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4. How Do I Claim Reimbursement Benefits? If you have elected reimbursement coverage, you may claim reimbursement for eligible medical and/or dependent care expenses. You have until March 31�t after the close of the Plan Year to have a correct and complete claim received by the Claims Administrator. Benefits are paid at least monthly. To be reimbursed you must deliver a completed claim form to: Finance Department City of Roseville 2660 Civic Center Drive Roseville, MN 55113 You must attach a copy of your bill or receipt or other satisfactory third party documentation of the amount of the expense and the date(s) the expense was incurred (a canceled check is not sufficient). You must also certify that each expense is eligible for reimbursement under the Plan, that it has not been previously reimbursed under the Plan and that it is not reimbursable from any other source (e.�., insurance). After your claim is reviewed, processed, and approved, you will receive a reimbursement. Claims with missing or illegible information will be denied, pending re-submission of legible information. If an expense is eligible for both medical and dependent care reimbursements, you may choose whether to submit the expense as a medical expense or a dependent care expense. You may also submit part of the expense for reimbursement under one type of coverage, and the remainder for reimbursement under the other, but you may only be reimbursed once for any expense. RESTRICTIONS ON RECEIVING BENEFITS Tax laws impose a variety of nondiscrimination requirements and benefits tests that must be met before benefits under the Plan will be nontaxable to all employees. These are generally intended to restrict the amount of nontaxable benefits available to certain employees of the Employer who are officers, directors, or "highly compensated." If the Employer believes that any of these requirements or limits may be violated, it may limit the amount of Pay Conversion Contributions certain participants may allocate to nontaxable benefits, so that the Plan and its benefits will not be discriminatory. 13