CCP 12-13-2004 - Laserfiche WebLink

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. . . Citv of Arden Hills Summarv Plan Description 2. Authorize Pre-tax Contributions in the required amount; 3. Observe all Plan rules and regulations; 4. Agree to inquiries by the Employer with respect to any physician, hospital, or other provider of health care or other services covered by this Plan; and 5. Submit to the Employer all reports, bills, and other information that the Employer may reasonably require. If you do not make a benefit election within the time period required by the Plan, you will not be eligible to pay for your benefits on a pre-tax basis. HOW THE PLAN WORKS HOW DO I PAY FOR BENEFITS? Benefits are paid for by you using your Pre-tax Contributions. Pre-tax Contributions are discussed below. WHAT ARE PRE-TAX CONTRIBUTIONS? Pre-tax Contributions are the amounts by which you reduce your regular gross (before tax) wages or salary in exchange for the Employer's contribution of equal amounts to the Plan. You will authorize Pre- tax Contributions by signing the application to participate. Any required employee contributions for benefit coverages will be automatically withheld on a pre-tax basis. WHAT BENEFITS ARE PROVIDED UNDER THE PLAN? The types of benefits available to you undcr the Plan allow you to improve on those benefits based on your individual needs. The benefits offered undcr the Plan are described below. If you do not elect to participate in these pre-tax benefits, you will receivc your regular taxable wages. 1. Health Covera~e. Payment of the employee cost of employee or family coverage under the City of Arden Hills Health Plan. This health plan is described in the City of Arden Hills Health Plan Summary Plan Description. 2. Dental Coverage. Payment of the employee cost for employee or family coverage under the City of Arden Hills Dental Plan. This dental coverage plan is described in the City of Arden Hills Dental Plan Summary Plan Description. 3. Health Care Reimbursement Expenses. If you elect health care reimbursement coverage, you can use your available Pre-tax Contributions to be reimbursed for health care expenses incurred by you, your spouse or any of your dependents during the Period of Coverage for a Plan Year that are related to the diagnosis, treatment, or prevention of disease or for sickness and injury. Premiums for insurance coverages and similar expenses (e.g., payments for a spouse's HMO coverage) are not reimbursable. If you elect to receive health care reimbursement coverage, within the Plan's limits you will elect your level of coverage for the Plan Year. The maximum level of coverage is $3,000 per Plan Year. SPD-3