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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 29 to any fees applicable to participate in the program, limitations as to card usage, the Plan’s right to withhold and offset ineligible claims, etc. You must agree to abide by the terms of the program each Plan Year. A Cardholder Agre ement will be provided to you. The card will be turned off effective the first day of each Plan Year if you do not affirmatively agree to abide by the terms of the program for the new Plan Year. The Cardholder Agreement is part of the terms and condition s of your Plan and this summary. (2) The balance of the card is limited. The balance of the card is limited to the balance of your account. (3) The card will be turned off when employment or coverage terminates. The card will be turned off when you terminate employment or coverage under the Plan. (4) You must certify proper use of the card. As specified in the Cardholder Agreement, you certify during the applicable Plan Year that the amounts in your account will only be used for Eligible Expenses and that you have not been reimbursed for the expense and that you will not seek reimbursement for the expense from any other source. Failure to abide by this certification will result in termination of card use privileges. (5) Expenses must be substantiated. To ensure that expenses for which the card is used are Eligible Expenses, the following procedures must be followed: (A) At the beginning of each Plan Year or, if later, upon beginning participation, you must pay the initial Eligible Expense to the dependent care provider and submit a paper claim to the Plan (as described above) for such expense. (B) Upon substantiation by the Claims Administrator of the initial Eligible Expense, the Plan will make available through the electronic payment card an amount equal to the lesser of: (i) the amount of the approved claim, or (ii) the balance of your account as of that date. (C) The electronic payment card may then be used to pay for subsequently incurred Eligible Expenses. (D) The amount available through the electronic payment card may be increased only as additional dependent care expenses are incurred and substantiated via submission of a paper claim, except as provided in paragraph (E) below. In no case will the amount available through the electronic payment card exceed the contributions to your account for the Plan Year to date minus the amount of expenses previously reimbursed during such Plan Year (whether such reimbursement was made in cash or by crediting the electronic payment card). (E) Dependent care expenses may be automatically substantiated without submission of a paper claim only as provided in this paragraph (E). If (i) an electronic payment card transaction collects information that matches information for a previously approved paper claim with respect to the dependent care provider, and (ii) the amount of the electronic payment card transaction is equal to or less than the previously approved paper