Benefit Plans Administrative Services BPAS 3/9/2020

2.16 Health Care Expense means: ® Maximum permitted by law (i.e., Section 213(d) medical expenses). ❑ Only expenses eligible for deductible&OOP credit under the following group medical plan: ❑ Only expenses for dental and vision care that qualify as Section 213(d) medical expenses, as modified by Section 106(f). LI Other 2.20 Limited Scope Health Care Expense means: ❑ N/A ® As provided in the Basic Plan Document. ❑ Other: 2.24 Name of Plan: City of Everett VEBA PRA Plan 2.26 Plan Year is: January 1 through December 31 The initial"short"Plan Year is: N/A (month,day,year) 2.30 Spouse means: ❑ An individual who is legally married to a Participant and who is treated as a"spouse" under the Code. ❑ Other(Describe): 2.31 Name of Trust: City of Everett VEBA Trust ARTICLE III: ELIGIBILITY AND PARTICIPATION OF EMPLOYEES AND FORMER EMPLOYEES 3.1 Eligibility requirements are as follows(check and complete only those that apply): ❑ Age (Describe): ❑ Length of Service (Describe): ❑ Employment Classification (e.g., union, part-time,full-time) (Describe): ® A former or deceased Employee who, at the time of termination of employment or death, is covered under the following health reimbursement arrangement sponsored by the Adopting Employer: City of Everett VEBA HRA Plan ® Other(Describe): any employee who is entitled to a contribution to the PRA under a CBA, Memorandum of Understanding, Labor Contract,or any other agreement for a Union or Non-Represented Participant. 3.4(a) Coverage options available under the Plan include: ® Full Scope Option. ® Limited Scope Option. ❑ Suspended Account Option. ©Copyright 2017 Hitesman&Wold,P.A. Page 2 PRA Basic Plan Document Adoption Agreement(Single Employer Non-ERISA)