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© 2019 Hitesman & Wold, P.A. MEDSURETY, LLC Cafeteria Plan 1-888-816-4234, www.medsurety.com Basic Plan Document 43 ARTICLE XII. GROUP DENTAL BENEFITS 12.1 Separate Written Plan. For purposes of Sections 105 and 106 of the Code, this Article shall constitute a separate written plan providing for the dire ct payment of Insurance Premiums. To the extent necessary, other provisions of the Plan are incorporated by reference in this document. 12.2 Purpose. The purpose of this Article is to provide Participants the opportunity to make pre-tax payments for the cost of Group Dental Coverage through this Plan. The Employer provides Group Dental Coverage through one or more “plans” within the meaning of Sections 105 and 106 of the Code. 12.3 Definitions. (a) Dependent means an individual (e.g., Spouse, child, domestic partner, etc.) who qualifies as a “dependent” under the terms and conditions of the applicable plan document governing the Group Dental Coverage. (b) Group Dental Coverage means the dental coverage made available by the Employer to which the Insurance Premiums relate. It does not include individual insurance policies. (c) Highly Compensated Individual means an individual who is highly compensated as defined in Section 105(h)(5) of the Code. (d) Insurance Contract means (1) any insurance contract secured from an Insurer authorized to do business in the state in which such contract is issued, which has been obtained for the purpose of providing Group Dental Coverage; or (2) ) a self-insured plan administered by a third party providing Group Dental Coverage. (e) Insurance Premiums means the amount that must be paid on a periodic basis in return for coverage under the Insurance Contract, which may include premiums for continuation coverage provided under applicable federal or state law . 12.4 Terms, Conditions and Limitations. The Employer shall secure the necessary Insurance Contracts for the provision of Group Dental Coverage. Coverage under the Group Dental Coverage shall begin, benefits shall be provided, and coverage shall terminate in accordance with the applicable Insurance Contracts. Such Insurance Contracts are expressly inc orporated into and made part of this Plan. 12.5 Payments. The Plan Administrator shall make Insurance Premium payments for the Group Dental Coverage on behalf of the Participant in an amount necessary to provide the benefit applicable to the Participant under this portion of the Plan for the applicable Plan Year. Such payments shall be made from Employer Contributions, if any, provided by the Employer under the Plan and, if necessary, contributions made in accordance with the salary reduction arrangement and other arrangements applicable to the Participant under the terms of the Plan. The appropriate portions shall depend on the coverage elected by the Participan t. The Plan Administrator shall also make such payments on behalf of the Participant’s Dependents who are enrolled in the Group Dental Coverage. To the extent a Dependent is provided coverage under the Group Dental Coverage and that Dependent is not the Participant’s Spouse or Tax Dependent, the tax consequence of such coverage shall be addressed as described in Section 4.2. 12.6 Nondiscrimination. To the extent the Group Dental Coverage is subject to Section 105(h) of the Code, it shall not discriminate in favor of Highly Compensated Individuals as to eligibility to