PREMIUM PAYMENT PLAN (2)CITY OF CLEARWATER
PREMIUM PAYMENT PLAN
EXHIBIT "A"
TABLE OF CONTENTS
ARTICLE I
DEFINITIONS
ARTICLE II
PARTICIPATION
2.1 ELIGIBILITY .................................................................................................................... 3
2.2 EFFECTIVE DATE OF PARTICIPATION ...................................................................... 4
2.3 TERMINATION OF PARTICIPATION ........................................................................... 4
2.4 CHANGE OF EMPLOYMENT STATUS ........................................................................ 4
2.5 TERMINATION OF EMPLOYMENT ............................................................................. 4
ARTICLE III
CONTRIBUTIONS TO THE PLAN
3.1 EMPLOYER CONTRIBUTION ....................................................................................... 5
3.2 SALARY REDIRECTION ................................................................................................ 5
3.3 APPLICATION OF CONTRIBUTIONS ..........................................................................5
3.4 PERIODIC CONTRIBUTIONS ........................................................................................6
ARTICLE IV
BENEFITS
4.1 BENEFIT OPTIONS ..........................................................................................................6
4.2 HEALTH INSURANCE BENEFIT ................. ..................................................................6
4.3 DENTAL INSURANCE BENEFIT ................. ..................................................................7
4.4 CANCER INSURANCE BENEFIT ................ ................ Error! Bookmark not defined.
4.5 VISION INSURANCE BENEFIT ................... ..................................................................7
4.6 NONDISCRIMINATION REQUIREMENTS ..................................................................7
ARTICLE V
PARTICIPANT ELECTIONS
5.1 INITIAL ELECTIONS ......................................................................................................8
5.2 SUBSEQUENT ANNUAL ELECTIONS ......................................................................... 8
5.3 CHANGE IN STATUS ...................................................................................................... 9
ARTICLE VI
BENEFITS AND RIGHTS
6.1 CLAIM FOR BENEFITS .................................................................................................12
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ARTICLE VII
ADMINISTRATION
7.1 PLAN ADMINISTRATION ............................................................................................12
7.2 EXAMINATION OF RECORDS ....................................................................................13
7.3 PAYMENT OF EXPENSES ............................................................................................13
7.4 INSURANCE CONTROL CLAUSE ...............................................................................13
7.5 INDEMNIFICATION OF ADMINISTRATOR ..............................................................13
ARTICLE VIII
AMENDMENT OR TERMINATION OF PLAN
8.1 AMENDMENT ................................................................................................................13
8.2 TERMINATION ..............................................................................................................14
ARTICLE IX
MISCELLANEOUS
9.1 PLAN INTERPRETATION ............................................................................................ 14
9.2 GENDER AND NUMBER .............................................................................................. 14
9.3 WRITTEN DOCUMENT ................................................................................................ 14
9.4 EXCLUSIVE BENEFIT .................................................................................................. 14
9.5 PARTICIPANT'S RIGHTS ............................................................................................. 14
9.6 ACTION BY THE EMPLOYER ..................................................................................... 15
9.7 EMPLOYER'S PROTECTIVE CLAUSES ..................................................................... 15
9.8 NO GUARANTEE OF TAX CONSEQUENCES ........................................................... 15
9.9 INDEMNIFICATION OF EMPLOYER BY PARTICIPANTS ..................................... 15
9.10 FUNDING ........................................................................................................................ 16
9.11 GOVERNING LAW ........................................................................................................ 16
9.12 SEVERABILITY ............................................................................................................. 16
9.13 CAPTIONS ...................................................................................................................... 16
9.14 FAMILY AND MEDICAL LEAVE ACT ....................................................................... 16
9.15 UNIFORM SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS
ACT .................................................................................................................................. 17
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CITY OF CLEARWATER PREMIUM PAYMENT PLAN
INTRODUCTION
The Employer has amended this Plan effective January 1, 2007, to recognize the
contribution made to the Employer by its Employees. Its purpose is to reward them by providing
benefits for those Employees who shall qualify hereunder and their dependents and beneficiaries.
The concept of this Plan is to allow Employees to choose among different types of benefits based
on their own particular goals, desires and needs. This Plan is a restatement of a Plan which was
originally effective on January 1, 1991. The Plan shall be known as City of Clearwater Premium
Payment Plan (the "Plan").
The intention of the Employer is that the Plan qualify as a "Cafeteria Plan" within
the meaning of Section 125 of the Internal Revenue Code of 1986, as amended, and that the
benefits which an Employee elects to receive under the Plan be excludable from the Employee's
income under Section 125(a) and other applicable sections of the Internal Revenue Code of
1986, as amended.
ARTICLE I
DEFINITIONS
1.1 "Administrator" means the individual(s) or corporation appointed by the
Employer to carry out the administration of the Plan. The Employer shall be empowered to
appoint and remove the Administrator from time to time as it deems necessary for the proper
administration of the Plan. In the event the Administrator has not been appointed, or resigns from
a prior appointment, the Employer shall be deemed to be the Administrator.
1.2 "Affiliated Employer" means the Employer and any corporation which is a
member of a controlled group of corporations (as defined in Code Section 414(b)) which
includes the Employer; any trade or business (whether or not incorporated) which is under
common control (as defined in Code Section 414(c)) with the Employer; any organization
(whether or not incorporated) which is a member of an affiliated service group (as defined in
Code Section 414(m)) which includes the Employer; and any other entity required to be
aggregated with the Employer pursuant to Treasury regulations under Code Section 414(0).
1.3 "Benefit" means any of the optional benefit choices available to a Participant as
outlined in Section 4.1.
1.4 "Code" means the Internal Revenue Code of 1986, as amended or replaced from
time to time.
1.5 "Compensation" means the dollar amounts received by the Participant from the
Employer during a Plan Year.
1.6 "Dependent" means any individual who qualifies as a dependent under an
Insurance Contract under Code Section 152 (as modified by Code Section 105(b)).
1.7 "Effective Date" means January 1, 2007.
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1.8 "Election Period" means the period immediately preceding the beginning of each
Plan Year established by the Administrator, such period to be applied on a uniform and
nondiscriminatory basis for all Employees and Participants. However, an Employee's initial
Election Period shall be determined pursuant to Section 5.1.
1.9 "Eligible Employee" means any Employee who has satisfied the provisions of
Section 2.1. In addition, an individual who meets the requirements of Florida Statutes Chapter
112.0801 shall be eligible to participate in the Plan. However, the following individuals shall not
be eligible to participate in the Plan:
(a) individuals who are not reported on the payroll records of the Employer as
a common law employee. In particular, it is expressly intended that individuals
not treated as common law employees by the Employer on its payroll records are
not "Eligible Employees" and are excluded from Plan participation even if a court
or administrative agency determines that such individuals are common law
employees and not independent contractors.
(b) Employees who are classified on the books and records of the Employer as
part-time, temporary, seasonal or emergency employees.
(c) Employee or former Employee who is not eligible to receive medical
benefits pursuant to a group medical plan sponsored by the Employer.
(d) individuals whose employment is governed by the terms of a collective
bargaining agreement between Employee representatives and the Employer under
which benefits were subject of good faith bargaining agreed that such individuals
were excluded from the Plan.
(e) individuals who are "leased employees" as defined in Code Section
414(n)(2).
1.10 "Employee" means any person who is employed by the Employer.
1.11 "Employer" means City of Clearwater and any successor which shall maintain
this Plan; and any predecessor which has maintained this Plan.
1.12 "Employer Contribution" means the contributions made by the Employer pursuant
to Section 3.1 to enable a Participant to purchase Benefits.
1.13 "ERISA" shall mean the Employee Retirement Income Security Act of 1974, as
amended, or any successor statute. It is understood that ERISA does not apply to this Plan.
References to ERISA should be interpreted as descriptive or explanatory and should not be
interpreted as applying ERISA to this Plan.
1.14 "Highly Compensated Employee" means an Employee described in Code Section
414(q) and the regulations thereunder.
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1.15 "Insurance Contract" means any contract issued by an Insurer underwriting a
Benefit.
1.16 "Insurer" means any insurance company that underwrites a Benefit under this
Plan.
1.17 "Key Employee" means an Employee described in Code Section 416(1)(1) and the
regulations thereunder.
1.18 "Participant" means any Eligible Employee who becomes a Participant pursuant
to Section 2.2 and has not for any reason become ineligible to participate further in the Plan.
1.19 "Plan" means this instrument, including all amendments thereto.
1.20 "Plan Year" means the 12-month period beginning January 1 and ending
December 31. The Plan Year shall be the coverage period for the Benefits provided for under
this Plan. In the event a Participant commences participation during a Plan Year, then the initial
coverage period shall be that portion of the Plan Year commencing on such Participant's date of
entry and ending on the last day of such Plan Year.
1.21 "Premium Expenses" or "Premiums" mean the Participant's cost for the Benefits
described in Section 4.1.
1.22 "Salary Redirection" means the contributions made by the Employer on behalf of
Participants pursuant to Section 3.2.
1.23 "Salary Redirection Agreement" means an agreement which is deemed to be
entered into between the Participant and the Employer under which the Participant agrees to
reduce his Compensation or to forego all or part of the increases in such Compensation and to
have such amounts contributed by the Employer to the Plan on the Participant's behalf. The
Salary Redirection Agreement shall apply only to Compensation that has not been actually or
constructively received by the Participant as of the date of the agreement (after taking this Plan
and Code Section 125 into account) and, subsequently does not become currently available to the
Participant.
1.24 "Spouse" means the legally married husband or wife of a Participant, unless
legally separated by court decree.
ARTICLE II
PARTICIPATION
2.1 ELIGIBILITY
Any Eligible Employee shall be eligible to participate hereunder as of the date he
satisfies the eligibility conditions as outlined in Section 2.2 of this Plan. However, any Eligible
Employee who was a Participant in the Plan on the effective date of this amendment shall
continue to be eligible to participate in the Plan.
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2.2 EFFECTIVE DATE OF PARTICIPATION
An Eligible Employee shall become a Participant effective as of the entry date
under the Employer's group medical plan, the provisions of which are specifically incorporated
herein by reference, unless such Employee elects, during the Election Period, not to participate in
the Plan.
2.3 TERMINATION OF PARTICIPATION
A Participant shall no longer participate in this Plan upon the occurrence of any of
the following events:
(a) His termination of employment, subject to the provisions of
Section 2.5;
(b) The end of the Plan Year during which he became a limited
Participant because of a change in employment status pursuant to Section 2.4;
(c) His death; or
(d) The termination of this Plan, subject to the provisions of Section
8.2.
2.4 CHANGE OF EMPLOYMENT STATUS
If a Participant ceases to be eligible to participate because of a change in
employment status or classification (other than through termination of employment), the
Participant shall become a limited Participant in this Plan for the remainder of the Plan Year in
which such change of employment status occurs. As a limited Participant, no further Salary
Redirection may be made on behalf of the Participant, and, except as otherwise provided herein,
all further Benefit elections shall cease, subject to the limited Participant's right to continue
coverage under any Insurance Contracts. Subject to the provisions of Section 2.5, if the limited
Participant later becomes an Eligible Employee, then the limited Participant may again become a
full Participant in this Plan, provided he otherwise satisfies the participation requirements set
forth in this Article II as if he were a new Employee and made an election in accordance with
Section 5.1.
2.5 TERMINATION OF EMPLOYMENT
If a Participant's employment with the Employer is terminated for any reason
other than death, his participation in the Benefit Options provided under Section 4.1 shall cease,
subject to the Participant's right to COBRA (Consolidated Omnibus Budget Reconciliation Act)
continuation coverage under any Insurance Contract for which premiums have already been paid.
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ARTICLE III
CONTRIBUTIONS TO THE PLAN
3.1 EMPLOYER CONTRIBUTION
The Employer shall make available to each Participant an Employer Contribution
in an amount to be determined by the Employer prior to the beginning of each Plan Year. Each
Participant's Employer Contribution shall be available to purchase Benefits as set forth in Section
4.1. The Employer's Contribution shall be made on behalf of the Participant on a pro rata basis
for each pay period. However, if such Participant fails to elect a Health Insurance Benefit
option, the Employer will automatically purchase an employee-only health insurance benefit for
such Participant whereby the Employer incurs the lowest premium payment expense available to
provide such health insurance benefit.
3.2 SALARY REDIRECTION
If a Participant's Employer Contribution is not sufficient to cover the total or
entire cost of Benefits or Premium Expenses he elects pursuant to Section 4. 1, his Compensation
will be reduced in an amount equal to the difference between the cost of Benefits he elected and
the amount of Employer Contribution available to him, and this shall be the maximum amount of
salary redirection available under this Plan. Such reduction shall be his Salary Redirection,
which the Employer will use on his behalf, together with his Employer Contribution, to pay for
the Benefits he elected. The amount of such Salary Redirection shall be specified in the Salary
Redirection Agreement and shall be applicable for a Plan Year. Notwithstanding the above, for
new Participants, the Salary Redirection Agreement shall only be applicable from the first day of
the pay period following the Employee's entry date up to and including the last day of the Plan
Year.
Any Salary Redirection shall be determined prior to the beginning of a Plan Year
(subject to initial elections pursuant to Section 5.1) and prior to the end of the Election Period
and shall be irrevocable for such Plan Year. However, a Participant may revoke a Benefit
election or a Salary Redirection Agreement after the Plan Year has commenced and make a new
election with respect to the remainder of the Plan Year, if both the revocation and the new
election are on account of and consistent with a change in status and such other permitted events
as determined under Article V of the Plan and consistent with the rules and regulations of the
Department of the Treasury. Salary Redirection amounts shall be contributed on a pro rata basis
for each pay period during the Plan Year. All individual Salary Redirection Agreements are
deemed to be part of this Plan and incorporated by reference hereunder.
3.3 APPLICATION OF CONTRIBUTIONS
As soon as reasonably practical after each payroll period, the Employer shall
apply the Employer Contribution and Salary Redirection necessary to provide for the Benefits
elected by the affected Participants.
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3.4 PERIODIC CONTRIBUTIONS
Notwithstanding the requirement provided above and in other Articles of this Plan
that Salary Redirections be contributed to the Plan by the Employer on behalf of an Employee on
a level and pro rata basis for each payroll period, the Employer and Administrator may
implement a procedure in which Salary Redirections are contributed throughout the Plan Year on
a periodic basis that is not pro rata for each payroll period.
ARTICLE IV
BENEFITS
4.1 BENEFIT OPTIONS
Each Participant may elect any one or more of the following optional Benefits:
(1) Health Insurance Benefit
(2) Dental Insurance Benefit
(3) Vision Insurance Benefit
(4) Other Insurance Benefits offered under the Plan
4.2 HEALTH INSURANCE BENEFIT
(a) Each Participant may elect to be covered under a Health Insurance
Contract for the Participant, his or her spouse, and his or her Dependents.
However, if such Participant fails to elect a Health Insurance Benefit option, the
Employer will automatically purchase an employee-only health insurance benefit
for such Participant whereby the Employer incurs the lowest premium payment
expense available to provide such health insurance benefit.
(b) The Employer may select suitable Health Insurance Contracts for
use in providing this health insurance benefit, which policies will provide uniform
benefits for all Participants electing this Benefit.
(c) The rights and conditions with respect to the benefits payable from
such Health Insurance Contract shall be determined therefrom, and such
Insurance Contract shall be incorporated herein by reference.
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4.3 DENTAL INSURANCE BENEFIT
(a) Each Participant may elect to be covered under the Employer's
Dental Insurance Contract. In addition, the Participant may elect either individual
or dependant coverage under such Insurance Contract.
(b) The Employer may select suitable Dental Insurance Contracts for
use in providing this dental insurance benefit, which policies will provide uniform
benefits for all Participants electing this Benefit.
(c) The rights and conditions with respect to the benefits payable from
such Dental Insurance Contract shall be determined therefrom, and such Dental
Insurance Contract shall be incorporated herein by reference.
4.4 VISION INSURANCE BENEFIT
(a) Each Participant may elect to be covered under the Employer's
Vision Insurance Contract. In addition, the Participant may elect either individual
or dependent coverage.
(b) The Employer may select suitable Vision Insurance Contracts for
use in providing this Vision Insurance Benefit, which policies will provide
uniform benefits for all Participants electing this Benefit.
(c) The rights and conditions with respect to the benefits payable from
such Vision Insurance Contract shall be determined therefrom, and such Vision
Insurance Contract shall be incorporated herein by reference.
4.5 OTHER INSURANCE BENEFITS
(a) Employer selects contracts. The Employer may select additional
health or other policies allowed under Code Section 125 or allow the purchase of
additional health or other policies by and for Participants, which policies will
provide uniform benefits for all Participants electing this Benefit.
(b) Contract incorporated by reference. A description of these
Insurance Contracts is attached as Appendix A. The rights and conditions with
respect to the benefits payable from any additional Insurance Contract shall be
determined therefrom, and such Insurance Contract shall be incorporated herein
by reference.
4.6 NONDISCRIMINATION REQUIREMENTS
(a) It is the intent of this Plan to provide benefits to a classification of
employees which the Secretary of the Treasury finds not to be discriminatory in
favor of the group in whose favor discrimination may not occur under Code
Section 125.
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(b) If the Administrator deems it necessary to avoid discrimination or
possible taxation to either a group or groups of employees in whose favor
discrimination may not occur in violation of Code Section 125, it may, but shall
not be required to, reduce contributions or non-taxable Benefits in order to assure
compliance with this Section. Any act taken by the Administrator under this
Section shall be carried out in a uniform and nondiscriminatory manner. If the
Administrator decides to reduce contributions or non-taxable Benefits, it shall be
done in the following manner. First, the non-taxable Benefits of the affected
Participant (an employee who is highly compensated) who has the highest amount
of non-taxable Benefits for the Plan Year shall have his non-taxable Benefits
reduced until the discrimination tests set forth in this Section are satisfied or until
the amount of his non-taxable Benefits equals the non-taxable Benefits of the
affected Participant who has the second highest amount of non-taxable Benefits.
This process shall continue until the nondiscrimination tests set forth in this
Section are satisfied. With respect to any affected Participant who has had
Benefits reduced pursuant to this Section, the reduction shall be made
proportionately among insured Benefits. Contributions which are not utilized to
provide Benefits to any Participant by virtue of any administrative act under this
paragraph shall be forfeited and deposited into the benefit plan surplus.
ARTICLE V
PARTICIPANT ELECTIONS
5.1 INITIAL ELECTIONS
An Employee who meets the eligibility requirements of Section 2.1 on the first
day of, or during, a Plan Year may elect to participate in this Plan for all or the remainder of such
Plan Year, provided he elects to do so before his effective date of participation pursuant to
Section 2.2. Employees who become eligible after the open enrollment period begins will be
required to elect their benefit options within one week of the date in which they become eligible
to participate in the Plan. Each Participant may elect to be covered under a Health Insurance
Contract for the Participant, his or her spouse, and his or her Dependents. However, if such
Participant fails to elect a Health Insurance Benefit option, the Employer will automatically
purchase an employee-only health insurance benefit for such Participant whereby the Employer
incurs the lowest premium payment expense available to provide such health insurance benefit.
5.2 SUBSEQUENT ANNUAL ELECTIONS
During the Election Period prior to each subsequent Plan Year, each Participant
shall be given the opportunity to modify his election. An Employee who fails to modify his or
her election for the Plan Year following the Election Period shall be deemed to have made the
same election as the prior year and will have to wait until the next Election Period before again
electing to modify his or her election in the Plan, except as provided for in Section 5.3. Each
Participant may elect to be covered under a Health Insurance Contract for the Participant, his or
her spouse, and his or her Dependents. However, if such Participant fails to elect a Health
Insurance Benefit option, the Employer will automatically purchase an employee-only health
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insurance benefit for such Participant whereby the Employer incurs the lowest premium payment
expense available to provide such health insurance benefit.
5.3 CHANGE IN STATUS
(a) Any Participant may change a Benefit election after the Plan Year
(to which such election relates) has commenced and make new elections with
respect to the remainder of such Plan Year if, under the facts and circumstances, the
changes are necessitated by and are consistent with a change in status which is
acceptable under rules and regulations adopted by the Department of the Treasury,
the provisions of which are incorporated by reference. Notwithstanding anything
herein to the contrary, if the rules and regulations conflict with the provisions of this
Plan, then such rules and regulations shall control.
In general, a change in election is not consistent if the change in status is the
Participant's divorce, annulment or legal separation from a spouse, the death of a
spouse or dependent, or a dependent ceasing to satisfy the eligibility requirements
for coverage, and the Participant's election under the Plan is to cancel accident or
health insurance coverage for any individual other than the one involved in such
event. If the Participant's spouse or dependent loses eligibility for coverage, then a
Participant's election under the Plan will decrease coverage for that individual under
the Plan. In addition, if the Participant's spouse or dependent gains eligibility for
coverage, then a Participant's election under the Plan for coverage will increase for
that individual under the Plan.
Regardless of the consistency requirement, if the individual, the individual's
spouse, or dependent becomes eligible for continuation coverage under the
Employer's group health plan as provided in Public Health Service Act (42 USC
300bb-1 et. seq.) or any similar state law, then the individual may elect to increase
payments under this Plan in order to pay for the continuation coverage. However,
this does not apply for COBRA eligibility due to divorce, annulment or legal
separation.
Any new election shall be effective at such time as the Administrator shall
prescribe, but not earlier than the first pay period beginning after the election is
properly executed in accordance with the procedures established by the
Administrator. For the purposes of this subsection, a change in status shall only
include the following events or other events permitted by Treasury regulations:
(1) Legal Marital Status: events that change a Participant's legal
marital status, including marriage, divorce, death of a spouse, legal
separation or annulment;
(2) Number of Dependents: Events that change a Participant's number
of dependents, including birth, adoption, placement for adoption, or death of
a dependent;
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(3) Employment Status: Any of the following events that change the
employment status of the Participant, spouse, or dependent: termination or
commencement of employment, a strike or lockout, commencement or
return from an unpaid leave of absence, or a change in worksite. In addition,
if the eligibility conditions of this Plan or other employee benefit plan of the
Employer of the Participant, spouse, or dependent depend on the
employment status of that individual and there is a change in that
individual's employment status with the consequence that the individual
becomes (or ceases to be) eligible under the plan, then that change
constitutes a change in employment under this subsection;
(4) Dependent satisfies or ceases to satisfy the eligibility requirements:
An event that causes the Participant's dependent to satisfy or cease to satisfy
the requirements for coverage due to attainment of age, student status, or
any similar circumstance; and
(5) Residency: A change in the place of residence of the Participant,
spouse or dependent, that would lead to a change in status (such as a loss of
HMO coverage).
(b) Notwithstanding subsection (a), the Participants may change an
election for health coverage during a Plan Year and make a new election that
corresponds with the special enrollment rights provided in American Health
Insurance Portability and Accountability Act of 1996 ("HIPAA"). Such change
shall take place on a prospective basis, unless retroactive coverage is both
permitted by HIPAA and elected by the participant. An election for prospective
coverage shall be effective either as of the date the Plan Administrator is notified
of the special enrollment event or the 1st day of the month following the date of
the special enrollment event, at the Participant's direction. An election for
retroactive coverage shall be effective as of the day of the special enrollment
event. Payment for prospective or retroactive coverage shall be made in
accordance with procedures established by the administrator in a uniform and
nondiscriminatory manner.
(c) Notwithstanding subsection (a), in the event of a judgment, decree,
or order ("order") resulting from a divorce, legal separation, annulment, or change
in legal custody which requires accident or health coverage for a Participant's
child (including a foster child who is a dependent of the Participant):
(1) The Plan may change a Participant's election to provide coverage
for the child if the order requires coverage under the Participant's plan; or
(2) The Participant shall be permitted to change an election to cancel
coverage for the child if the order requires the former spouse to provide
coverage for such child, under that individual's plan if verification of such
coverage is actually provided to the Administrator.
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(d) If the cost of a Benefit provided under the Plan increases or
decreases during a Plan Year, then the Plan shall automatically increase or
decrease, as the case may be, the Salary Redirections of all affected Participants
for such Benefit. Alternatively, if the cost of a benefit package option increases
significantly, the Administrator shall permit the affected Participants to either
make corresponding changes in their payments or revoke their elections and, in
lieu thereof, receive on a prospective basis coverage under another benefit
package option with similar coverage, or drop coverage prospectively if there is
no benefit package option with similar coverage.
A cost increase or decrease refers to an increase or decrease in the amount
of elective contributions under the Plan, whether resulting from an action taken by
the Employer or the insurer.
If the coverage under a Benefit is significantly curtailed or ceases during a
Plan Year, affected Participants may revoke their elections of such Benefit and, in
lieu thereof, elect to receive on a prospective basis coverage under another plan
with similar coverage, or drop coverage prospectively if no similar coverage is
offered.
If, during the period of coverage, a new benefit package option or other
coverage option is added, an existing benefit package option is significantly
improved, or an existing benefit package option or other coverage option is
eliminated, then the affected Participants may elect the newly-added option, or
elect another option if an option has been eliminated prospectively and make
corresponding election changes with respect to other benefit package options
providing similar coverage. In addition, those Eligible Employees who are not
participating in the Plan may opt to become Participants and elect the new or
newly improved benefit package option.
A Participant may make a prospective election change to add group health
coverage for the Participant, the Participant's spouse or dependent if such
individual loses group health coverage sponsored by a governmental or
educational institution, including a state children's health insurance program
under the Social Security Act, the Indian Health Service or a health program
offered by an Indian tribal government, a state health benefits risk pool, or a
foreign government group health plan.
A Participant may make a prospective election change that is on account
of and corresponds with a change made under the plan of a spouse's, former
spouse's or dependent's employer if (1) the cafeteria plan or other benefits plan of
the spouse's, former spouse's or dependent's employer permits its participants to
make a change; or (2) the cafeteria plan permits participants to make an election
for a period of coverage that is different from the period of coverage under the
cafeteria plan of a spouse's, former spouse's or dependent's employer.
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ARTICLE VI
BENEFITS AND RIGHTS
6.1 CLAIM FOR BENEFITS
(a) Any claim for Benefits underwritten by Insurance Contract(s) shall
be made to the Insurer. If the Insurer denies any claim, the Participant or
beneficiary shall follow the Insurer's claims review procedure.
ARTICLE VII
ADMINISTRATION
7.1 PLAN ADMINISTRATION
The operation of the Plan shall be under the supervision of the Administrator. It
shall be a principal duty of the Administrator to see that the Plan is carried out in accordance
with its terms, and for the exclusive benefit of Employees entitled to participate in the Plan. The
Administrator shall have full power to administer the Plan in all of its details, subject, however,
to the pertinent provisions of the Code. The Administrator's powers shall include, but shall not be
limited to the following authority, in addition to all other powers provided by this Plan:
(a) To make and enforce such rules and regulations as the
Administrator deems necessary or proper for the efficient administration of the
Plan;
(b) To interpret the Plan, the Administrator's interpretations thereof in
good faith to be final and conclusive on all persons claiming benefits by operation
of the Plan;
(c) To decide all questions concerning the Plan and the eligibility of
any person to participate in the Plan and to receive benefits provided by operation
of the Plan;
(d) To reject elections or to limit contributions or Benefits for certain
highly compensated participants if it deems such to be desirable in order to avoid
discrimination under the Plan in violation of applicable provisions of the Code;
(e) To provide Employees with a reasonable notification of their
benefits available by operation of the Plan;
(f) To appoint such agents, counsel, accountants, consultants, and
actuaries as may be required to assist in administering the Plan.
Any procedure, discretionary act, interpretation or construction taken by the
Administrator shall be done in a nondiscriminatory manner based upon uniform principles
consistently applied and shall be consistent with the intent that the Plan shall continue to comply
with the terms of Code Section 125 and the Treasury regulations thereunder.
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7.2 EXAMINATION OF RECORDS
The Administrator shall make available to each Participant, Eligible Employee
and any other Employee of the Employer such records as pertain to their interest under the Plan
for examination at reasonable times during normal business hours.
7.3 PAYMENT OF EXPENSES
Any reasonable administrative expenses shall be paid by the Employer unless the
Employer determines that administrative costs shall be borne by the Participants under the Plan
or by any Trust Fund which may be established hereunder. The Administrator may impose
reasonable conditions for payments, provided that such conditions shall not discriminate in favor
of highly compensated employees.
7.4 INSURANCE CONTROL CLAUSE
In the event of a conflict between the terms of this Plan and the terms of an
Insurance Contract of an independent third party Insurer whose product is then being used in
conjunction with this Plan, the terms of the Insurance Contract shall control as to those
Participants receiving coverage under such Insurance Contract. For this purpose, the Insurance
Contract shall control in defining the persons eligible for insurance, the dates of their eligibility,
the conditions which must be satisfied to become insured, if any, the benefits Participants are
entitled to and the circumstances under which insurance terminates.
7.5 INDEMNIFICATION OF ADMINISTRATOR
The Employer agrees to indemnify and to defend to the fullest extent permitted by
law any Employee serving as the Administrator or as a member of a committee designated as
Administrator (including any Employee or former Employee who previously served as
Administrator or as a member of such committee) against all liabilities, damages, costs and
expenses (including attorney's fees and amounts paid in settlement of any claims approved by the
Employer) occasioned by any act or omission to act in connection with the Plan, if such act or
omission is in good faith.
ARTICLE VIII
AMENDMENT OR TERMINATION OF PLAN
8.1 AMENDMENT
The Employer, at any time or from time to time, may amend any or all of the
provisions of the Plan without the consent of any Employee or Participant. No amendment shall
have the effect of modifying any benefit election of any Participant in effect at the time of such
amendment, unless such amendment is made to comply with Federal, state or local laws, statutes
or regulations.
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8.2 TERMINATION
The Employer is establishing this Plan with the intent that it will be maintained
for an indefinite period of time. Notwithstanding the foregoing, the Employer reserves the right
to terminate this Plan, in whole or in part, at any time. In the event the Plan is terminated, no
further contributions shall be made. Benefits under any Insurance Contract shall be paid in
accordance with the terms of the Insurance Contract.
ARTICLE IX
MISCELLANEOUS
9.1 PLAN INTERPRETATION
All provisions of this Plan shall be interpreted and applied in a uniform,
nondiscriminatory manner. This Plan shall be read in its entirety and not severed except as
provided in Section 9.12.
9.2 GENDER AND NUMBER
Wherever any words are used herein in the masculine, feminine or neuter gender,
they shall be construed as though they were also used in another gender in all cases where they
would so apply, and whenever any words are used herein in the singular or plural form, they
shall be construed as though they were also used in the other form in all cases where they would
so apply.
9.3 WRITTEN DOCUMENT
This Plan, in conjunction with any separate written document which may be
required by law, is intended to satisfy the written Plan requirement of Code Section 125 and any
Treasury regulations thereunder relating to cafeteria plans.
9.4 EXCLUSIVE BENEFIT
This Plan shall be maintained for the exclusive benefit of the Employees who
participate in the Plan.
9.5 PARTICIPANT'S RIGHTS
This Plan shall not be deemed to constitute an employment contract between the
Employer and any Participant or to be a consideration or an inducement for the employment of
any Participant or Employee. Nothing contained in this Plan shall be deemed to give any
Participant or Employee the right to be retained in the service of the Employer or to interfere
with the right of the Employer to discharge any Participant or Employee at any time regardless of
the effect which such discharge shall have upon him as a Participant of this Plan.
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9.6 ACTION BY THE EMPLOYER
Whenever the Employer under the terms of the Plan is permitted or required to do
or perform any act or matter or thing, it shall be done and performed by a person duly authorized
by its legally constituted authority.
9.7 EMPLOYER'S PROTECTIVE CLAUSES
(a) Upon the failure of either the Participant or the Employer to obtain
the insurance contemplated by this Plan (whether as a result of negligence, gross
neglect or otherwise), the Participant's Benefits shall be limited to the insurance
premium(s), if any, that remained unpaid for the period in question and the actual
insurance proceeds, if any, received by the Employer or the Participant as a result
of the Participant's claim.
(b) The Employer shall not be responsible for the validity of any
Insurance Contract issued hereunder or for the failure on the part of the Insurer to
make payments provided for under any Insurance Contract. Once insurance is
applied for or obtained, the Employer shall not be liable for any loss which may
result from the failure to pay Premiums to the extent Premium notices are not
received by the Employer.
9.8 NO GUARANTEE OF TAX CONSEQUENCES
Neither the Administrator nor the Employer makes any commitment or guarantee
that any amounts paid to or for the benefit of a Participant under the Plan will be excludable from
the Participant's gross income for federal or state income tax purposes, or that any other federal
or state tax treatment will apply to or be available to any Participant. It shall be the obligation of
each Participant to determine whether each payment under the Plan is excludable from the
Participant's gross income for federal and state income tax purposes, and to notify the Employer
if the Participant has reason to believe that any such payment is not so excludable.
Notwithstanding the foregoing, the rights of Participants under this Plan shall be legally
enforceable.
9.9 INDEMNIFICATION OF EMPLOYER BY PARTICIPANTS
If any Participant receives one or more payments or reimbursements under the
Plan that are not for a permitted Benefit, such Participant shall indemnify and reimburse the
Employer for any liability it may incur for failure to withhold federal or state income tax or
Social Security tax from such payments or reimbursements. However, such indemnification and
reimbursement shall not exceed the amount of additional federal and state income tax (plus any
penalties) that the Participant would have owed if the payments or reimbursements had been
made to the Participant as regular cash compensation, plus the Participant's share of any Social
Security tax that would have been paid on such compensation, less any such additional income
and Social Security tax actually paid by the Participant.
15
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9.10 FUNDING
Unless otherwise required by law, contributions to the Plan need not be placed in
trust or dedicated to a specific Benefit, but may instead be considered general assets of the
Employer until the Premium Expense required under the Plan has been paid. Furthermore, and
unless otherwise required by law, nothing herein shall be construed to require the Employer or
the Administrator to maintain any fund or segregate any amount for the benefit of any
Participant, and no Participant or other person shall have any claim against, right to, or security
or other interest in, any fund, account or asset of the Employer from which any payment under
the Plan may be made.
9.11 GOVERNING LAW
This Plan is governed by the Code and the Treasury regulations issued thereunder
(as they might be amended from time to time). In no event shall the Employer guarantee the
favorable tax treatment sought by this Plan. To the extent not preempted by Federal law, the
provisions of this Plan shall be construed, enforced and administered according to the laws of the
State of Florida.
9.12 SEVERABILITY
If any provision of the Plan is held invalid or unenforceable, its invalidity or
unenforceability shall not affect any other provisions of the Plan, and the Plan shall be construed
and enforced as if such provision had not been included herein.
9.13 CAPTIONS
The captions contained herein are inserted only as a matter of convenience and for
reference, and in no way define, limit, enlarge or describe the scope or intent of the Plan, nor in
any way shall affect the Plan or the construction of any provision thereof.
9.14 FAMILY AND MEDICAL LEAVE ACT
If a Participant initiates an FMLA Leave, he may revoke an existing election of
any accident or health plan coverage and make such other election for the remaining portion of
the coverage period as may be provided for under FMLA and in accordance with this Section,
but such Participant must continue to maintain, at least, individual coverage in the group medical
insurance plan.
In the event that any Participant takes an FMLA Leave, then such Participant shall
be entitled to continue participation in this Plan, or to be subsequently reinstated as a Participant
in this Plan, in accordance with the requirements of the Family and Medical Leave Act (or any
applicable state law that provides more generous family or medical leave).
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9.15 UNIFORM SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT
Notwithstanding any provision of this Plan to the contrary, contributions, benefits
and service credit with respect to qualified military service shall be provided in accordance with
USERRA and the regulations thereunder.
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IN WITNESS WHEREOF, this Plan document is hereby executed this
day of 2008.
Countersigned:
!?• By:
Frank V. Hibbard
Mayor
Approved as to form:
Leslie K. Dougall-S' e
Assistant City Attorney
Attest:
CITY OF CLEARWATER, FLORIDA
William B. Horne II
City Manager
%'->?- A??, 4,,,, da,
Cynthi udeau
Of
Clerk S?p`ofro"C
2*1
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