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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 36 If there are enough dollars credited to your Health FSA, you will be reimbursed for your Eligible Expenses according to the schedule established by the Plan Administrator. Claim Deadline. You may submit claims for reimbursement of Eligible Expenses incurred during the Plan Year for ninety (90) days following the end of that Plan Year. This period following the end of the Plan Year during which claims for reimbursement may be filed is referred to as the “claims run-out period.” Grace Period. You may submit claims for reimbursement of Eligible Expenses incurred after the Plan Year for up to sixty (60) days following the end of that Plan Year. This period following the end of the Plan Year during which claims for reimbursement may incurred is referred to as the “grace period.” (b) Electronic Payment Card Claims. The electronic payment card allows you to pay for Eligible Expenses at the time that you incur the expense. The electronic payment card works as follows: (1) You must make an election to use the card. In order to be eligible for the electronic payment card, you must agree to abide by the terms and conditions of the electronic payment card program as set forth herein and in the electronic payment cardholder agreement (the “Cardholder Agreement”), including agreeing 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 Agreement 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 conditions of your Plan and this Summary Plan Description. (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 coverage terminates. The card will be turned off when your coverage under the Health FSA terminates. (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 (i.e., medical care expenses incurred by you, your spouse, and your tax dependents), that you have not been reimbursed for the expense and that you will not seek reimbursement for the expense from any other source, and that you will obtain and retain a third party statement from the health care provider (e.g., receipt, invoice, et c.) each time you swipe the card. Failure to abide by this certification will result in termination of card use privileges. (5) Reimbursement under the card is limited to certain places where you purchase health care related items. Use of the card is limited to merchants who: (i) have health care related merchant category codes other than the drug store or pharmacies merchant category code; (ii) have the drug store or pharmacies merchant category code and with respect to whom 90% of the store’s gross receipts during the prior taxable year consisted of items that qualify as expenses for medical care under Section 213(d) of the Code (a “90% pharmacy”); or (iii) participate in an inventory information approval system developed by the