INTERNATIONAL CITY MANAGEMENT ASSOCIATION RETIREMENT CORPORATION (ICMA-RC) (CITY MANAGER)

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X. Permissible Medical Benefit Payments Biowfin eligible for reimbursement consist of [0 All Medical Expenses eligible under IRC Section 213 ocher than (i) direct long-term care expenses, and (ii) expenses for medicines or drugs which arc nor prescribed drugs (other than insulin). ❑ The following Medical Expenses eligible under IRC Section 21;g otter than (i) direct long -terns care expenses, and (ii) expenses for medicines or drugs which are nor prescribed drugs (other than insulin). Select only die expenses you. wish to cover under the Employer's welfare hcnerics plan: ❑ Medical Insurance Premiums ❑ Medical Out-of-pocket Expenses* ❑ Medicare Part B Insurance Premiums ❑ Medicare Part D Insurance Premiums ❑ Medicare Supplemental Insurance Premiums ❑ Prescription Drug Insurance Premiums ❑ COBRA Insurance Premiums ❑ Dental Insurance Premiums ❑ Dental Out -of -Packer Expenses* ❑ Vision Imuranca Premiums ❑ Vision Otte-ol~Pocket Expcnses` ❑ Qualified Long -Term Care Insurance Premiums ❑ Non -Prescription medications allowed under IRS guidance Other qualifying medical expenses (describe)* Non-tn(lrerively bruganredplans that rcimbrase medical expenses other than insiurnece presduncrsbould znnsult their benefus couruel regarding ioeyyere plu: rtnndlsariminrzrlon rules if the oniplayer elects to snake contributions baud on a percena,;e of earrings. XI. Benefits After the Deathof the Participant In the event of Participant's death• the following shall apply: A. SurvivingSpouse and/or Surviving Dependenrs Upon the death of participant, the surviving spouse andlor surviving eligible dependents (as defined in Section XII.D.) of the deceased Pmrticipa irate immediately eligible to maintain the Parriciparns RHS account mad utilizing the remaining balance to brad eligible medical beneflcc specified in Section X above. Upon notification of Paxdcipcuu's death, the Parncipant s account balance will be transferred into VT II Cash Management Fund" (or another fund sclecred by the Employer). The account balance may he reallocated by die surviving spouse or dependents, "* Before investing in the Frnrd yn shoulhicarefaly consider your invesmienrgoab, rolerance for risk, investment time horizon, and personal cirvxtnuunues. There is no gummrree thar the Fund mill meet its lnvestrnenr objerrivr rind you can lose money. For ail boom/ information regarding the Franc,, including a description of the principal risks, please consult the hanrarcTrvst pl cords Diselosure Afenorramlam and fund fitet sheer, which is available whom you log in at wiara.icmenrbrg or Open requen by eallhtZ 800,669-7400, f the pin i defaulr fund is nor rbe VT Il Cash Management Fund, please, read the disclosure nrrtterhuh or prospectus applicable to the deyealijaml If a Participant's account balance has not been fitly utilized upon the death of the eligible spouse, the aceounr 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 die Employer's election under Section Vil l of the I4utrageGare RHSAdoprimr Agreement, 11:17