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❑ Medicare Supplemental Insurance Premiums ❑ Prescription Drug Insurance Premiums ❑ COBRA Insurance. Premiums ❑ Dental Insurance Premiums ❑ Dental Out -of Pocket Expenses' ❑ Vision Insurance Premiums ❑ Vision Out-of-pocket Expenses' ❑ Qualified Long -Term Care Insurance Premiums ❑ Non -Prescription medicationsallowed under IRS guidance' ❑ Other qualifying medical expenses (describe)' `Sec Section V.A. for a-ditu,rfat ofnondiseinbnatio,.rtdei which may apply m ton -collectively bargained, self-insured Plat,: XI, Benefits After the Death of the Participant In the event of a Participant's death, the following shall apply: A. Surviving Spouse and/or Surviving Dependents The surviving spouse and/or surviving eligible dependents (as defined in Section XILD) of the deceased Participant are immediately eligible to maintain the account and utilize it m fund eligible medical benefits specified inSection X above. Upon notification of a Participant's death, the participant's account balance will be transferred into Dreyfus Cash Managcmentfund' (or another fund selected by the Employer). The account balance may be reallocated by the surviving spouse or dependents. 'In invemnrnt in the Dreyfi, Cath Management nnuney market fond h not injured a, guaranteed by the Federal DelowitInsuranre Corporation or any othrrgooenunent agenry. Although the fund seek; to preserve the Oahu of your investment at$1.00 per share, it i; possible to lou money by investing in tfie find luveitori sbomld rontider the innei,nert abjectivet, risks, charges, and eapeuer ofthefnnd rarrfidly before inveitirrg. You may visit us at uwmicmarrtorg or call 800-669-7400 to obtain a prarpecnu that nnntain; thin and orber information about the frond. Read the prosperna carefrdly, before invetbrg. 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 to the Plan to be applied as specified in Section VIII. B. No Surviving Spouse or Surviving Dependents If there are no living spouse or dependents it the time of death of the Participant, the account will revert to the Plan to be applied as specified in Section VIII. XII. The Plan will operate according to the following provisions: A. Employer Responsibilities I. The Employer will submit all VantageCare Retirement Health Savings Plan contribution data via electronic submission. 2. The Employer will submit all VanragcCare Retirement Health Savings Plan Participant status updates or personal information updates via electronic submission. This includes but is nor limited to rermination notification and benefit eligibility notification. B. Participant account administration and asset-based fees will be paid through the redemption of Participant account shares, unless agreed upon otherwise in the Administrative Services Agreement.