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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 12 be effective no later than the day immediately following the last day for which the coverage under the Group Medical Plan was effective (i.e., there is no break in coverage). The Plan Administrator may rely on your reasonable representation that the requirements of this paragraph (iii) are met. (e) Reduction in Hours Without Loss of Eligibility. If you have made an election to pay for Group Medical Plan coverage, you may revoke that election if the following conditions are satisfied: (1) You have been in an employment status under which you were reasonably expected to average at least thirty (30) hours of service per week; (2) You have experienced a change in employment status such that you will reasonably be expected to average less than thirty (30) hours of service per week after the change but nevertheless will remain eligible for the Group Medical Plan; (3) You cancel coverage under the Group Medical Plan in accordance with the requirements of that plan; and (4) You, and any related individuals who were also enrolled in the Group Medical Plan, have enrolled or intend to enroll in other medical coverage that provides minimum essential coverage and that will be effective no later than the first day of the second month following the month in which coverage under the Group Medical Plan ends. The Plan Administrator may rely on your reasonable representation that the requirements of this paragraph (4) are met. (f) Family and Medical Leave Act. If you take a leave governed by the Family and Medical Leave Act of 1993 (“FMLA”), you may revoke or change an election as may be provided for under the FMLA and the Employer’s FMLA policy required thereunder, provided the Employer is subject to FMLA. (g) Special Rule for HSA Contribution Feature . You may change your election with respect to the HSA Contribution Feature prospectively on at least a monthly basis. You may also revoke your election with respect to the HSA Contribution Feature prospectively if you become ineligible to make or have made HSA contributions under the HSA Contribution Feature. (h) Other. The Plan Administrator shall have the discretion to allow a change to , or termination of, an election to the extent such change or termination is the result of any other situation informally recognized by the IRS as providing an exception to the general rule that elections are irrevocable (e.g., corrections of mistakes, failure to satisfy underwriting). If the Plan Administrator determines before or during any Plan Year the Cafeteria Plan or an Optional Benefit may fail to satisfy any nondiscrimination requirement imposed by the Internal Revenue Code or other applicable law, the Plan Administrator may take such action as the Plan Administrator deems appropriate, under rules uniformly applicable to similarly situated Participants, to further compliance with such requirements or limitation. Such action may include, without limitation, a modification of your election downward with or without your consent. (i) Procedure for Requesting a Change. If a change in election is allowed under the foregoing rules, you must typically inform the Plan Administrator of your new election within thirty (30) days of the occurrence of the event allowing the change. Your election