GODINEZ, RAUL II (2) - Laserfiche WebLink

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X. Permissible Medical Benefit Payments Benefits eligible for reimbursement consist of All Medical Expenses eligible under IRC Section 213 other than (I) direct long-term care expenses, and (ii) expenses for medicines or drugs which are not prescribed drugs (other than insulin). ❑ The following Medical Expenses eligible under IRC Section 213 otter than (i) direct long-term care expenses, and (ii) expenses for medicines or drugs which are not prescribed drugs (other than insulin). Select only the expenses you wish to cover under the Employees welfare benefits plan: ❑ Medical Imurmcc Premiums ❑ Medical Outof-Pocket Expenses" ❑ Medicare Part B Insurance Premiums ❑ Medicare Part D Insurance Premiums ❑ Meditate Supplemental Insurance Premiums ❑ Prescription Drug Insurance Premiums ❑ COBRA Insurance Premiums ❑ Dental Insurance Premiums ❑ Dental Out -of -Pocket Expenses` ❑ %ision Insurance Premiums ❑ Vision Ourof-Packet Expenses' ❑ Qualified Long -Term Care Insurance Premiums ❑ Non -Prescription medications allowed under IRS guidance ❑ Other qualifying medical expenses (describe)" • Non-cvllarrim4 burgained planar shot reimburse medical "peruesother class imumncepmmiumrsboubl consult rlieir benefiu counsel rcgardingwelfare plan nondisc munation rules ifthe employer elects to make contributions based on a percentage of earnings. Xi. Benefits After the Death of the Participant In the event ofa Participant's death, the following shall apply: A. Surviving Spouse and/or Surviving Dependents Upon the death of a participant, the surviving spouse and/or surviving eligible dependents (as defined in Section XII.D.) of die deceased Participant are immediately eligible to maintain the Participants RHS account and utilizing the remaining balance to fund eligible medical benefits specified in Section X above. Upon notification of a Participant's death, the Participant's account balance will be transferred into VT II Cash Management Fund" (or another fund selected by the Employer). The account balance may be reallocated by the surviving spouse or dependents .. Before invouing in rhe Fundyau should carefully comideryour invesimentgoak, ro/erance far risk, investment rime horizon, and personal tirrumsmnca. There is noguaninsee chat the Fund will meet in investment objective and yon can lase money. For additional information regarding the Fund, inked inga description of the principal risks, please consuls the Van rage Trust II Funds Diselouere Mmwrandxm and fiend facrsheer, which is available when you log in at www, immreorg or upon request by calling 800-669-7400. Ifthe phrn I defaulr fmtd is not the VT II Cash Managemenr Fund, please read rhe disclosrne martriak or prospectus applicable in the defauh-find If a Participant's account balance has not been fully utilized upon the death of the eligible spouse, the account balance may continue to be utilized to pay benefits of eligible dependents. Upon the death of all eligible dependents, the account will revert in accordance with the Employer's election under Section VIII of the VanmgeCare RHS Adoption Agreement. 11:17