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Benefit Plans Administrative Services 12/26/2018
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Benefit Plans Administrative Services 12/26/2018
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Last modified
1/17/2019 10:42:27 AM
Creation date
1/17/2019 10:40:55 AM
Metadata
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Template:
Contracts
Contractor's Name
Benefit Plans Administrative Services
Approval Date
12/26/2018
Council Approval Date
12/12/2018
Department
Human Resources
Department Project Manager
Sharon DeHaan
Subject / Project Title
HRA VEBA Account for LEOFF Trust Plan B
Tracking Number
0001615
Total Compensation
$0.00
Contract Type
Agreement
Contract Subtype
Professional Services
Retention Period
6 Years Then Destroy
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E.FLEXIBLE SPENDING ACCOUNTS <br /> Carryover <br /> 13. The Plan will carry over unused Health FSA balances at the end of the Plan Year for the following Benefits: <br /> a. 0 Health Flexible Spending Account: (may not exceed $500). <br /> b. 0 Limited Purpose/Post-Deductible Health Flexible Spending Account (HSA-Compatible FSA): (may not <br /> exceed $500) <br /> NOTE:If carryover is selected(E.13a or E.13b is selected for the applicable FSA), the Plan may not provide for a <br /> Grace Period for the applicable FSA and the Plan may not provide for a Grace Period for the applicable FSA in the <br /> Plan Year to which the carryover amount is applied. <br /> Termination of Employment <br /> 14. In the event of a Termination of Employment the Participant may elect to continue to make contributions to FSAs <br /> under the Plan on an after-tax basis and reimbursements will be allowed for the remainder of the Plan Year. <br /> a. ❑ Yes <br /> b. 0 Yes-subject to the following limitations: <br /> c. RI No <br /> NOTE:If E.14c is selected, then contributions shall cease upon Termination and reimbursements will be allowed only <br /> for expenses incurred prior to Termination. <br /> NOTE:If applicable, any COBRA elections shall supersede this section. <br /> 15. In the event of a Termination of Employment, a Participant may submit claims for reimbursement from the <br /> applicable FSA no later than: <br /> a. 0 days after a Termination of Employment. <br /> b. Q 90 days following the Plan Year in which the Termination occurs. <br /> NOTE:If E.14a or E.14b is selected, then E.15b must be selected. <br /> Qualified Reservist Distributions <br /> 16. Q Qualified Reservist Distributions are available for: <br /> a. ❑ The entire amount elected for the applicable Health FSA for the Plan Year minus applicable Health FSA <br /> reimbursements received as of the date of the Qualified Reservist Distribution request. <br /> b. Q The amount contributed to the applicable Health FSA as of the date of the Qualified Reservist Distribution <br /> request minus applicable FSA reimbursements received as of the date of the Qualified Reservist Distribution <br /> request. <br /> c. 0 Other amount (not to exceed the entire amount elected for the applicable for the Plan Year minus <br /> reimbursements): <br /> F. HEALTH SAVINGS ACCOUNT(HSA Account) (Article 9) <br /> NOTE:If HSA Account is not a permitted Benefit under A.5f,Section F is disregarded. <br /> Employer Contributions <br /> 1. Matching Contributions.The Plan permits Employer matching contributions to the HSA Account as follows(not to <br /> 10 Copyright©2002-2018 <br /> Benefit Plans Administrative Services LLC <br />
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