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10-10-2022 Council Packet
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10-10-2022 Council Packet
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<br />© 2019 Hitesman & Wold, P.A. MEDSURETY, LLC <br />Cafeteria Plan 1-888-816-4234, www.medsurety.com <br />Basic Plan Document <br />24 <br />Administrator’s designee. The appeal shall state the specific reasons the Participant <br />believes he or she is entitled to benefits or greater or different benefits. <br />Within sixty (60) days after receipt of the appeal, the Plan Administrator, or Plan <br />Administrator’s designee, shall afford the Participant (and the Participant's counsel, if <br />any) an opportunity to present the Participant's position to the Plan Administrator, or <br />Plan Administrator’s designee, orally or in writing, and the Participant (or the Participant's <br />counsel) shall have the right to review the pertinent documents. <br />(c) Decision on Appeal. The Plan Administrator shall notify the Participant of its decision <br />on appeal in writing within said sixty (60) day period of said decision. If it is determined <br />that a person is not eligible for benefits or for full benefits the notice shall set forth: <br />(1) The specific reasons for the denial; <br />(2) A specific reference to the provision of the Plan on which the denial is based; <br />(3) A statement of the Participant’s right to review (on request and at no charge) <br />relevant documents and other information; <br />(4) If the Plan Administrator relied on “internal rule, guideline, protoc ol, or other <br />similar criterion” in making the decision, a description of the specific rule, <br />guideline, protocol, or other similar criterion or a statement that such a rule, <br />guideline, protocol, or other similar criterion was relied on and that a copy of <br />such rule, guideline, protocol, or other similar criterion will be provided free of <br />charge to you upon request; and <br />(5) If the Optional Benefit is subject to ERISA, a statement of the Participant’s right <br />to bring suit under ERISA § 502(a). <br />In the event of the death of a Participant, the same procedure shall be applicable to the <br />Participant's beneficiaries. <br />6.10 Authorization of Benefit Payments. The Plan Administrator shall issue directions to the <br />Employer concerning all benefits which are to be paid from the Employer’s assets, pursuant to <br />the provisions of the Plan, and shall warrant at the time the directions are provided that all such <br />directions are in accordance with the Plan. <br />6.11 Overpayments. If a payment for benefits is made by the Plan in excess of the benefit to which <br />a Participant is entitled under the Plan, the Plan shall have the right to recover such overpayment <br />from the Participant. Repayment of an overpayment is a condition of participation in the Plan. <br />6.12 Inability to Locate Payee. <br />(a) Entities Subject to ERISA. If benefits are due under this Plan and the Plan <br />Administrator is unable, after reasonable attempts to do so, to locate the Participant to <br />whom such benefits are payable, such benefits shall be forfeited in accordance with <br />Section 5.7. For purposes of the foregoing, the Plan Administrator shall be deemed to be <br />unable to locate a Participant if a check issued for benefits payable under the Plan has <br />been sent to the payee’s last known address and has not been cashed within twelve (12) <br />months of its date of issuance <br />(b) Entities Not Subject to ERISA: If benefits are due under this Plan and the Plan <br />Administrator is unable, after reasonable attempts to do so, to locate the Participant to <br />whom such benefits are payable, such benefits shall be handled in accor dance with
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