INTERNATIONAL CITY MANAGEMENT ASSOCIATION RETIREMENT CORPORATION (ICMA) (CITY MANAGER) 1E

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IX. Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health Savings Plan A. A Participant is eligible to receive benefits: ❑ At retirement only (also complete Section B.) D6nition of retirement: ❑ Same as Section VIL &. ❑ Other 6Z7 At separation from service with the following restrictions 0 No restrictions ❑ Other.,,, __... S. Termination prior to general benefit eligibility: In case where the general benefit eligibility as outlined in Section IX.A includes a retirement component, a participant who separates from service of the Employer prior to retirement will be eligible to receive benefits: 0 Immediately upon separation from service ❑ Other C. A Participant that becomes totally and permanently disabled ❑ as defined by the Social Security Administration 10 as defined by the Employer's primary retirement plan ❑ other will become Immediately eligible to receive medical benefit payments from his /her VantageCare Retirement Health Savings Plan account. D. Upon the death of the Participant, benefits shall become payable as outlined in Section XL. 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 (ocher than insulin). ❑ The following 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 (ocher than insulin). Select only the expenses you wish to cover under the VantageCare Retirement Health Savings Plan: ❑ Medical Insurance Premiums ❑ Medical Out-of- Pocket Expenses' ❑ Medicare Part B Insurance Premiums ❑ Medicare Part D Insurance Premiums