Flexible Spending Accounts are voluntary programs that allow you to use before-tax dollars to reimburse yourself for eligible out-of-pocket expenses. Two separate accounts are available:

• Health Care Account
• Dependent Care Account

You may elect to participate in one, both, or neither of these accounts.

Eligibility Period
If you are a new associate, have just become eligible for benefits or have experienced a work/life event, you may participate in either Flexible Spending Account on the first of the next month. However, enrollment deadlines apply. You are required to re-enroll in the Flexible Spending Accounts during the annual enrollment period in order to be enrolled in the program in the upcoming year. Eligible expenses incurred on or after the effective date through December 31 of the current year (or up through the last day of benefit eligibility, if sooner) are eligible for reimbursement under this plan. All other participating associates may submit expenses incurred from January 1 through December 31 of the current year.

Health Care Account
The Health Care Account lets you use before-tax dollars to reimburse yourself for certain health care expenses. When you put money in this account, you don't pay federal income or FICA taxes on that money (or state taxes either in most cases). Instead, the money you would have paid in taxes goes straight to you. You can choose whether or not to participate in this account.

Who Can Be Covered Under the Health Care Account
You can cover eligible health care expenses for:

• Yourself
• Your legally married spouse
• Your or your legally married spouse’s unmarried children defined as:
  - Biological child(ren)
  - Legally adopted child(ren) or child(ren) placed with you for adoption
  - Child(ren) for whom you or your legally married spouse have documentation of legal guardianship
  - Your handicapped children of any age, if they become unable to earn a living before they reach age 19 (or become age 25 if they are full-time students). You must be able to present appropriate documentation if requested by the claims administrator.
  - Your non-custodial child(ren), as required by any Qualified Medical Child Support Order
  - Your dependent parents
  - Other dependents recognized by the IRS.
• Unmarried children can be covered until:
  - The end of the year in which they attain age 19; or
  - The end of the month in which they attain age 25 if they are enrolled as a full-time student; or
  - The end of the month in which they are no longer enrolled as full-time students.

Importantly, health cae expenses are eligible only if the person receiving such care receives more than half of their support from you during the plan year.

You don't have to be enrolled in the Health Alliance medical or dental plans to use this account. You can use the account to pay with pre-tax dollars eligible out-of-pocket expenses incurred, but not paid, under another employer's insurance plan.

eligible and ineligible expenses . | . calculate your contributions

Contributions
If you choose to contribute to the Health Care Account, the minimum contribution is $10 per bi-weekly paycheck ($260 a year). The maximum contribution is $192.31 per biweekly paycheck (up to $5,000 annual maximum). Contributions will be deducted on a before-tax basis from every paycheck during the eligible period.

Participants enrolling in a Health Care Account for the first time will receive $20 from the Health Alliance which will be added to their Health Care Account. This $20 one-time incentive will be available for reimbursement after the end of the closest quarter of the year following the participant’s effective date of participation.

Using Your Account
When you incur eligible expenses, you will need to complete a claim form available from your human resources department or Custom Design Benefits, Inc. Mail the completed claim form to Custom Design Benefits, Inc. and include an Explanation of Benefits (EOB) or itemized bill from your health insurance provider that shows the amounts not reimbursed by your medical, dental or vision plan. Your claim will be processed and payment will be mailed to your home. Checks are issued every Friday for approved claims that are received in the Custom Design Benefits, Inc. office by noon on Thursday, the day before. A statement will also accompany each check to report the status of your account activity. Amounts reimbursed from the Health Care Account may not be claimed as a deduction on your personal income tax return.

Deadlines For Filing Claims
If you remain in a benefits-eligible status and are enrolled in the Health Care Account until the end of the calendar year, you have until March 31 of the following calendar year to submit claims for eligible expenses. Such eligible expenses must have been incurred during the just completed calendar year. If you terminate employment or change to a benefits-ineligible status, you can only claims expenses incurred up to the date that you terminate employment or change status. You have 90 days after the date of your termination or change to benefits-ineligible status to submit such claims for reimbursement. Please review your Summary Plan Description (SPD) regarding continuation of this benefit through COBRA.