed denied on review. If a dispute arises with respect to any matter under this Plan, the Plan Administrator may refrain from taking any other or further action in connection with the matter involved in the controversy until the dispute has been resolved. Repayment of Excess Reimbursements If it is determined that a Participant has received reimbursements (including via debit card) in excess ofthe amount ofeligible expenses, the Plan Administrator shall give the Participant written notice of any excess amount, and the Participant shall repay the amount of such excess to the Employer within sixty (60) days of such notice. Coordination of Benefits The Plan is intended solely to pay benefits for unreimbursed health care expenses as defined by IRC Section 213(d), with the exception that reimbursement of premiums is not permitted. Accordingly, it shall not be considered a group health plan for coordination of benefits purposes, and its benefits shall not be taken into account when determining benefits under any other plan. Disposition of Unused Funds If an Employee's contributions exceed the amount reimbursed after the end of the claim filing period for the Plan Year ( or the date of any final action by the Appeals Committee, whichever is later), up to $500 ofthe excess contributions will be added to the subsequent Plan Year's account balance provided the Employee remains a Participant for that Plan Year. Unused amounts above $500 will be forfeited. Ifthe Employee does not remain a Participant for the subsequent Plan Year all excess contributions will be forfeited. The Employer may use any remaining funds as it sees fit except it may not return the funds to the Participants to offset any forfeiture. Funding Contributions required to pay benefits under this Plan shall consist of contributions by the Participants under the Employer's Flexible Benefit Plan, and other funds from the general assets ofthe Employer. Continuation of Coverage under COBRA Participants in this Plan may have rights to continue participation under Code Section 4980B ( commonly known as COBRA) ifthe participant or a family member experience a qualifying event that would otherwise cause coverage to end. Participants are notified of specific rights under COBRA via a separate notice. 6

7 HIPAA Privacy Federal regulations including the Health Insurance Portability and Accountability Act define the rights and obligations of participants, the Employer and the Plan with regard to protecting the privacy ofpersonal health information. Plan Administrator The Plan Administrator shall have the authority to manage the operation and administration ofthe Plan and to adopt such rules and regulations consistent with the Plan as it shall deem appropriate to administer the Plan. All determinations by the Plan Administrator shall be conclusive and binding on all Participants, their spouses and dependents. Amendment and Termination This Plan may be amended, suspended or terminated at any time by the Plan Administrator in accordance with delegation provided in Resolution R Miscellaneous Except where otherwise indicated by the context, any masculine terminology used herein shall also include the feminine and vice versa, and the definition ofany term herein in the singular shall also include the plural, and vice versa. This Plan shall not be deemed to constitute a contract between the Employer and any Participant or Employee or to be consideration or an inducement for the employment of any Participant or Employee. Nothing contained in this Plan shall be deemed to give any Participant or Employee the right to be retained in the service ofthe Employer or to interfere with the right ofthe Employer to discharge any Participant or Employee at any time regardless of the effect the discharge shall have upon him as a Participant ofthis Plan. This Plan shall be construed and enforced according to the laws of the State of Florida, except to the extent those laws are preempted by the laws of the United States ofamerica. 7

8 IN wn rnss WHEREOF, the Employer has caused this indenture to be executed on the <93' 4 day of c 'u.jf,{,20 I 8'. By:?4 ~ Title: {);rec to{ of ~Uff\tlJJ efj(jf.j...([e.j I {!j/{ct) ATTEST: By: &~s-~ Title: ~ ~ 8