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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 />52 <br />14.15 HIPAA. The Limited Scope Health Flexible Spending Account shall comply with the Privacy Rules <br />and Security Rules under HIPAA (if applicable) as further provided in Article XXII. <br />14.16 Patient Protection and Affordable Care Act. The Limited Scope Health Flexible Spending <br />Account is intended to be an excepted benefit under HIPAA because: <br />(a) All Participants of this Optional Benefit are eligible for Group Medical Coverage, and the <br />maximum reimbursement available does not exceed the greater of (1) two times the <br />Participant’s salary reduction election or (2) the Participant’s salary reduction election <br />plus $500; or <br />(b) Limited Scope Medical Expense is defined to include only expenses for dental and visi on <br />care, in which case the Health Flexible Spending Account provides only HIPAA excepted <br />benefits. <br />Accordingly, certain provisions of the Patient Protection and Affordable Care Act, as amended, <br />including the preventative care mandate, do not apply to the Limited Scope Health Flexible <br />Spending Account. <br />14.17 Further Limitations on Benefits. <br />(a) This Article does not cover expenses incurred for any loss caused by or resulting from <br />injury or disease for which benefits are payable under any worker’s compensation law or <br />other employer, union, association or governmental sponsored group insurance plan. <br />(b) This Article does not cover expenses incurred for any loss caused by or resulting from <br />injury or disease for which benefits are received by the Participant, the Participant ’s <br />Spouse or the Participant’s Dependent under any health and accident insurance policy or <br />program, whether or not premiums are paid by the Employer or the Participant, the <br />Participant’s Spouse or the Participant’s Dependent child. <br />(c) Amounts reimbursed under a dependent care assistance program described in Section <br />129 of the Code shall not be reimbursed under this Plan. <br />(d) Other limitations, if any, shall be set forth in the Adoption Agreement. <br /> <br /> <br />