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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 4 (a) observe all Plan rules and regulations; (b) agree to inquiries by the Plan Administrator with respect to any physician, hospital, or other provider of medical care or other services covered by this Cafeteria Plan; (c) submit to the Plan Administrator all notifications, reports, bills, and other information that the Employer may reasonably require; and (d) agree to repay any overpayments or incorrect payments you receive from the Cafeteria Plan. Participation continues until you elect not to participate, you are no longer an Eligible Employee, the Cafeteria Plan terminates, your contributions cease, or your participation is terminated for cause. 1.6 How do I enroll and make benefit elections? (a) Generally. The Plan Administrator will provide you with the forms necessary to enroll and make elections, including information about the costs of the various Optional Benefits. (b) Initial Enrollment. If you become an Eligible Employee other than at the start of a P lan Year, the initial enrollment period takes place at the time you become eligible to participate as described in Section 1.5. If you do not make an election during the initial enrollment period, you must generally wait until the next annual enrollment period to begin participation. However, if you have enrolled in the Group Medical Plan, Group Dental Plan, Dependent Care Assistance Plan, Flexible Spending Account, Limited Purpose Flexible Spending Account or the Health Savings Account Contribution Feature, you will be deemed to have elected to pay through salary reduction any portion of the cost for which you are responsible under such plans. This will occur unless you specifically elect not to participate with respect to such coverage. Such an election must be in writing and must be received by the Plan Administrator prior to the date your participation in the Cafeteria Plan would otherwise begin. Furthermore, if you fail to make an election, the Employer contribution will be considered same as a Waiver of Medical, in which case the remaining Employer Contribution of $180.16 can be used for Dental, FSA, DCAP or taken as cash. (c) Annual Enrollment. The annual enrollment period for the coming Plan Year begins and ends on or before the last day of each Plan Year. If you do not make an election during the annual enrollment period, you will be deemed to have elected to not participate in the Cafeteria Plan. However, if you have enrolled the Group Medical Plan, Group Dental Plan, Dependent Care Assistance Plan, Flexible Spending Account, Limited Purpose Flexible Spending Account or the Health Savings Account Contribution Feature, you will be deemed to have elected to pay through salary reduction any portion of the cost for which y ou are responsible under such plans. This will occur unless you specifically elect not to participate with respect to such coverage. Such an election must be in writing and must be received by the Plan Administrator prior to the first day of the Plan Year. Furthermore, if you fail to make an election, the Employer contribution will be considered the same as a Waiver of Medical - $180.16 - Can be used for Dental, FSA, DCAP or taken as cash. NOTE: Enrollment forms received after the close of the enrollment period shall be void. CAUTION: With limited exceptions, once made, elections remain in effect for the entire Plan Year. The exceptions are described below at Question 1.8.