Article XV: Long Term Disability Benefits Available Not Available 15.6 Insurance Premiums paid through the Plan are: Included in the gross income (after-tax). Participant’s Excluded from the gross income (pre-tax). Participant’s Article XVI: Short Term Disability Benefits Available Not Available 16.6 Insurance Premiums paid through the Plan are: Included in the gross income (after-tax). Participant’s Excluded from the gross income (pre-tax). Participant’s Article XVII: Individual Premium Plan Available Not Available The Claims Run-Out Period refers to the period of time, after the Plan Year ends, during which Participants may submit eligible expenses (i.e., premium costs) incurred during the Plan Year for payment. 17.3(a) Claims Run-Out Period means: The 60-day period following the end of Plan Year. The 90-day period following the end of Plan Year. Other (Describe): Use the option to restrict or expand the definition in the Basic Plan Document. The Basic Plan “Other” Document defines as a which is the definition described above in Section “Dependent” “Tax Dependent,” 11.3(b). Expanding the definition creates a tax issue. See Section 17.10 of the Basic Plan Document. 17.3(b) Dependent means: As provided in the Basic Plan Document. Other (Describe): Caution: The definition of Insurance Contract should be limited to coverages other than major medical coverage (e.g., dental, vision, accident, indemnity, diseases-specific, etc.). Including major medical insurance policies in this plan will likely cause the plan to violate the ACA. Insurance Contract means: 17.3(g) As provided in the Basic Plan Document (i.e., all accident and health coverages except major medical coverage). All accident and health coverages (except as provided in the Basic Plan Document) other than coverages offered by the Employer on a group basis. Other (Describe): If the second option is selected, enter the number of days during which a former Participant may submit claims.
Article XV: Long Term Disability Benefits Available Not Available 15.6 Insurance Premiums paid through the Plan are: Included in the Participant’s gross income (after-tax). Excluded from the Participant’s gross income (pre-tax). Article XVI: Short Term Disability Benefits Available Not Available 16.6 Insurance Premiums paid through the Plan are: Included in the Participant’s gross income (after-tax). Excluded from the Participant’s gross income (pre-tax). Article XVII: Individual Premium Plan Available Not Available The Claims Run-Out Period refers to the period of time, after the Plan Year ends, during which Participants may submit eligible expenses (i.e., premium costs) incurred during the Plan Year for payment. 17.3(a) Claims Run-Out Period means: The 60-day period following the end of Plan Year. The 90-day period following the end of Plan Year. Other (Describe): Use the “Other” option to restrict or expand the definition in the Basic Plan Document. The Basic Plan Document defines “Dependent” as a “Tax Dependent,” which is the definition described above in Section 11.3(b). Expanding the definition creates a tax issue. See Section 17.10 of the Basic Plan Document. 17.3(b) Dependent means: As provided in the Basic Plan Document. Other (Describe): Caution: The definition of Insurance Contract should be limited to coverages other than major medical coverage (e.g., dental, vision, accident, indemnity, diseases-specific, etc.). Including major medical insurance policies in this plan will likely cause the plan to violate the ACA. 17.3(g) Insurance Contract means: As provided in the Basic Plan Document (i.e., all accident and health coverages except major medical coverage). All accident and health coverages (except as provided in the Basic Plan Document) other than coverages offered by the Employer on a group basis. Other (Describe): If the second option is selected, enter the number of days during which a former Participant may submit claims.
flexiblebenefitplanadoptionagreement.docx