Benefit Plans Administrative Services 12/26/2018

B.ELIGIBILITY Leave of Absence under FMLA 6. If a Participant takes an unpaid leave of absence under FMLA,the Participant may elect the following with respect to the health Benefits under the Plan (i.e., Premium Conversion Account, Health FSA, and Limited Purpose Health FSA) (select at least one): a. Q Revoke coverage,which will be reinstated under the same terms upon the Participant's return from the FMLA leave of absence. b. Q Continue coverage but discontinue payment of his or her contribution for the period of the FMLA leave of absence. 7. Q If B.6b. is selected,the Employer may recover the Participant's suspended contributions when the Participant returns to work from the FMLA leave of absence. 8. A Participant on leave of absence under FMLA(select only one): a. Q may continue coverage for all Benefits for which he is eligible when on FMLA leave, including non-health Benefits. b. ❑ may only continue coverage for Premium Conversion Accounts, Health FSA, and Limited Purpose Health FSA, as applicable. 9. A Participant who continues coverage for Benefits while on FMLA leave of absence may make contributions for such Benefits as follows(select at least one): a. Q pre-pay on a pre-tax(to the extent permissible under Code section 125) or after-tax basis, prior to commencement of the FMLA leave of absence period,the contributions due for the FMLA leave of absence period b. CR1 pay on an after-tax basis the same schedule as payments would have been made if the Participant were not on a leave of absence or if contributions were being made under COBRA c. to the extent agreed in advance, the Participant will repay amounts advanced by the Employer to the Plan on behalf of the Participant upon the Participant's return from the FMLA leave of absence NOTE:8.9a may only be elected together with B.9.b or 8.9c. NOTE:8.9b must be elected if available for non-FMLA leaves of absence. NOTE:B.9c may only be elected together with B.9a and/or B.9b unless it is the only option available to Participants on a non-FMLA leave of absence. Non-FMLA 10. Q A Participant may elect to continue coverage of Benefits when on unpaid non-FMLA leave of absence. Termination of Participation 11. If a Participant remains an Employee but is no longer an Eligible Employee, his or her participation in the Plan shall terminate: a. 0 on the last day of employment during which the Participant ceases to be an Eligible Employee b. ❑ on the last day of the payroll period during which the Participant ceases to be an Eligible Employee c. ❑ on the last day of the month during which the Participant ceases to be an Eligible Employee d. 0 on the last day of the Plan Year during which the Participant ceases to be an Eligible Employee e. Q Other Employee may elect to continue participation to the last day of the plan year or terminate participation on the last day of the pay period. 4 Copyright©2002-2018 Benefit Plans Administrative Services LLC