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2.20 Limited Scope Health Care Expense means: <br /> ❑ N/A <br /> ® As provided in the Basic Plan Document. <br /> ® Other: <br /> 2.24 Name of Plan: City of Everett VEBA HRA Plan <br /> 2.26 Plan Year is: January 1 through December 31 <br /> (month,day,year) <br /> The initial"short" Plan Year is: N/A <br /> (month,day,year) <br /> 2.30 Spouse means: <br /> ® An individual who is legally married to a Participant and who is treated as a"spouse" <br /> under the Code. <br /> ❑ Other (Describe): <br /> 2.31 Name of Trust: City of Everett VEBA Trust <br /> ARTICLE III: ELIGIBILITY AND PARTICIPATION OF EMPLOYEES <br /> 3.1 Eligibility requirements are as follows (check and complete only those that apply): <br /> ❑ Age (Describe): <br /> ❑ Length of Service (Describe): <br /> ❑ Employment Classification (e.g., union, part-time, full-time) (Describe): <br /> ❑ Coverage under a specified group medical plan (Describe): <br /> ❑ Eligible for coverage under the Adopting Entity's group medical plan and actually <br /> covered under a group medical plan (the Adopting Entity's or another employer's) <br /> ® Coverage under the Adopting Employer's group medical plan <br /> ❑ Other (Describe): <br /> 3.4(a) Coverage options available under the Plan include: <br /> ® Full Scope Option. <br /> ® Limited Scope Option. <br /> ❑ Suspended Account Option. <br /> Coverage for Spouses and Dependents: <br /> ❑ Only if enrolled in the Adopting Employer's group medical plan. <br /> ® If enrolled in any group medical plan (i.e., the Adopting Employer's or another <br /> employer's) <br /> ©Copyright 2017 Hitesman&Wold, P.A. Page 2 <br /> HRA Basic Plan Document Adoption Agreement(Single Employer Non-ERISA) <br />