Benefit Plans Administrative Services 12/26/2018

E.FLEXIBLE SPENDING ACCOUNTS incurred: a. 0 until the date the child attains age 26 b. Q until the last day of the calendar year in which the child attains age 26 Reimbursement 7. Q Amounts Available for Reimbursement.The Plan Administrator may direct reimbursement of FSAs up to the entire annual amount elected by the Eligible Employee on the Salary Reduction Agreement for the Plan Year for the applicable FSA, less any reimbursements already disbursed from the applicable FSA for the following Benefits: a. 0 Dependent Care Assistance Plan Account b. 0 Adoption Assistance Flexible Spending Account NOTE:If 7.a or 7.b is not selected, the Plan Administrator may direct reimbursement only up to the amount in the applicable FSA at the time the reimbursement request is received by the Plan Administrator. Grace Period 8. Q The Plan will reimburse claims incurred during a Grace Period immediately following the end of the Plan Year for the following Benefits. a. Q Health Flexible Spending Account b. 0 Limited Purpose/Post-Deductible Health Flexible Spending Account (HSA-Compatible FSA) c. Ei Dependent Care Assistance Plan Account d. 0 Adoption Assistance Flexible Spending Account NOTE: The Plan cannot reimburse claims incurred during a Grace Period if carryovers are permitted in Part E.12. 9. Last day of Grace Period: a. Q Fifteenth day of the 3rd month following end of the Plan Year b. 0 Other Run Out Period 10. If no Grace Period applies for the Plan Year, an active Participant must submit claims for the Plan Year for reimbursement from the applicable FSA no later than: a. 0 days after the end of the Plan Year b. 0 (insert date, e.g., March 31) immediately following such Plan Year 11. If a Grace Period applies for the Plan Year, an active Participant must submit claims for the Plan Year for reimbursement from the applicable FSA no later than: a. 0 days after the end of the Grace Period b. Q March 31 (insert date, e.g., March 31st) immediately following such Plan Year NOTE: The date in E.11b should be later than the last day of the Grace Period. Automatic Payment of Claims 12. Eligible expenses not covered under the Employer-sponsored health plan (e.g., co-payments, co-insurance, deductibles) automatically paid from the applicable FSA. a. 0 Health Flexible Spending Account b. 0 Limited Purpose/Post-Deductible Health Flexible Spending Account (HSA-Compatible FSA) 9 Copyright©2002-2018 Benefit Plans Administrative Services LLC