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© 2019 Hitesman & Wold, P.A. MEDSURETY, LLC Cafeteria Plan 1-888-816-4234, www.medsurety.com Basic Plan Document 42 11.16 Patient Protection and Affordable Care Act. The Health Flexible Spending Account is intended to be an excepted benefit under HIPAA because: (a) All Participants of this Optional Benefit are eligible for Group Medical Coverage, and (b) The maximum reimbursement available does not exceed the greater of (1) two times the Participant’s salary reduction election or (2) the Participant’s salary reduction elec tion plus $500. Accordingly, certain provisions of the Patient Protection and Affordable Care Act, as amended, including the preventative care mandate, do not apply to the Health Flexible Spending Account. 11.17 Further Limitations on Benefits. (a) This Article does not cover expenses incurred for any loss caused by or resulting from injury or disease for which benefits are payable under any worker’s compensation law or other employer, union, association or governmental sponsored group insurance plan. (b) This Article does not cover expenses incurred for any loss caused by or resulting from injury or disease for which benefits are received by the Participant, the Participant ’s Spouse or the Participant’s Dependent under any health and accident insurance policy or program, whether or not premiums are paid by the Employer or the Participant, the Participant’s Spouse or the Participant’s Dependent child. (c) Amounts reimbursed under a dependent care assistance program described in Section 129 of the Code shall not be reimbursed under this Plan. (d) A Participant of the Health Flexible Spending Account is not eligible for contributions to a health savings account (“HSA”) (within the meaning of Section 223 of the Code) during the Plan Year. (e) Other limitations, if any, shall be set forth in the Adoption Agreement.