GODINEZ, RAUL II (2) - Laserfiche WebLink

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If a Participant permanently opts out and waives future reimbursements, wallowed under IRS Notice 2013-54, all funds in the Participants account at the time of waiver shall be forfeited in accordance with the box checked under this section.* ❑ Remain in the Trust to be reallocated among all Plan Participants with a balance as Direct Employer Contributions for the next and succeeding contribution cycle(s).** © Remain in the Trust to be reallocated on an equal dollar basis among all Plan Participants with a balance." ❑ Remain in the Trust to be reallocated among all Plan Participants based upon Participant account balances." ❑ Revert to the Employer via check IX. Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement health Savings Program A. A Participant is eligible to receive benefits: ❑ At retirement only (also complete Section B.) Definition of retaemena ❑ Same" Section VILB. ❑ Other 21 At sepatation from service with the following restrictions ❑ No restrictions ❑ Other B. Termination prior to general benefit eligibility: In case where the general benefit eligibility as outlined in Section 1X.A includes a retirement component, a Participant who separates from service of the Employer prior to retirement will be eligible to receive benefits: ® Immediately upon separation from service ❑ Ocher C. A Participant that becomes totally and permanently disabled ❑ as defined by the Social Security Administration ❑✓ as defined by the Employetss primary retirement plan ❑ other will become immediately eligible to receive medical benefit payments from his/her account under the Employer's welfare benefits plan. D. Upon the death of the Participant, benefits shall become payable as outlined in Section XI. *Ifthe Employer's RHS Program does not limit eligibility to participants who have separated from service, the employer will be required to provide further direction to ICMA-RC regarding the treatment of passible contributions that are required to be made following the participant's waiver. ** Ifthe forfeited balance is smallwhereby the reallocation amount to each Plan Participant with a balance is minima( tbeasseu will revert to employer's forfeiture account for further dimetiorh from the employer. Ifthere are participants without a balance who should receive forfeiture aceta, pleare provide altermaive instructions to ICW-RC on the forfeiture reallocation notice. 11:16