Benefit Plans Administrative Services BPAS 3/9/2020

3.4(b) Coverage option determined as follows: ❑ N/A Z As provided in the Basic Plan Document(i.e., Full Scope Option unless affirmative election of another option) ❑ Participants enrolled in the high deductible health plan are automatically enrolled in the following option unless they affirmatively elect another option: ❑ Limited Scope Option. ❑ Suspended Account Option. 3.4(c) Reimbursement rules: ❑ N/A ® As provided in the Basic Plan Document ❑ Other: 3.5 Termination of Contributions: ❑ As provided in the Basic Plan Document(i.e., upon ceasing to be eligible,termination of employment, death, or termination of plan). ❑ Upon completion of the account transfer described in Section 5.1. ® Other(Describe): based on CBA, Memorandum of Understanding, Labor Contract or any other agreement for a Union or Non-Represented Participant. 3.6 Termination of Participation: ® As provided in the Basic Plan Document ❑ Other(Describe): ARTICLE IV: BENEFITS UNDER THE PLAN 4.3(a) Claims Run-out Period: In general,there is no deadline for filing claims. However, when (1) a Participant dies without a surviving Spouse or Dependent, (2)a deceased Participant's last surviving Spouse or Dependent dies,or(3)a Participant opts out of the Plan,all claims incurred prior to the date on which such person's participation ceases must be submitted to the Plan within 365 days following the date on which participation ceases. Forfeiture of the HC Account will not occur until such deadline has passed. 4.4 Expenses must be incurred: ® After termination of the Participant's employment with Employer ❑ Additional events: 4.7 Post-death Access by Spouse&Dependents: ® As provided in the Basic Document. ❑ Other(Describe): ©Copyright 2017 Hitesman&Wold,P.A. Page 3 PRA Basic Plan Document Adoption Agreement(Single Employer Non-ERISA)