Benefit Plans Administrative Services BPAS 3/9/2020

• pharmacist; (b) the pharmacist assigns a prescription number and dispenses the over-the-counter drug or medicine in accordance with applicable law; (c)the pharmacy retains a record of the transaction, including the name on prescription, prescription number, date, and the amount of the purchase; (d)the pharmacy's records are accessible by the employer or its agent; (e) the debit card system does not allow over- the-counter drugs or medicines without a prescription number; and (f) the expense is substantiated in accordance with the standard rules described above in paragraph (6). (iii) At merchants having healthcare related merchant codes(other than merchants described in item ii above) if the expense is substantiated in accordance with the standard rules described above in paragraph (6). (8) A Participant shall repay the Plan for a payment with respect to any claim not substantiated (and therefore not eligible for reimbursement) as required above. The Plan shall handle unsubstantiated claims as required under the Code and applicable regulations. (9) The use of an electronic payment card does not constitute a "claim" under the claims procedures. 4.4 Incurred Expenses. An expense is "incurred" when the Participant is provided with the care giving rise to the Eligible Expense, not when the service is billed or paid. Reimbursement shall not be made for future projected expenses. To be reimbursable, the Participant must have incurred an Eligible Expense after his/her Entry Date. In addition, the Participant must have incurred the Eligible Expense after termination of employment and such other event identified in the Adoption Agreement(if any). Notwithstanding the foregoing, if a Participant with an HC Account balance is rehired by the Employer after having terminated employment,then any Eligible Expenses incurred by the Participant (or the Participant's Spouse or Dependents) during the Participant's period of reemployment by the Employer shall not be eligible for reimbursement under the Plan. The restriction on reimbursements described in the preceding sentence shall apply regardless of: (1) the length of the period of time between the initial separation from service and the reemployment; (2)the nature of the Participant's employment upon rehire(e.g.,whether the Participant is rehired on part-time, temporary, seasonal, etc. basis); and (3) any other factor (e.g., vesting status, the number of hours per week the Participant is reemployed to work, etc.). Upon such reemployed Participants subsequent termination of employment with the Employer, the Participant shall again become eligible to receive reimbursements from his or her HC Account for Eligible Expenses incurred after his or her reemployment ends. 4.5 Timing of Reimbursement. For claims made via a paper claim, Participants shall be reimbursed weekly. 4.6 Maximum Reimbursement. The maximum reimbursement a Participant may receive at any time shall be the amount of the Participant's HC Account balance at the time the reimbursement request is processed. The maximum reimbursement requirements apply to the Participant,Spouse, and Dependents on an aggregate basis, not an individual basis. Notwithstanding the foregoing, in order to accommodate fluctuations in the market value of the assets in which an HC Account is invested, the Plan Administrator (or its designee) may limit the amount of reimbursements a Participant may receive to 90% of the Participant's HC Account balance at the time the reimbursement request is processed. If a Participant's claim is for an amount that is more than the maximum described above,the excess, unreimbursed part of the claim will be pended and paid as the balance of the Participant's HC Account becomes adequate. Notwithstanding the foregoing, ©2017 Hitesman&Wold,P.A. 11 Funded Post-Employment HRA Basic Plan Document(Single Employer Non-ERSA)