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<br />. <br /> <br />. <br /> <br />. <br /> <br />City of Arden Hills <br /> <br />Summary Plan Descriotion <br /> <br />. Fax or Mail the Reimbursement Claim Form to the Acclaim Benefits Flexible Spending <br />Account Department. Claims received by Fax or Mail will be audited and entered within 24- <br />hours of initially receiving the reimbursement claim form. It is recommended that you keep <br />a copy of the fax confirmation for your records. <br /> <br />Claims should be: faxed to: (763) 278-4004 or (866) 278-4004 (toll free) <br />mailed to: PO Box 47338, Minneapolis, MN 55447 <br /> <br />. After your claim is reviewed, processed, and approved, a chcck or advice of deposit will be <br />mailed directly 10 your home addrcss. <br /> <br />ARE THERE ANY RESTRICTIONS ON RECEIVING BENEFITS? <br /> <br />Tax laws impose a variety of nondiscrimination requirements and benefits tests that must be met before <br />benefits under the Plan will be nontaxable to all employees. These are generally intended to restrict the <br />amount of nontaxable benefits available to certain employees of the Employer who are officers, directors, <br />or "highly compensated". If the Employcr believes that any of these requirements or limits may be <br />violated, it may limit the amount of Pre-tax Contributions certain participants may allocate to nontaxable <br />benefits, so that the Plan and its benefits will not be discriminatory. <br /> <br />HOW DO I MAKE A BENEFIT ELECTION? <br /> <br />Prior to the start of your participation in the Plan for a Plan Year, at a time announced by the Employer, <br />you must complete and retum to the Employer a benefit election form setting out your benefit elections <br />and indicating how much of your Pre-tax Contributions, if any, that you want used to pay your benefits. <br />If you do not make a benefits election, you will not be able to participate in the Plan for the Plan Year. <br /> <br />If you become a participant after the beginning of a Plan Year, your bencfit election will become <br />effective as of the first day of the month and after your benefit election form is filed with the Employer. <br /> <br />HOW DO I CHANGE MY BENEFIT ELECTION? <br /> <br />After a Plan Year begins you generally cannot change your benefit election or allocation of Pre-tax <br />Contributions. You may request a mid-year election change only if you experience a "status change". <br />Any such election change must be on account of and consistent with the status change. <br /> <br />STATUS CHANGES <br />1. Change in legal marital status (marriage, divorce, death of spouse, legal separation and annulment). <br />2. Change in the number of tax dependents (birth, placement for adoption, death). <br />3. Employment status change for you, your spouse or your dependent (termination or commencement of <br />employment, full-time to part-time, unpaid leave of absence, change in worksite, strike or lockout). <br />4. Dependent satisfies or ceases to satisfy eligibility requirements (attainment of age limit, student <br />status, marriage). . <br />5. Residence change by you, your spouse or dependent; thc change must affect eligibility for an <br />underlying benefit, such as moving outside of an HMO service area. <br />6, Change in coverage due to spouse or dependeilt's open enrollment. <br />7. For adoption assistance benefits, if applicable, starting or ending adoption proceedings. <br /> <br />SPD-7 <br />