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❑ Alediasre Supplemental Insurance Premiums ❑ Prescription Drug Insurance Premiums ❑ .COBRA Insurance Premiums ❑ Dental Insurance Premiums ❑ Denral Our -of -Pocket Expenses' ❑ Vision Insurance Premiums ❑ Vision Out -of -Pocket Expenses' ❑ Qualified Long -Term Care Insurance Premiums ❑ Non -Prescription medications allowed under IRS guidance' ❑ Other qualifying medical expenses (describe)` 'see Section Vel. fora drrcnnion ofoandirrrinunatiwr rider Urdu) rraj appy to non -collectively bargained, n!f_Grrored plan. XI. Benefits After the Death of the Participant In the event of a Participant's death, the followingshill apply: A. Surviving Spouse anchor Surviving Dependents The surviving spouse and/or surviving eligible dependents (as defined in Section :GILD] of the deceased Participant ate Immediately eligible to maintain the account and utilize it to find eligible medical benefit specified in Section X above. Upon nodficatfon of a Participant's death, the Participant's account balance will be transferred into Dreyfus Cash sbfanagemenr fund' (or another fund selected by the Employer). The account balance may he reallocated by the survivingspouse or dependents. A,, invatnnnt in the Drv;fiu Cirri; rslanagmrnr none;, inarkerfurid ii nor inrnnd ogrramnital byte Feder I Deparir Innrrmre Corporation oraty other wcenrmeor agency. Although de fiord ieekr to prerace the cadre afyour investment at SL 00 purbare, it it terrible N Ione money by inverting in rbefund Ir, rmtand... Id n nrido rhe inunrnma objectives, risks, Anger, and espenitr oftbefrad rarrfuly before invaiiiig. Ynu unq Quit m at wwty.innartmg arra!/ R00-669-yt00 ro obn+in n proipnnu di tr ronrainr 16ir.nrAorbrr hifunnatian nbu:a rbejuna. Raid the proiperrrn rorefidly before investing. If a Participants account balance has not been fully utilized upon the death of the eligible spuust, theaccount balance may coutinuc to be utilized to pay benefits of eligible dependents. Upon dse death oral[ eligible dcpcndcnts, the accounr will revert to the Plan to be applied as specified in Section Vlll. B. No Surviving Spouse or Surviving Dependents If there are no living spouse or dependents at the time of death of tine Participant, rite account will revert to the Plan to be applied as specified in Section V I 11. XII. The Plan will operate according to the following provisionst A. Employer Responsibilities L "Bic Employer will submit all VanngeCare Retirement Flealth Savings Plan contribution data via electronic submission. The Employer will submit all VantageCare Retirement Healtls Savings Plan Participant status updates or personal information updates via electronic submission. Ibis includes but is not limited to termination notifintion and benefit eligibility notification. B. Participant account administration and asset-based fees will be paid risrough the redemption of Participant account shares, unless agreed upon otherwise in rile Administrative Services Agreamem. 25E-96