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F.HEALTH SAVINGS ACCOUNT(HSA Account)(Article 9) <br /> exceed the limits in Section 9.04): <br /> a. 0 None <br /> b. 0 Discretionary <br /> c. 0 %of the Participant's elected HSA Account contribution up to %of the Participant's <br /> Compensation <br /> d. ❑ %of the Participant's elected HSA Account contribution up to $ <br /> e. 0 Other: <br /> NOTE:If the Plan is intended to be a simple cafeteria plan, the matching contributions in this section will apply in <br /> addition to the contributions at A.6b. <br /> 2. Employer Non-Elective Contributions. The Plan permits Employer non-elective contributions to the HSA Account as <br /> follows (not to exceed the limits in Section 9.04): <br /> a. 0 None <br /> b. 0 Discretionary <br /> c. ❑ %of the Participant's Compensation <br /> d. ❑ $ per Eligible Employee <br /> e. 0 Other: <br /> i <br /> NOTE:If the Plan is intended to be a simple cafeteria plan, the Employer n this non elective contributions t s section <br /> will apply in addition to the contributions atA.6b. <br /> 3. Contribution Limits. Select the maximum allowable contribution to a Participant's HSA Account in any Plan Year: <br /> a. 0 The maximum amount permitted under Code section 223(b), reduced by any Employer contributions. <br /> b. ❑ Other amount: (not to exceed the Code section 223(b) maximum when combined with any Employer <br /> contributions). <br /> G. FLEXIBLE BENEFIT CREDITS (Flex Credits) (Section 11.01) <br /> Health Flex Contribution <br /> NOTE:If Flexible Benefit Credits are not permitted Benefits in A.Sg, Section G is disregarded. <br /> 1. ❑ Health Flex Contribution.The Flex Credit is intended to qualify as a "health flex contribution" under Treas. Reg. <br /> section 1.5000A-3(e)(3)(ii)(E): The Participant may not opt to receive the Flex Credit as a cash or taxable benefit <br /> and the Participant may only use the Flex Credit for the payment of premiums applicable to health care and toward <br /> the Health FSA or HSA-Compatible Health FSA Benefits. <br /> 2. Eligible Benefits. Participants may elect to contribute the Flex Credits to the following benefits: <br /> a. 0 All Benefits offered under the Plan <br /> b. ❑ All Benefits offered under the Plan except the following: <br /> c. ❑ Only the following Benefits: <br /> d. 0 Only the portion of the (i) Premium Conversion Account paid toward Employer-sponsored Health Contract <br /> premiums and/or(ii) Health FSA or HSA-Compatible Health FSA Benefits. <br /> NOTE:If G.1 is selected, G.2d must be selected. <br /> 3. Amount of Flex Credit.The Employer will contribute a Flex Credit on behalf of each Eligible Employee as follows: <br /> a. 0 $ per Eligible Employee <br /> b. ❑ A discretionary amount as determined by the Employer <br /> c. ❑ Other: <br /> d. ❑ The amount of the simple cafeteria plan contributions described in A.6b <br /> 11 Copyright©2002-2018 <br /> Benefit Plans Administrative Services LLC <br />