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© 2019 Hitesman & Wold, P.A. MEDSURETY, LLC Cafeteria Plan 1-888-816-4234, www.medsurety.com Basic Plan Document 46 13.4 Eligibility for HSA Contributions. To be eligible to participate in the HSA Contribution Feature, the Employee must: (a) Be eligible to participate in this Plan under Section 3.1; (b) Be covered by the High Deductible Health Plan; (c) Not have any health coverage through the Employer other than Permitted Insurance, Permitted Coverage, or coverage under the High Deductible Health Plan; and (d) If provided in the Adoption Agreement, certify to the Plan Administrator (on a form provided by the Plan Administrator) that he/she is eligible to make contribut ions to an HSA upon the Participant’s initial Election to participate in the HSA Contribution Feature and periodically thereafter as requested by the Plan Administrator. 13.5 Contributions. (a) Employer Contributions. Employer Contributions, if any, will be contributed to the Participant’s HSA at the times established by the Employer. (b) Employee Contributions. Amounts withheld from a Participant’s Compensation pursuant to an agreement authorizing salary reduction with respect to this Optional Benefit shall be contributed to the Participant’s HSA as soon as administratively feasible. 13.6 Limits on Contributions. Except as otherwise provided in the Adoption Agreement, the maximum contribution a Participant may make through this HSA Contribution Feature shall be determined in accordance with the following rules: (a) General Limit. During a taxable year, contributions to the HSA may not exceed the statutory indexed amount applicable under Code § 223 . (b) Catch Up Contributions. An additional “catch-up” amount (determined on a monthly basis) can be contributed for eligible individuals who attain age 55 before the close of the taxable year. (c) Pro-rated limit if Not Eligible on December 1st. If a Participant ceases to satisfy the eligibility requirements described in Section 18.4 prior to December 1st of any calendar year, the contribution limit for that year shall be determined by multiplying 1/12 of the applicable limit by the number of months the first day of which the Participant had satisfied the eligibility requirements described in Section 18.4. The Employer shall not be required to take an corrective action in the event the amount of HSA contributions made by the Participant prior to the date on which he/she ceased to satisfy the eligibility requirements described in Section 18.4 exceed the pro-rated limit described herein (as adjusted under paragraph (e)). (d) Special Rule if Eligible on December 1st. If a Participant becomes eligible to make contributions under this HSA Contribution Feature (as provided in Section 18.4) during the taxable year and is eligible on December 1st of such year, the Participant shall be deemed to have been eligible for each month in such taxable year and may make HSA contributions up to the full annual limit. This special rule applies to all contrib utions made during the applicable taxable year, including contributions made prior to or after December 1st. Example: An Eligible Employee becomes eligible for HSA contributions on July 1st and remains eligible through December 1st. The Eligible Employee may begin making