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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 />39 <br />accordance with the Cafeteria Plan Regulations, the Plan reimburses Medical Expenses for <br />orthodontia care in advance. <br />11.7 Reimbursement of Expense. The Participant shall be reimbursed as specified in Section 6.8 <br />from the Participant’s Account for eligible Medical Expenses incurred during the applicable Plan <br />Year and the Grace Period, if applicable, for which the Participant submits the documentation <br />required under Article VI. An amount up to the sum of the Participant’s Election and the amount <br />of carryover, if any, and reduced as of any particular time for prior reimbursements for the same <br />Plan Year, and the Grace Period, if applicable, shall be available for reimbursement at all times <br />during the Plan Year, and the Grace Period, if applicable. Claims for reimbursement within a Plan <br />Year, and Grace Period, if applicable, must be submitted prior to the close of the Claims Run -Out <br />Period for such Plan Year. <br />In no case shall a payment be made which exceeds the balance in the Participant’s Account at <br />the time reimbursement is processed. If a claim for reimbursement exceeds the balance in the <br />Participant’s Account, the excess part of the claim will be denied. Except as provided in Section <br />11.13(b), under no circumstances (a) will any balance remaining in a Participant’s Account at the <br />end of the Plan Year, and the Grace Period, if applicable, be carried over to the next Plan Year, or <br />(b) will an otherwise eligible Medical Expense be carried over to the next Plan Year. <br />11.8 Annual Maximum. The maximum reimbursement a Participant may receive for a Plan Year <br />under this portion of the Plan shall be the dollar amount indicated in the Adoption Agreement. <br />The maximum reimbursement amount applies to the Participant, Spouse, and Dependent children <br />on an aggregate basis, not an individual basis. For Plan Years that are less than 12 months, <br />unless indicated otherwise in the Adoption Agreement, this maximum shall be pro-rated by <br />multiplying the applicable maximum by a fraction with a numerator of the number of months in <br />the short Plan Year and with a denominator of 12. For Pa rticipants beginning participation in the <br />Plan mid-Plan Year, unless indicated otherwise in the Adoption Agreement, this maximum shall <br />be pro-rated by multiplying the applicable maximum by a fraction with a numerator of the <br />number of complete calendar months remaining in the Plan Year at the time the Participant <br />begins participation and with a denominator of 12. Notwithstanding the foregoing, salary <br />reduction contributions to this portion of the Plan shall not exceed any maximum imposed under <br />applicable law. <br />11.9 Reimbursement Upon Termination of Participation. If an individual ceases to be a <br />Participant in this portion of the Plan, coverage shall cease (which means that reimbursements <br />shall cease) unless benefits under the Plan are continued as provided in Sec tion 11.14, if <br />applicable. If coverage ceases, reimbursements for eligible Medical Expenses incurred before <br />participation terminated will continue to be made as provided in the Adoption Agreement. <br />11.10 Participant’s Death. In the event a Participant dies having incurred an eligible Medical <br />Expense (a) which would have been reimbursable out of the Partici pant’s Account had the <br />Participant not died, and (b) for which a person or the Participant’s estate has paid for or <br />assumed liability for the expense, reimbursement may be made to that person or the estate for <br />that payment or assumption. The remainder of the Participant’s Account shall be forfeited in <br />accordance with Section 5.7. <br />11.11 Nondiscrimination. The Health Flexible Spending Account shall not discriminate in favor of <br />Highly Compensated Individuals as to eligibility to participate or benefits. If the Pl an <br />Administrator determines that the Health Flexible Spending Account is or may be discriminatory, <br />the Plan Administrator may take action permitted by law to a void such result as provided in <br />Section 6.16.