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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 33 PART V. HEALTH FLEXIBLE SPENDING ACCOUNT 5.1 What benefits are provided? The Plan permits you to elect to receive reimbursement for some or all of your uninsured medical and dental expenses under the Health Flexible Spending Account ("Health FSA"). Under the Health FSA, you provide a source of pre-tax dollars by entering into a salary reduction agreement with your Employer. You may also use any available Employer contributions. Those pre-tax dollars will be used to reimburse you for your Eligible Expenses. You save Social Security and income taxes on the amount of your salary reduction for medical expenses. The coverage provided through the Health FSA is subject to the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). The Health FSA is intended to be an excepted benefit under the HIPAA portability ru les. Accordingly, neither the HIPAA portability rules nor the mandates of the Patient Protection and Affordable Care Act, as amended, including the preventive care mandate, apply to the Health FSA. 5.2 How do I become a Participant? To become a Participant in the Health FSA, you must first become a Participant in the Cafeteria Plan. You must also satisfy the eligibility requirements for the Health FSA. The Health FSA’s eligibility requirements are the same as the eligibility requirements for the Cafeteria Plan as described in Section 1.4. If you satisfy those requirements, you become a Participant in the Health FSA by electing benefits under the Health FSA during your initial or subsequent annual enrollment periods. NOTE: Participation in this Health FSA will make you ineligible to participate in the HSA Contribution Feature, and will make you and any of your dependents covered by the Health FSA ineligible to make or receive contributions to a health savings account. 5.3 What is my account? If you elect benefits under the Health FSA, an account will be established in your name to keep a record of the benefits to which you are entitled. When you complete the election form, you specify the amount of benefits you wish to receive. These benefits may be funded by allocation of any available Employer contribution and, to the extent the Employer contribution is insufficient, with pre-tax dollars through salary reduction contributions. The full amount of your election under the Health FSA will be available at any time during the Plan Year, reduced by the amount of prior reimbursements under the Health FSA received during the Plan Year. The account is a bookkeeping account only. Benefits under the Health FSA are paid from the Employer’s general assets. There is no trust. 5.4 What are the maximum reimbursements I may receive? The maximum amount of medical expense reimbursements is the IRS maximum per Plan Year. To receive the full maximum, you must include any Employer contribution allocated to the Health FSA. For a short Plan Year, the maximum is unchanged for the number of pay periods remaining in the Plan Year. If you enter the plan mid-year, this maximum amount is unchnaged for the number of pay periods remaining in the Plan Year. 5.5 What is an "Eligible Expense"?