WELLSPAN HEALTH CAFETERIA PLAN (As Amended and Restated Effective January 1, 2014)

Transcription

1 WELLSPAN HEALTH CAFETERIA PLAN (As Amended and Restated Effective January 1, 2014)

2 WELLSPAN HEALTH CAFETERIA PLAN (As Amended and Restated Effective January 1, 2014) TABLE OF CONTENTS Page ARTICLE I. DEFINITIONS... 1 ARTICLE II. ELIGIBILITY AND PARTICIPATION Commencement of Participation Ineligible Individuals FMLA Leave Cessation of Participation Continuation Coverage Uniformed Service Other Leaves of Absence... 8 ARTICLE III. BENEFITS Benefit Programs Nondiscrimination... 8 ARTICLE IV. PLAN FUNDING Plan Cost Participating Employer Contributions Participant Contributions FMLA Leave Use of Contributions Subrogation ARTICLE V. CLAIMS PROCEDURE Claims Procedure Health Plan Claims ARTICLE VI. ADMINISTRATION Fiduciary Responsibility Duties and Powers of the Administrator Rules and Decisions Administrative Expenses Authority to Establish Premiums Exclusive Benefit Rule

3 ARTICLE VII. AMENDMENT AND TERMINATION OF THE PLAN Amendment Termination ARTICLE VIII. MISCELLANEOUS Limited Purpose of Plan Gender Nonalienation Facility of Payment Governing Law and Exclusive Jurisdiction APPENDICES APPENDIX A APPENDIX B APPENDIX C SECTION 125 PLAN HEALTH PLAN BENEFIT PROGRAMS ii

4 Name of the Plan: WellSpan Health Cafeteria Plan Company Identification Number: Employer and Plan Sponsor: WellSpan Health 1135 Edgar St. P. O. Box York, PA Plan Number: 501 Type of Plan: Health and Welfare Plan Administrator: WellSpan Health 1135 Edgar St. P. O. Box York, PA Named Fiduciary for Claim Determination: WellSpan Health 1135 Edgar St. P. O. Box York, PA Agent for Service of Legal Process: Shirley Dwyer 1135 Edgar St. P. O. Box York, PA End of Plan Year: December 31 GENERAL INFORMATION

5 WELLSPAN CAFETERIA PLAN (As Amended and Restated Effective January 1, 2014) This is the WellSpan Health Cafeteria Plan (the Plan ), as amended and restated effective January 1, 2014, covering the eligible employees of WellSpan Health, and such of its affiliates as have adopted the Plan. The Plan consists of three components, the Section 125 Plan, the Health Plan and all other welfare benefit programs. The main portion of the Plan contains provisions generally applicable to all WellSpan Health welfare benefit programs. The purpose of the Plan is to help provide certain welfare benefits for each participating Employee and his or her eligible spouse and dependents. Accordingly, the Plan is intended to constitute an employee welfare benefit plan within the meaning of section 3(1) of ERISA (defined below). This document together with the Applicable Contracts (defined below) and Summary Plan Descriptions (defined below) are intended to constitute one single plan for purposes of the reporting and disclosure requirements of ERISA and the Internal Revenue Code of 1986, as amended. You must read this document along with the respective Applicable Contracts and Summary Plan Descriptions to fully understand the benefits being provided under the Plan. The purpose of the Section 125 Plan is to allow each eligible Employee to elect to receive certain amounts, either in the form of cash compensation or in the form of various nontaxable benefits. The Section 125 Plan is intended to qualify as a cafeteria plan within the meaning of section 125 of the Code, and to include a flexible spending arrangement together with a dependent care assistance program within the meaning of section 129 of the Code. The provisions specific to the Section 125 Plan are described in Appendix A and its accompanying schedules. The purpose of the Health Plan is to help provide certain medical care benefits for each participating employee or former employee and his or her eligible spouse and dependents. The Health Plan is intended to be a group health plan within the meaning of section 733(a) of ERISA. The provisions specific to the Health Plan are described in Appendix B. WellSpan Health has amended Appendix B in good faith to comply with the requirements of a recent federal law entitled the Patient Protection and Affordable Care Act ( PPACA ). However, some of the regulations and other guidance under PPACA are interim, or in some cases not yet promulgated. WellSpan Health reserves the right to amend this Plan document, retroactively, if deemed necessary, to comply with PPACA and the regulations and other guidance promulgated thereunder. WellSpan Health intends for the Plan to continue indefinitely; however, it reserves the right to amend, modify or terminate the Plan (including benefits to eligible former employees) at any time and for any reason

6 ARTICLE I. DEFINITIONS The following words and phrases as used herein have the following meanings unless a different meaning is provided under an applicable Appendix Administrator means the individual, entity or committee, appointed pursuant to Article VI to administer the Plan Affiliated Employer means any other employer included with the Sponsor in a controlled group of corporations or trades or businesses within the meaning of section 414(b) or section 414(c) of the Code, or an affiliated service group within the meaning of section 414(m) of the Code Applicable Contract means the contract, certificate, booklet, summary, agreement, plan, trust, policy manual, term sheets and other similar documents (excluding any collective bargaining agreement or Summary Plan Description) pursuant to which Benefits are provided under a Benefit Program. The terms of any such Applicable Contract, as in effect from time to time, are hereby incorporated into the Plan and each applicable Benefit Program Benefit means the amount payable to, or on behalf of, a Participant, Dependent or Beneficiary on account of coverage under any Benefit Program as specified from time to time in the Applicable Contracts and Summary Plan Descriptions, as in effect from time to time Benefit Program means each of the various programs offering Benefits under the Plan as listed on Appendix C. The substantive terms of each Benefit Program are set forth in the Applicable Contracts and Summary Plan Descriptions, as in effect from time to time Section 125 Plan is that portion of the Plan that is intended to qualify as a cafeteria plan within the meaning of section 125 of the Code, and that may include a dependent care assistance program within the meaning of section 129 of the Code COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended Code means the Internal Revenue Code of 1986, as amended Covered Person means any Eligible Employee covered under the Plan, and any individual who is eligible for and covered under the Plan due to the individual's relationship to an Eligible Employee (such as the Employee's spouse, child, or other eligible family member). If a benefit requires enrollment, only an individual who has enrolled is considered a Covered Person with respect to that benefit Effective Date means the effective date of this amendment and restatement of the Plan, which is January 1, Employee means any individual who is employed by the Employer as a common law employee, excluding any individual who is an independent contractor or any other person who is not classified or otherwise treated by an Employer as an employee for purposes of

7 withholding federal employment taxes, regardless of any contrary governmental or judicial determination relating to such employment status or tax withholding. If an individual in such a non-employee classification is subsequently reclassified as, or determined to be, an employee by the Internal Revenue Service, any other governmental agency or authority, or a court, or if an Employer is required to reclassify such an individual as an employee as a result of such reclassification or determination, such individual shall not become eligible to become a Participant in this Plan by reason of such reclassification or determination Employer means the Sponsor, and any other entity included with the Sponsor in a controlled group of corporations or trade or businesses within the meaning of section 414(b) or section 414(c) of the Code, or an affiliated service group within the meaning of section 414(m) of the Code who shall have adopted the Plan; provided that any such entity shall be included within the term Employer only while a member of such group including the Sponsor ERISA means the Employee Retirement Income Security Act of 1974, as amended FMLA means the Family and Medical Leave Act of 1993, as amended FMLA Leave means a leave of absence to which the FMLA applies Participating Employer means the Sponsor and each Affiliated Employer that has joined the Plan Plan means the WellSpan Health Cafeteria Plan Plan Year means the twelve-month period ending each December Section 125 Plan is that portion of the Plan that is intended to qualify as a cafeteria plan within the meaning of section 125 of the Code, and that may include a dependent care assistance program within the meaning of section 129 of the Code Sponsor means WellSpan Health Spouse means the individual who is legally married to a Participant Summary Plan Description means a written description of the Plan or any Benefit Program (or any portion thereof) provided to Participants, Spouses and Beneficiaries pursuant to section 104(b) of ERISA. The terms of the Summary Plan Description, as in effect from time to time, are hereby incorporated into the Plan and each applicable Benefit Program USERRA means the Uniformed Services Employment and Reemployment Rights Act of 1994, as amended

8 ARTICLE II. ELIGIBILITY AND PARTICIPATION 2.1. Commencement of Participation An Eligible Employee with respect to the Plan is any Employee who is eligible to participate in and receive benefits under one or more of the component benefit programs in accordance with the terms and conditions of the Plan (including the terms of the applicable component program). Certain component benefit programs require enrollment (either once or annually) for coverage. Information about enrollment procedures, including when coverage begins and ends for the various component benefit programs, is found in the Appendices. An Eligible Employee begins participating in the Plan upon his or her election to participate in a component benefit program in accordance with the terms and conditions established for that program or, if earlier, upon meeting the eligibility criteria and becoming covered under a component benefit program that does not require enrollment or an election.. Subject to Section 2.2 below, an Employee who has satisfied the eligibility requirements with respect to one or more Benefit Programs as specified in the Applicable Contracts and Summary Plan Descriptions and who has properly filed an application in accordance with procedures established by the Administrator shall begin to participate in the Plan on the date established in such Benefit Program(s) Other individuals, such as an Eligible Employee's spouse, children, or other family members, may be eligible to participate in and receive benefits under one or more of the component benefit programs due to their relationship to an Eligible Employee. Information about such eligibility and coverage is found in the respective is found in the respective Attachments A former Employee (and his eligible Dependents) who (i) satisfies the retiree eligibility requirements with respect to one or more Benefit Programs as specified in the Applicable Contracts and Summary Plan Descriptions or (ii) who is entitled to continuation coverage pursuant to COBRA with respect to one or more Benefit Programs, shall continue to participate in the Plan as established in the applicable Benefit Program(s) and as set forth in the Applicable Contracts and Summary Plan Descriptions provided the former Employee (or his eligible Dependent) has properly applied for such retiree or COBRA coverage in accordance with procedures established by the Administrator Termination of Participation. When an Eligible Employee's participation in the Plan terminates, benefits under the Plan for the Eligible Employee and Covered Persons covered through that Eligible Employee will cease. When an Eligible Employee's participation in a component benefit program terminates, benefits under that component benefit program for the Eligible Employee and Covered Persons covered through that Eligible Employee will cease. Termination of participation in a component benefit program occurs in accordance with the terms and conditions established for that program. Benefits under all component programs (for all Covered Persons) will cease upon termination of the Plan. Other circumstances can result in the termination of benefits. The insurance contracts (including the certificate of insurance booklets), plans, and other governing documents in the applicable Appendices provide additional information

9 2.3. Continuation Coverage. Notwithstanding the foregoing, an eligible Participant or Dependent may elect to continue coverage under the Health Plan in accordance with COBRA. COBRA rights are explained in detail in the applicable certificate of insurance booklet and the summary of continuation coverage rights under COBRA provided in the SPD for the applicable component document. If a Covered Person's coverage under a component benefit program that is a group health plan (e.g., medical or dental coverage; Health FSA) ceases because of certain qualifying events specified in COBRA (such as termination of employment, reduction in hours, divorce, death, or a child's ceasing to meet the definition of dependent), then the Covered Person may have the right to purchase continuation coverage for a temporary period of time Uniformed Service. A Participant who is absent from employment with a Participating Employer on account of being in uniformed service, as that term is defined under USERRA, may elect to continue participation in the Plan in accordance with the terms of USERRA Qualified Medical Child Support Orders. The Plan will extend medical benefits to an Eligible Employee's non-custodial child as required by any qualified medical child support order (QMCSO) under ERISA 609(a), including a National Medical Support Notice. The Plan has procedures for determining whether an order qualifies as a QMCSO. Covered Persons and beneficiaries can obtain, without charge, a copy of such procedures from the Employer s Benefits Department Other Leaves of Absence. A Participant who is absent from employment with the Employer on account of being on a temporary Employer-approved non-fmla leave of absence, may continue participation for the time period and in accordance with the terms described in the Applicable Contracts or Summary Plan Descriptions. ARTICLE III. BENEFITS 3.1. Benefit Programs. The Plan is comprised of the Benefit Programs as provided in Appendix C. To qualify for Benefits under a Benefit Program, an eligible Employee or Dependent must meet the eligibility requirements applicable to that specific Benefit Program. The Benefits payable under each Benefit Program, and the eligibility therefor, are set forth in the Applicable Contracts and the Summary Plan Descriptions, as in effect from time to time. In addition, a Qualified Benefit Program is also subject to the provisions of Appendix A, and the Health Plan is subject to the provisions of Appendix B. The Plan shall not provide any Benefits attributable to claims that arise after an individual ceases to be a Participant or Dependent Nondiscrimination. To the extent Benefits are provided under any part of the Plan that is subject to section 79, section 105(h), section 125 or section 129 of the Code, such Benefits shall not discriminate in favor of Restricted Individuals. The Administrator may limit or deny any Benefit to the extent necessary to avoid any such discrimination. In addition, to the extent Benefits are provided under the Health Plan, such Benefits shall not discriminate against any Employee, Participant or Dependent on the basis of genetic information in accordance with the provisions of the Genetic Information Nondiscrimination Act of 2008, as may be amended, and the regulations issued thereunder

10 ARTICLE IV. PLAN FUNDING 4.1. Plan Cost. The cost of each Benefit Program shall be paid by the Participating Employers and the Participants, in such proportion as the Sponsor shall determine from time to time Participating Employer Contributions. Participating Employer contributions shall be paid from the Participating Employers general assets or from any other funding medium established by the Participating Employers Participant Contributions. Each Participant may be required to contribute to the Plan in an amount established by the Sponsor from time to time for the type of Plan coverage selected by such Participant. In addition, the rate of Participant contributions may depend upon the employment status and compensation of the Participant as established by the Sponsor. Each Participant shall complete an election form authorizing such contributions. Participant contributions may be collected by Participating Employers by means of payroll deductions or such other method as may be determined by the Participating Employers, including, but not limited to payments pursuant to the Section 125 Plan Use of Contributions. Participating Employer and Participant contributions may be used to provide Benefits directly or may be used to purchase insurance or other contracts to provide Benefits as determined by the Sponsor Right to Recover Benefit Overpayments and Other Erroneous Payments. If, for any reason, any benefit under the Plan is erroneously paid or exceeds the amount appropriately payable under the Plan to a Covered Person, the Covered Person shall be responsible for refunding the overpayment to the Plan. In addition, if the Plan makes any payment that, according to the terms of the Plan, should not have been made, the Plan Administrator, the Employer (or designee), or the applicable insurance company (or other benefit provider) may recover that incorrect payment, whether or not it resulted from the company's or Plan Administrator s (or its designee s) own error, from the person to whom it was made or from any other appropriate party. As may be permitted in the sole discretion of the Plan Administrator, the refund or repayment may be made in one or a combination of the following methods: (a) in the form of a single lump-sum payment, (b) as a reduction of the amount of future benefits otherwise payable under the Plan, (c) as automatic deductions from pay or (d) any other method as may be required or permitted in the sole discretion of the Plan Administrator or the applicable insurance company. The Plan may also seek recovery of the erroneous payment or benefit overpayment from any other appropriate party to the fullest extent permitted by applicable law. With respect to component benefit programs provided through insurance or other benefit provider, the contract language may contain information regarding the Plan s right to subrogate or seek reimbursement of erroneously paid benefits (including payments in excess of the amount appropriately payable). With respect to self-insured component benefit programs, subrogation or reimbursement rights may be set forth in the plan document or other governing documentation. Right to Information and Fraudulent Claims. Any person claiming benefits under the Plan shall furnish the Plan Administrator or, with respect to a fully insured benefit, the insurance

11 company with such information and documentation as may be necessary to verify eligibility for or entitlement to benefits under the Plan. The Plan Administrator (and, with respect to a fully insured benefit, the insurance company) shall have the right and opportunity to have a Covered Person examined when benefits are claimed, and when and so often as it may be required during the pendency of any claim under the Plan. The Plan Administrator and, with respect to a fully insured benefit, the insurance company also shall have the right and opportunity to have an autopsy done in the case of death, where it is not forbidden by law. If a person is found to have falsified any document in support of a claim for benefits or coverage under the Plan, or failed to have corrected information which such person knows or should have known to be incorrect, or failed to bring such misinformation to the attention of the Plan Administrator or the insurance company, the Plan Administrator may, without the consent of any person and to the fullest extent permitted by applicable law, terminate the person s Plan coverage, including retroactively. In addition, the insurance company may refuse to honor any claim for benefits under the Plan for the Covered Person related to the person submitting the falsified information. Such person shall be responsible to provide restitution, including monetary repayment to the Plan, with respect to any overpayment or ineligible payment of benefits. ARTICLE V. CLAIMS PROCEDURE 5.1. Claims and Appeals for Fully Insured Benefits. For purposes of determining the amount of, and entitlement to, benefits of the component benefit programs provided under insurance or contracts, the respective insurer is the named fiduciary under that component benefit of the Plan, with the full power to interpret and apply the terms of the Plan as they relate to the benefits provided under the applicable insurance contract. To obtain benefits from the insurer of a component benefit program, the Covered Person must follow the claims procedures under the applicable insurance contract, which may require the Covered Person to complete, sign, and submit a written claim on the insurer's form. The insurance company will decide a Covered Person's claim in accordance with its reasonable claims procedures, as required by ERISA. The insurance company has the right to secure independent medical advice and to require such other evidence as it deems necessary in order to decide a claim. If the insurance company denies a claim in whole or in part, then the Covered Person will receive a written notification setting forth the reason(s) for the denial. If a claim is denied, the Covered Person may appeal to the insurance company for a review of the denied claim. The insurance company will decide the appeal in accordance with its reasonable claims procedures, as required by ERISA if applicable. If the Covered Person does not appeal on time, then he or she may lose his or her right to file suit in a state or federal court, as he or she will not have exhausted his or her internal administrative appeal rights (which generally is a prerequisite to bringing a suit in state or federal court). To the extent the component benefit program is subject to provisions of PPACA requiring external review, procedures to that effect will be available

12 The insurance contract (including the certificate of insurance) in the applicable Attachment provides information about how to file a claim and appeal a denied claim, and details regarding the insurance company's claims procedures 5.2. Claims and Appeals for Self-Insured Benefits. For purposes of determining the amount of, and entitlement to, benefits under the component benefit programs provided through the Company's general assets, the Plan Administrator is the named fiduciary under the Plan, with the full power to make factual determinations and to interpret and apply the terms of the Plan as they relate to the benefits provided through a self-insured arrangement. To obtain benefits from a self-insured arrangement, the Covered Person must complete, execute, and submit to the Plan Administrator a written claim on the form available from the Plan Administrator. The Plan Administrator has the right to secure independent medical advice and to require such other evidence as it deems necessary to decide a claim. The Plan Administrator will decide a Covered Person's claim in accordance with reasonable claims procedures, as required by ERISA. If the Plan Administrator denies a claim in whole or in part, then the Covered Person will receive a written notification setting forth the reason(s) for the denial. If a claim is denied, the Covered Person may appeal to the Plan Administrator for a review of the denied claim. The Plan Administrator will decide the appeal in accordance with reasonable claims procedures, as required by ERISA. If the Covered Person does not appeal on time, then the Covered Person may lose his or her right to file suit in a state or federal court, because he or she will not have exhausted the internal administrative appeal rights (which generally is a prerequisite to bringing a suit in state or federal court).see the summary plan description (SPD) or other governing document among the applicable Attachments for more information about how to file a claim and appeal a denied claim, and for details regarding the claims procedures applicable to a claim. ARTICLE VI. ADMINISTRATION 6.1. Fiduciary Responsibility. The Administrator shall be the committee appointed by the Board of Directors to administer the Plan and shall be the named fiduciary and administrator of the Plan, as those terms are defined by ERISA, and its agent designated to receive service of process Duties and Powers of the Administrator. The Administrator shall have the exclusive power and authority in its sole and absolute discretion to control and manage the operation and administration of the Plan and shall have all powers necessary to accomplish these purposes. The responsibility and authority of the Administrator shall include, but shall not be limited to, the following duties and powers: (a) to construe and interpret the Plan and decide all questions of eligibility and participation; (b) to prescribe procedures to be followed by Participants in making elections under the Plan; (c) to prepare and distribute information explaining the Plan to Participants; (d) to receive from Participating Employers and from Participants such information as shall be necessary for the proper administration of the Plan; (e) to furnish Participating Employers and Participants such information as shall be necessary for

13 the proper administration of the Plan; (f) to keep reports of elections, claims and disbursements for claims under the Plan, as appropriate; (g) to employ such persons including but not limited to actuaries, accountants, consultants and counsel, as it deems appropriate to perform such duties as may from time to time be required under ERISA or the Code (and regulations thereunder) and to render advice upon request with regard to any matters arising under the Plan; (h) to accept, modify or reject elections under the Plan; (i) to prepare and file any reports or returns with respect to the Plan required by applicable law; and (j) to take all other steps deemed necessary to properly administer the Plan in accordance with its terms and the requirements of applicable law Rules and Decisions. The Administrator shall have the sole discretion to interpret the Plan and decide any matters arising hereunder and may adopt such rules and procedures as it deems necessary, desirable or appropriate in the administration of the Plan, provided that such determinations do not conflict with the Plan or applicable law. All rules and decisions of the Administrator shall be uniformly and consistently applied to all Participants in similar circumstances and shall be conclusive and binding on all persons having an interest in the Plan. When making any decision or determination, the Administrator shall be entitled to rely upon such information as may be furnished to it by a Participant, a Participating Employer, legal counsel or the administrator of any Benefit Program that is subject to this Plan. Any final determination by the Administrator shall be binding on all parties. If challenged in court, such determination shall not be subject to de novo review and shall not be overturned unless proven to be arbitrary and capricious upon the evidence presented to the Administrator at the time of his determination Administrative Expenses. Except as permitted by COBRA or Plan, all ordinary and necessary expenses of the administration of the Plan shall be paid by the Participating Employers Authority to Establish Premiums. The Administrator shall have the authority to enter into any contract or agreement or execute any document to provide Benefits under the Plan. Any such contract, agreement or document shall be considered an Applicable Contract and shall be incorporated herein without amending the Plan document Exclusive Benefit Rule. The Administrator shall administer the Plan for the exclusive benefit of Participants and their Dependents. ARTICLE VII. AMENDMENT AND TERMINATION OF THE PLAN 7.1. Amendment. The Plan may be amended at any time and from time to time by the Board of Directors or its designee. In addition, the Administrator may prepare and execute on behalf of each Participating Employer, all technical, administrative, regulatory and compliance amendments to the Plan, that the Administrator, with appropriate advice of counsel or other benefits consultants, determine to be necessary or appropriate to the administration, operation or continued tax-exempt status of the Plan. The Administrator may revise any Applicable Contract or any provision of the Plan as necessary to reflect any necessary administrative changes in the operation of the Plan, including the amount of Benefits provided under the Plan

14 7.2. Termination. If a Participating Employer ceases to be an Affiliated Employer, its participation in the Plan shall immediately terminate and its employees shall immediately cease to be Participants under each Benefit Program, unless otherwise specified by the Plan Administrator. ARTICLE VIII. MISCELLANEOUS 8.1. Limited Purpose of Plan. The establishment or existence of the Plan shall not confer upon any eligible Employee the right to be continued as an Employee. Each Participating Employer expressly reserves the right to discharge any eligible Employee whenever in its judgment its best interests so require Gender. As used herein, terms of the masculine gender shall incorporate the feminine Nonalienation. No benefit payable under the Program shall be subject in any manner to anticipation, assignment, or voluntary or involuntary alienation Facility of Payment. If the Administrator, in its sole discretion, deems a Participant or Dependent who is entitled to receive any payment hereunder to be incompetent to receive the same by reason of age, illness or any infirmity or incapacity of any kind, the Administrator may apply such payment directly for the benefit of such person, or make payment to any person selected by the Administrator to disburse the same for the benefit of the Participant or his Dependent. Payments made pursuant to this Section 8.4 shall operate as a discharge, to the extent thereof, of all liabilities of the Participating Employer and the Plan to the person for whose benefit the payments are made Governing Law and Exclusive Jurisdiction. Unless otherwise provided in an Applicable contract, to the extent not preempted by federal law, the provisions of the Plan shall be construed, enforced and administered according to the laws of the Commonwealth of Pennsylvania. To record the amendment and restatement of the Plan, WellSpan Health has caused its authorized officer to execute the Plan effective as of January 1, WELLSPAN HEALTH By:

15 APPENDIX A WellSpan Health Section 125 Plan As Amended And Restated Effective January 1, Restatement of Section 125 Plan ARTICLE I. INTRODUCTION This is the WellSpan Health Section 125 Plan ( Section 125 Plan ) that is a component of the WellSpan Health Cafeteria Plan (the Plan ). This Appendix A applies to any Benefit Program offered under the Section 125 Plan portion of the Plan. The following provisions shall replace any similar or conflicting provisions under the Plan. WellSpan Health ( Employer ) adopted the Section 125 Plan, originally effective July 1, The Section 125 Plan is hereby restated in its entirety effective, except as otherwise provided herein, January 1, Capitalized terms used in this that are not otherwise defined shall have the meanings set forth in Article II Legal Status This Section 125 Plan is intended to qualify as a cafeteria plan under Code section 125 and the regulations issued thereunder, and shall be interpreted consistent therewith. The health care reimbursement component is intended to qualify as a self-insured medical reimbursement plan under Code section 105, and the health care expenses reimbursed thereunder are intended to be eligible for exclusion from participating Employees' gross income under Code section 105(b). The dependent care assistance component is intended to qualify as a dependent care assistance program under Code section 129, and the dependent care expenses reimbursed thereunder are intended to be eligible for exclusion from participating Employees' gross income under Code section 129(a) Code ARTICLE II. DEFINITIONS The Internal Revenue Code of 1986, as amended A-1

16 2.2. COBRA The Consolidated Omnibus Budget Reconciliation Act of 1985, as amended. COBRA Continuation Coverage is the COBRA requirement that a group health plan provide continuing benefits to certain covered persons after coverage would otherwise terminate Compensation For purposes of identifying a key employee, highly compensated employee, or highly compensated individual and complying with the nondiscrimination requirements with respect to contributions and benefits, compensation means a participant's earned income and any earnings reportable as W-2 wages for federal income tax withholding purposes for the calendar year ending with or within the plan year. W-2 wages means wages as defined in Code section 3401(a) but determined without regard to any rules that limit the remuneration included in wages based on the nature or location of the employment or the services performed (such as the exception for agricultural labor in Code section 3401(a)(2)). Compensation is the compensation actually paid or includable in gross income during such year. Compensation shall include elective contributions. Elective contributions are amounts excludable from the employee's gross income and contributed by the Employer, at the employee's election to this or any other cafeteria plan (excludable under Code section 125); a Code section 401(k) arrangement (excludable under Code section 402(e)(3)); a simplified employee pension (excludable under Code section 402(h)); a tax sheltered annuity (excludable under Code section 403(b)); a Code section 457 plan; a Code section 501(c)(18) plan; or a Code section 132(f)(4) qualified transportation fringe benefit plan. In conducting testing to determine compliance with nondiscrimination requirements with respect to contributions and benefits, the Plan Administrator shall take into account a participant's annual compensation only up to the amount specified in Code section 401(a)(17), as adjusted for cost-of-living increases in accordance with Code section 401(a)(17)(B) Dependent Dependent means a qualifying child or a qualifying relative as described herein and as further defined in Code section 152. (a) Qualifying Child A qualifying child means an individual who is: (i) the participant's child or stepchild, grandchild (or descendent thereof), sibling or step-sibling, or niece or nephew; year; (ii) residing with the participant for more than one-half of the calendar (iii) less than 19 years of age as of the end of the calendar year or less than 24 years of age as of the end of the calendar year and attending on a full-time basis a school maintaining a regular faculty and an established curriculum for at least 5 months during such year; and A-2

17 (iv) not providing over one-half of his own support for the calendar year. An individual who meets all of the above requirements but exceeds the age requirement is a qualifying child if the individual is permanently and totally disabled as defined in Code section 22(e)(3). Notwithstanding the foregoing, for purposes of any group health plan, a Qualifying Child shall include any child (as defined in Code section 152(f)(1)) of the Participant who as of the end of the taxable year has not attained age 27. (b) Qualifying Relative A qualifying relative means an individual satisfying the following requirements of (A) or (B) and (C) and (D). (i) The individual is the participant's child or stepchild, grandchild (or descendent thereof), sibling or step-sibling, parent or stepparent, grandparent (or ancestor thereof), niece or nephew, aunt or uncle, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law. (ii) In the alternative, the individual is an unrelated person (not the participant's spouse) whose principal residence is with the participant and who is a member of the participant's household. (iii) The participant provides over one-half of the individual's support for the calendar year. (iv) The individual is not a qualifying child of the participant (or any other person) as determined under Section 1.3(a)(1) for the calendar year. For the limited purpose of determining whether a required premium is payable before or after tax with respect to an included employee benefit plan that is not a group health plan, an individual shall not constitute a qualifying relative unless, in addition to satisfying the preceding requirements, his gross income for the calendar year is less than the exemption amount as defined in Code section 151(d). This additional requirement shall not apply if the Code exempts dependents from this requirement under the provisions applicable to the particular included employee benefit plan. (c) Effect of halfblood, adoption, and divorce The terms brother, sister, and sibling include a brother or sister by the halfblood. In determining whether any of these relationships exists, a legally adopted child of an individual (and a child who is a member of an individual's household, if placed with such individual by an authorized placement agency for legal adoption by such individual), or a foster child of an individual (if such child has as his principal place of abode the individual's home and is a member of the individual's household), shall be treated as a child of such individual by blood. Any child of divorced parents to whom Code section 152(e) applies shall be treated as a dependent of both parents. (d) Applicability to Domestic Partner The term dependent shall include the domestic partner who satisfies the qualifying relative requirements with respect to the employee-participant. Dependent shall not include the domestic partner who does not meet the qualifying relative requirements. A child of the domestic partner who is not the A-3

18 child of the participant may satisfy either the qualifying child or the qualifying relative requirements, provided the domestic partner does not claim the child as a dependent for tax purposes COBRA Dependent For the purpose of the COBRA continuation coverage rights, dependent means: (a) A qualifying child of the employee or a dependent child as otherwise defined under the applicable included employee benefit plan. (b) An unmarried child of the employee who has exceeded the applicable age restriction if such child: (i) was a dependent under Paragraph (1) on the date he attained the specified age for loss of coverage; and (ii) was prior to attainment of such age and has continuously remained mentally or physically handicapped and incapable of earning a living; provided that such handicap and incapacity is certified to the Plan Administrator on the form provided no later than 60 days after such child's attainment of the age specified by the applicable age restriction and at such other times as the Plan Administrator shall determine. (c) An unmarried child of the employee who has exceeded the applicable age restriction but is eligible for coverage due to his status as a student if the employee certifies to the Plan Administrator on the form provided and at such times prescribed by the Plan Administrator that: (i) such child is attending on a full-time basis a school maintaining a regular faculty and an established curriculum and (ii) such child is not providing over one-half of his own support for the calendar year in which the plan year begins. (d) Child shall include a child who is born to or placed for adoption with the covered employee during the period of continuation coverage If the definition of dependent under an included employee benefit plan differs from Section 2.4(a), the definition provided under such plan shall control with respect to that plan Eligible Dependent for Dependent Care Reimbursement Account purposes means any individual who is: (a) a qualifying child of the employee who is under the age of 13; or (b) a qualifying child of the employee who is over the age of 12, a qualifying relative of the employee (including the domestic partner or a child of the domestic partner A-4

19 meeting the requirements of a qualifying relative) whose gross income for the calendar year is less than the exemption amount as defined in Code section 151(d), or the spouse of the employee who: (i) is physically or mentally incapable of caring for himself and (ii) both resides with the employee for more than one-half of the calendar year and regularly spends at least eight hours each day in the employee's household Dependent Care Expenses Dependent Care Expenses means expenses incurred by an employee that: (a) are incurred for the care of an eligible dependent of the employee or for related household services; (b) are paid or payable to a Dependent Care Service Provider; and (c) are incurred to enable the employee to be gainfully employed for any period for which there are one or more eligible dependents with respect to the employee. Dependent care expenses shall include expenses incurred for services outside the employee's household for the care of an eligible dependent, excluding the cost of a camp where the eligible dependent stays overnight. Dependent care expenses shall be deemed to be incurred at the time the services to which the expenses relate are rendered Dependent Care Reimbursement Account Dependent Care Reimbursement Account means the account described in Article VI hereof Dependent Care Service Provider Dependent Care Service Provider means a person who provides care or other services described in Section 2.5. Such term shall include a dependent care center only if it: complies with all applicable governmental regulations; provides care for more than six individuals (other than individuals who reside at the facility); and receives a fee, payment, or grant for providing services for any of the individuals (regardless of whether such facility is operated for profit). Dependent Care Service Provider shall not include a related individual with respect to whom the employee or his spouse or domestic partner is entitled to a deduction under Code section 151(c) as a dependent or a child (including a stepchild or foster child) of the employee under the age of 19 as of the last day of the calendar year Effective Date Effective Date of the Section 125 Plan is July 1, A-5

20 The effective date of this amendment and restatement is January 1, 2014; provided, however that the Section 125 Plan provisions addressing the Heroes Earnings Assistance and Relief Tax Act of 2008 (HEART) shall be effective as of January 1, 2009 or as of such later date as specified herein, the Section 125 Plan provisions required to comply with the regulations issued under Code section 125 as published August 6, 2007 shall be effective for plan years beginning on or after January 1, 2009, the Section 125 Plan provisions required to comply with the American Recovery and Reinvestment Act of 2009 shall be effective February 17, 2009, the Section 125 Plan provisions required to comply with the Children's Health Insurance Program Reauthorization Act of 2009 shall be effective April 1, 2009, the Section 125 Plan provisions required to comply with the Genetic Information Non-Discrimination Act of 2008 (GINA) shall be effective for plan years beginning on or after May 21, 2009, and the Section 125 Plan provisions required to comply with Michelle's Law shall be effective for plan years beginning on or after October 9, 2009, except as specified otherwise in this Section 125 Plan or in said Act or Regulation Employee Employee means any common law employee of the Employer. The term does not include a self-employed individual if the Employer is a sole proprietorship or a partnership nor does it include a 2% shareholder or his spouse if the Employer is an S corporation Employer Employer means WellSpan Health, a corporation with its principal place of business in the Commonwealth of Pennsylvania or any successor entity by merger, purchase, consolidation, or otherwise; or an organization affiliated with the Employer that assumes the obligations of this Section 125 Plan with respect to its employees by becoming a party to this Section 125 Plan Employer for Compliance Testing For purposes of determining whether the plan satisfies the applicable nondiscrimination requirements, Employer shall mean the employer that adopts this plan as set forth in Subsection (a), and all members of a controlled group of corporations (as defined in Code section 414(b)), all commonly controlled trades or businesses (as defined in Code section 414(c)) or affiliated service groups (as defined in Code section 414(m)) of which the adopting employer is a part, and any other entity required to be aggregated with the employer pursuant to regulations under Code section 414(o) ERISA The Employee Retirement Income Security Act of 1974, as amended Health Care Reimbursement Account Health Care Reimbursement Account means the account described in Article V hereof A-6

21 2.13.Highly Compensated Highly Compensated Individual means, for purposes of determining that the Section 125 Plan as a whole is nondiscriminatory, a participant or individual who is one of the following: (a) an officer of the Employer during the preceding plan year (or the current plan year in the case of the employee's first year of employment); (b) a more than 5% owner of the voting power or value of all classes of stock of the Employer (determined without attribution) at any time during the preceding or current plan year; (c) an employee who during the preceding plan year (or the current plan year in the case of the employee's first year of employment); (i) had compensation from the Employer in excess of the amount specified in Code section 414(q)(1)(B), as adjusted, and (ii) if the Plan Administrator elects the application of this Subparagraph for the plan year, was in the top-paid group of employees for such year. For this purpose, an employee is in the top-paid group of employees for any plan year if such employee is in the group consisting of the top 20% of the employees when ranked on the basis of compensation paid during such year; or (d) a spouse or dependent (as defined in Section 2.4(a)) of an individual described in Paragraph (1), (2), or (3) above Health Care Reimbursement Account Highly Compensated Individual For purposes of determining that the Health Care Reimbursement Account is nondiscriminatory and, therefore, a non-taxable benefit, a highly compensated individual is an individual who at any time during the current plan year is: (a) one of the 5 highest paid officers of the Employer; (b) a more than 10% owner of the value of all classes of stock of the Employer (applying the constructive ownership rules of Code section 318, and applying the principles of Code section 318, for an unincorporated entity); or (c) among the highest paid 25% of all employees (including the 5 highest paid officers, but excluding employees who are not participants and who are permitted to be excluded under Code section 105(h)(3)(B) because they have not completed 3 years of service, have not attained age 25, are part-time or seasonal employees, are covered by a collective bargaining agreement, or are nonresident aliens) Dependent Care Reimbursement Account Highly Compensated Employee For purposes of determining that the Dependent Care Reimbursement Account is nondiscriminatory, a highly compensated employee is any employee who: A-7

22 (a) was a more than 5% owner of the Employer (applying the constructive ownership rules of Code section 318, and applying the principles of Code section 318, for an unincorporated entity) at any time during the current plan year or the look-back year; or (b) for the look-back year (i) had compensation from the Employer in excess of the amount specified in Code section 414(q)(1)(B), as adjusted, and (ii) if the Plan Administrator elects the application of this Subparagraph for such look-back year, was in the top-paid group of employees for such lookback year. For this purpose, an employee is in the top-paid group of employees for any look-back year if such employee is in the group consisting of the top 20% of the employees when ranked on the basis of compensation paid during such look-back year. The look-back year is the twelve-month period immediately preceding the current plan year. The term highly compensated employee also includes any former employee who separated from service (or has a deemed separation from service, as determined under Treasury regulations) prior to the plan year, performs no service for the employer during the plan year, and was a highly compensated employee either for the separation plan year or any plan year ending on or after his 55th birthday, based on the applicable rules in effect for such plan year. For purposes of determining whether the plan satisfies the nondiscrimination requirements of Code section 129, Employer shall mean the employer that adopts this plan and all members of a controlled group of corporations (as defined in Code section 414(b)), all commonly controlled trades or businesses (as defined in Code section 414(c)) or affiliated service groups (as defined in Code section 414(m)) of which the adopting Employer is a part, and any other entity required to be aggregated with the Employer pursuant to regulations under Code section 414(o) Determination of Highly Compensated The Plan Administrator shall make the determination of who is highly compensated Included Employee Benefit Plans Included Employee Benefit Plans means the employee welfare benefit programs established by the Employer for the benefit of its employees: Medical Program Dental Program Vision Program Flexible Spending Accounts A-8