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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 21 PART III. GROUP DENTAL BENEFITS 3.1 What benefits are provided? An important feature of the Cafeteria Plan is the opportunity it provides to pay your share of the cost of dental coverage on a pre-tax basis. The dental coverage is provided through your Employer and is referred to herein as the “Group Dental Plan.” Your share of the cost for that coverage is paid with the allocation of Employer contributions and pre-tax dollars through salary reduction under this portion of the Cafeteria Plan. The Group Dental Plan is described in separate materials which have been provided to you either directly by the carrier (the insurance company or DMO) or by your Employer. Those descriptive materials are incorporated into this summary description by reference. If you have not been provided this information, you should contact the Plan Administrator. The benefits under the Group Dental Plan are provided in accordance with the applicable Group Dental Plan documents. The Group Dental Plan is subject to the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). 3.2 How do I become a Participant? To participate in this portion of the Cafeteria Plan, you must first enroll in the Group Dental Plan. You may select coverage under the Group Dental Plan for just yourself, or you may select coverage for yourself and others who are eligible for coverage under the terms of the Group Dental Plan. Please refer to the contract or policy governing the Group Dental Plan for information regarding who is eligible for coverage under that plan and how to enroll in that plan. If you have enrolled in the Group Dental Plan, then you may participate in this portion of the Cafeteria Plan if you satisfy the general eligibility requirements for the Cafeteria Plan described in Section 1.4. If you satisfy those requirements, you will automatically become a Participant in this portion of the Cafeteria Plan for purposes of paying your share of the cost of Group Dental Plan coverage unless you elect not to do so. 3.3 How is my cost of group dental coverage paid? If you participate in this portion of the Cafeteria Plan, your cost of coverage under the Group Dental Plan is generally paid by allocation of any available Employer contribution and, to the extent the Employer contribution is insufficient, with pre-tax dollars through salary reduction. NOTE: You must be a Participant in the Cafeteria Plan for your portion of the premiums to be paid pre-tax. If you pay the cost of Group Dental Plan coverage through this portion of the Cafeteria Plan and you have enrolled an individual who is not your spouse or “tax dependent” (as those terms are defined in Section 1.16), then the taxation of that individual’s coverage will be handled as described in Section 1.16.