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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 />45 <br />ARTICLE XIII. <br />HSA CONTRIBUTION FEATURE <br />13.1 Separate Written Plan. For purposes of Section 223 of the Code, this Article shall constitute a <br />separate written plan. To the extent necessary, other provisions of the Plan are incorporated by <br />reference. This HSA Contribution Feature and the underlying HSAs are not subject to ERISA. <br />13.2 Purpose. The purpose of this Article is to provide Participants an opportunity to make HSA <br />contributions through this Plan. <br />13.3 Definitions. <br />(a) HSA means a health savings accounts under Code Section 223 established and owned by <br />a Participant to which contributions are made under this portion of the Plan. The <br />Employer does not sponsor a Participant’s HSA and a Participant’s HSA is not an <br />employer-sponsored group health plan. Unless indicated otherwise in the Adoption <br />Agreement, for administrative convenience, an HSA must be established only at the <br />trustee/custodian selected by the Employer. <br />(b) HSA Contribution Feature means the portion of the Plan described in this Article, <br />which consists of contributions to a Participant’s HSA throug h salary reduction and <br />Employer Contributions, if any. <br />(c) High Deductible Health Plan means, unless otherwise specified in the Adoption <br />Agreement, a “qualifying high deductible health plan” under Section 223(c)(2) of the <br />Code. <br />(d) Permitted Insurance or Permitted Coverage means: <br />(1) Insurance in which substantially all of the coverage relates to liabilities incurred <br />under workers’ compensation laws, tort liabilities, liabilities related to ownership <br />or use of property, or similar liabilities as specified by the IRS; <br />(2) Insurance for specified disease or illness (e.g., cancer insurance); <br />(3) Insurance that pays a fixed amount per day (or other period) of hospitalization <br />(e.g., hospital indemnity insurance); <br />(4) Coverage for accidents, disability, dental care, vision care, preventive care, or <br />long-term care; <br />(5) Some medical reimbursement accounts and health reimbursement arrangements <br />(“HRAs”) (e.g., limited scope medical reimbursement accounts and HRAs, <br />suspended HRAs, post-deductible medical reimbursement accounts and HRAs, <br />and retirement HRAs); and <br />(6) Some wellness programs and employee assistance programs (e.g., those that do <br />not provide significant benefits in the nature of non-preventive medical care or <br />treatment).