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5/14/2013 - Adopted Board Records
ACTION NO. A- 051413 -1 ITEM NO. E -1 AT A REGULAR MEETING OF THE BOARD OF SUPERVISORS OF ROANOKE COUNTY, VIRGINIA HELD AT THE ROANOKE COUNTY ADMINISTRATION CENTER MEETING DATE: May 14, 2013 AGENDA ITEM: Request to appropriate $20,015 for the June 11, 2013 Democratic Primary Election SUBMITTED BY: Judy Stokes General Registrar APPROVED BY: B. Clayton Goodman III County Administrator COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: The State Board of Elections has issued an order for a Democratic primary to be held on June 11, 2013, for the offices of Lt. Governor and Attorney General. Below is a summary of the costs associated with this primary: Elections Officials and Staff $18,115 Required advertising 650 Rent of polling places 300 Postage and printed forms 950 Total $20,015 FISCAL IMPACT: The cost of the primary was not included in the current budget inasmuch as it was not certified by the State Board of Elections until April 5, 2013. No reimbursement will be made by the State. Funds are available in the Board Contingency. STAFF RECOMMENDATION: Staff recommends appropriating $20,015 from the Board Contingency for the June 11, 2013, Democratic Primary. Page 1 of 2 VOTE: Supervisor Church moved to approve the staff recommendation. Motion approved. cc: Judith Stokes, General Registrar Rebecca Owens, Director of Finance Page 2 of 2 Yes No Absent Ms. Moore � ❑ ❑ Mr. Flora � ❑ ❑ Mr. Church � ❑ ❑ Mr. Elswick � ❑ ❑ Mr. Altizer � ❑ ❑ cc: Judith Stokes, General Registrar Rebecca Owens, Director of Finance Page 2 of 2 AT A REGULAR MEETING OF THE BOARD OF SUPERVISORS OF ROANOKE COUNTY, VIRGINIA, HELD AT THE ROANOKE COUNTY ADMINISTRATION CENTER ON TUESDAY, MAY 14, 2013 RESOLUTION 051413 -2 APPROVING AND CONCURRING IN CERTAIN rrEMS SET FORTH ON 'rHE BOARD OF SUPERVISORS AGENDA FOR THIS DATE DESIGNATED AS ITEM H- CONSENT AGENDA BE IT RESOLVED by the Board of Supervisors of Roanoke County, Virginia, as follows: That the certain section of the agenda of the Board of Supervisors for May 14, 2013 designated as Item H - Consent Agenda be, and hereby is, approved and concurred in as to each item separately set forth in said section designated Items 1 through 4 inclusive, as follows: 1. Approval of minutes — April 9, 2013; April 23, 2013 2. Request to adopt a resolution to authorize a health reimbursement arrangement and approve plan documents 3. Request to approve an agreement with the Yakama Nation to resolve pending litigation 4. Request to appropriate $26,677.80 to the Clerk of the Circuit Court from the Commonwealth of Virginia for fiscal year 2012/2013 On motion of supervisor Altizer to adopt the resolution, and carried by the following roll call and recorded vote: AYES: Supervisors Moore, Flora, Church, Elswick, Altizer NAYS: None A COPY TESTE: Deborah C. Jack Clerk to the Board of Vrpervisors Page 1 of 1 AT A REGULAR MEETING OF THE BOARD OF SUPERVISORS OF ROANOKE COUNTY, VIRGINIA, HELD AT THE ROANOKE COUNTY ADMINISTRATION CENTER ON TUESDAY, MAY 14 2013 RESOLUTION 051413 -2a ADOPTING THE HEALTH REIMBURSEMENT ARRANGEMENT FOR ROANOKE COUNTY BE IT RESOLVED by the Board of Supervisors of Roanoke County, as follows: 1. That the Health Reimbursement Arrangement effective July 1, 2013, presented to the Board of Supervisors at this meeting is hereby approved and adopted and that the County Administrator, or his designee, is hereby authorized and directed to execute and deliver to Flex Benefit Administrators, the Administrator of the Plan, one or more counterparts of the Plan; and 2. That the Administrator of the Plan shall be instructed to take such actions that are deemed necessary and proper in order to implement the Plan, and to set up adequate accounting and administrative procedures to provide benefits under the Plan; and 3. That the County Administrator, or his designee, shall act as soon as possible to notify the employees of the County of the adoption by delivering to each participating employee a copy of the summary description of the Plan in the form of the Summary Plan Description presented to this meeting, which form is hereby approved; and 4. That the Clerk to the Board of Supervisors further certifies that attached hereto as Exhibits A and B, respectively, are true copies that have not been modified or rescinded of the County of Roanoke Health Reimbursement Arrangement Plan Page 1 of 2 Document and the Summary Plan description approved and adopted in the foregoing resolutions; and 5. That this Resolution is effective from and after July 1, 2013. On motion of Supervisor Altizer to adopt the resolution, and carried by the following roll call and recorded vote: AYES: Supervisors Moore, Flora, Church, Elswick, Altizer NAYS: None A CORY TESTE: Deborah C. Jacks Clerk to the Board Leupervisors cc: Rebecca Owens, Director of Finance Joe Sgroi, Director of Human Resources Page 2of2 Attachment A County of Roanoke HEALTH REIMBURSEMENT ARRANGEMENT BASIC PLAN DOCUMENT © Copyright 2005 SunGard Inc. TABLE OF CONTENTS ARTICLE I DEFINITIONS 1.1 Administrator 1 -------------------------------------------------------------------------------------------- - - - - -- 1.2 Affiliated Employer ---------------------------------------------------------------------------------- - - - - -- 1 1.3 Code 1 ----------------------------------------------------------------------------------------------------------- - - - - -- 1.4 Coverage Period ---------------------------------------------------------------------------------------- - - - - -- 1 1.5 Dependent -------------------------------------------------------------------------------------------------- - - - - -- 1 1.6 Effective Date 1 1.7 Eligible Employee ------------------------------------------------------------------------------------- - - - - -- 1 1.8 Employee --------------------------------------------------------------------------------------------------- - - - - -- 2 1.9 Employer .--------------------------------------------------------------------------------------------------- - - - - -- 2 1.10 Employer Contribution ----------------------------------------------------------------------------- - - - - -- 2 1.11 ERISA 2 -------------------------------------------------------------------------------------------------------- - - - - -- 1.12 Leased Employee -------------------------------------------------------------------------------------- - - - - -- 2 1.13 Participant -------------------------------------------------------------------------------------------------- - - - - -- 2 1.14 Plan 3 ------------------------------------------------------------------------------------------------------------ - - - - -- 1.15 Premiums 3 --------------------------------------------------------------------------------------------------- - - - - -- 1.16 Qualifying Medical Expenses ------------------------------------------------------------------ - - - - -- 3 ARTICLE II PARTICIPATION 2.1 Eligibility ----------------------------------------------------------------------------------------------------- - - - - -- 3 2.2 Effective Date of Participation ------------------------------------------------------------------- - - - - -- 3 2.3 Termination of Participation, ---------------------------------------------------------------------- - - - - -- 4 ARTICLE III BENEFITS 3.1 Establishment of Plan 4 ------------------------------------------------------------------------------------- 3.2 Nondiscrimination Requirements ------------------------------------------------------------ - - - - -- 4 3.3 Health Reimbursement Arrangement Claims ----------------------------------------- - - - - -- 5 3.4 Debit and Credit Cards 5 ----------------------------------------------------------------------------- - - - - -- ARTICLE IV ERISA PROVISIONS 4.1 Claim for Benefits 7 ------------------------------------------------------------------------------------------ 4.2 Named Fiduciary.-------------------------------------------------------------------------------------- - - - - -- 9 4.3 General Fiduciary Responsibilities .--------------------------------------------------------- - - - - -- 9 4.4 Nonassignability of Rights ----------------------------------------------------------------------- - - - - -- 9 © Copyright 2005 SunGard Inc. ARTICLE V ADMINISTRATION 5.1 Plan Administration 10 5.2 Examination of Records 10 --------------------------------------------------------------------------------- 5.3 Indemnification of Administrator 11 ARTICLE VI AMENDMENT OR TERMINATION OF PLAN 6.1 Amendment ----------------------------------------------------------------------------------------------- - - - - -- 10 6.2 Termination 11 ----------------------------------------------------------------------------------------------- - - - - -- ARTICLE VII MISCELLANEOUS 7.1 Plan Interpretation ------------------------------------------------------------------------------------ - - - - -- 11 7.2 Gender and Number,--------------------------------------------------------------------------------- - - - - -- 11 7.3 Written Document ------------------------------------------------------------------------------------------ 11 7.4 Exclusive Benefit 12 7.5 Participant's Rights ---------------------------------------------------------------------------------- - - - - -- 12 7.6 Action by the Employer.--------------------------------------------------------------------------- - - - - -- 12 7.7 No Guarantee of Tax Consequences ------------------------------------------------------- - - - - -- 12 7.8 Indemnification of Employer by Participants ----------------------------------------- - - - - -- 12 7.9 Funding .----------------------------------------------------------------------------------------------------- - - - - -- 13 7.10 Governing Law ----------------------------------------------------------------------------------------- - - - - -- 13 7.11 Severability ----------------------------------------------------------------------------------------------- - - - - -- 13 7.12 Headings .--------------------------------------------------------------------------------------------------- - - - - -- 13 7.13 Continuation of Coverage ------------------------------------------------------------------------ - - - - -- 13 7.14 Family and Medical Leave Act ---------------------------------------------------------------- - - - - -- 13 7.15 Health Insurance Portability and Accountability Act ----------------------------- - - - - -- 13 7.16 Uniformed Services Employment and Reemployment Rights Act ------- - - - - -- 14 7.17 HIPAA Privacy Standards .----------------------------------------------------------------------- - - - - -- 14 7.18 HIPAA Electronic Security Standards ---------------------------------------------------- - - - - -- 16 Certificate of Adopting Resolution .--------------------------------------------------------------------- - - - - -- 19 © Copyright 2005 SunGard Inc. HEALTH REIMBURSEMENT ARRANGEMENT As used in this Plan, the following words and phrases shall have the meanings set forth herein unless a different meaning is clearly required by the context: ARTICLE I DEFINITIONS 1.1 "Administrator" means the individual(s) or committee appointed by the Employer to carry out the administration of the Plan. In the event the Administrator has not been appointed, or resigns from a prior appointment, the Employer shall be deemed to be the Administrator. 1.2 "Affiliated Employer" means any corporation which is a member of a controlled group of corporations (as defined in Code Section 414(b)) which includes the Employer; any trade or business (whether or not incorporated) which is under common control (as defined in Code Section 414(c)) with the Employer; any organization (whether or not incorporated) which is a member of an affiliated service group (as defined in Code Section 414(m)) which includes the Employer; and any other entity required to be aggregated with the Employer pursuant to Treasury regulations under Code Section 414(0). 1.3 "Code" means the Internal Revenue Code of 1986, as amended. 1.4 "Coverage Period" means the time period as set forth in the Adoption Agreement. 1.5 "Dependent" means any individual who qualifies as a dependent under Code Section 152 (as modified by Code Section 105(b)). Any child of a Participant who is an "alternate recipient" under a qualified medical child support order under ERISA Section 609 shall be considered a Dependent under this Arrangement. 1.6 "Effective Date" means the date specified in the Adoption Agreement. 1.7 "Eligible Employee" means any Eligible Employee as elected in the Adoption Agreement and as provided herein. An individual shall not be an "Eligible Employee" if such individual is not reported on the payroll records of the Employer as a common law employee. In particular, it is expressly intended that individuals not treated as common law employees by the Employer on its payroll records are not "Eligible Employees" and are excluded from Plan participation even if a court or administrative agency determines that such individuals are common law employees and not independent contractors. Furthermore, Employees of an Affiliated Employer will not be treated as "Eligible Employees" prior to the date the Affiliated Employer adopts the Plan as a Participating Employer. However, aself- employed individual as defined under Code Section 401(c) or a 2- percent shareholder as defined under Code Section 1372(b) shall not be eligible to participate in this Plan. © Copyright 2005 SunGard Inc. 1.8 "Employee" means any person who is employed by the Employer. The term "Employee" shall also include any person who is an employee of an Affiliated Employer and any Leased Employee deemed to be an Employee as provided in Code Section 414(n) or (o). 1.9 "Employer" means the entity specified in the Adoption Agreement, any successor which shall maintain this Plan and any predecessor which has maintained this Plan. In addition, unless the context means otherwise, the term "Employer" shall include any Participating Employer which shall adopt this Plan. 1.10 "Employer Contribution" means the amounts contributed to the Plan by the Employer. 1.11 "ERISA" means the Employee Retirement Income Security Act of 1974, as amended from time to time. 1.12 "Leased Employee" means, effective with respect to Plan Years beginning on or after January 1, 1997, any person (other than an Employee of the recipient Employer) who, pursuant to an agreement between the recipient Employer and any other person or entity ( "leasing organization "), has performed services for the recipient (or for the recipient and related persons determined in accordance with Code Section 414(n)(6)) on a substantially full time basis for a period of at least one year, and such services are performed under primary direction or control by the recipient Employer. Contributions or benefits provided a Leased Employee by the leasing organization which are attributable to services performed for the recipient Employer shall be treated as provided by the recipient Employer. Furthermore, Compensation for a Leased Employee shall only include Compensation from the leasing organization that is attributable to services performed for the recipient Employer. A Leased Employee shall not be considered an employee of the recipient Employer if: (a) such employee is covered by a money purchase pension plan providing: (1) a nonintegrated employer contribution rate of at least ten percent (10 %) of compensation, as defined in Code Section 415(c)(3), but for Plan Years beginning prior to January 1, 1998, including amounts contributed pursuant to a salary reduction agreement which are excludable from the employee's gross income under Code Sections 125, 402(e)(3), 402(h)(1)(B), 403(b), or for Plan Years beginning on or after January 1, 2001 (or as of a date, no earlier than January 1, 1998, as specified in an addendum to the Adoption Agreement), 132(fl(4), (2) immediate participation, and (3) full and immediate vesting; and (b) leased employees do not constitute more than twenty percent (20 %) of the recipient Employer's nonhighly compensated workforce. 1.13 "Participant" means any Eligible Employee who has satisfied the requirements of Section 2.1 and has not for any reason become ineligible to participate further in the Plan. © Copyright 2005 SunGard Inc. 2 1.14 "Plan" means this Basic Plan Document and the Adoption Agreement as adopted by the Employer, including all amendments thereto. "Plan" means the "Health Reimbursement Arrangement." 1.15 "Premiums" mean the Participant's cost for any health plan coverage. 1.16 "Qualifying Medical Expenses" means any expense eligible for reimbursement under the Health Reimbursement Arrangement which would qualify as a "medical expense" (within the meaning of Code Section 213(d) and as allowed under Code Section 105 and the rulings and Treasury regulations thereunder) of the Participant, the Participant's spouse or a Dependent and not otherwise used by the Participant as a deduction in determining the Participant's tax liability under the Code or reimbursed under any other health coverage, including a health Flexible Spending Account. Qualifying Medical Expenses covered by this Plan are limited as elected in the Adoption Agreement. Furthermore, a Participant may not be reimbursed for "qualified long -term care services" as defined in Code Section 7702B(c). If the Employer provides Health Savings Accounts for Participants, Qualifying Medical Expenses reimbursed shall be limited to those allowed under Code Section 223. ARTICLE II PARTICIPATION 2.1 Eligibility Any Eligible Employee shall be eligible to participate hereunder on the date such Employee satisfies the conditions of eligibility elected in the Adoption Agreement. 2.2 Effective Date of Participation An Eligible Employee who has satisfied the conditions of eligibility pursuant to Section 2.1 shall become a Participant effective as of the date elected in the Adoption Agreement. If an Employee, who has satisfied the Plan's eligibility requirements and would otherwise have become a Participant, shall go from a classification of a noneligible Employee to an Eligible Employee, such Employee shall become a Participant on the date such Employee becomes an Eligible Employee or, if later, the date that the Employee would have otherwise entered the Plan had the Employee always been an Eligible Employee. If an Employee, who has satisfied the Plan's eligibility requirements and would otherwise become a Participant, shall go from a classification of an Eligible Employee to a noneligible class of Employees, such Employee shall become a Participant in the Plan on the date such Employee again becomes an Eligible Employee, or, if later, the date that the Employee would have otherwise entered the Plan had the Employee always been an Eligible Employee. © Copyright 2005 SunGard Inc. 2.3 Termination of Participation This Section shall be applied and administered consistent with any rights a Participant and the Participant's Dependents may be entitled to pursuant to Code Section 4980B, Section 7.13 of the Plan, or any election on the Adoption Agreement. In the case of the death of the Participant, any remaining balances may only be paid out as reimbursements for Qualifying Medical Expenses and shall not constitute a death benefit to the Participant's estate and /or the Participant's beneficiaries. ARTICLE III BENEFITS 3.1 Establishment of Plan (a) This Health Reimbursement Arrangement is intended to qualify as a Health Reimbursement Arrangement under Code Section 105 and shall be interpreted in a manner consistent with such Code Section and the Treasury regulations thereunder. (b) Participants in this Health Reimbursement Arrangement may submit claims for the reimbursement of Qualifying Medical Expenses as defined under the Plan and the Adoption Agreement. Unless otherwise elected in the Adoption Agreement, this Plan shall reimburse any expenses only after amounts in all other Plans that could reimburse the expense have been exhausted. (c) The Employer shall make available to each Participant an Employer Contribution as elected in the Adoption Agreement, for the reimbursement of Qualifying Medical Expenses. No salary reductions may be made to this Health Reimbursement Arrangement. (d) This Plan shall not be coordinated or otherwise connected to the Employer's cafeteria plan (as defined in Code Section 125), except as permitted by the Code and the Treasury regulations thereunder, to the extent necessary to maintain this Plan as a Health Reimbursement Arrangement. (e) If the Employer maintains Health Savings Accounts for Participants, this Arrangement shall be operated in accordance with the restrictions under Code Section 223. 3.2 Nondiscrimination Requirements (a) It is the intent of this Health Reimbursement Arrangement not to discriminate in violation of the Code and the Treasury regulations thereunder. © Copyright 2005 SunGard Inc. (b) If the Administrator deems it necessary to avoid discrimination under this Health Reimbursement Arrangement, it may, but shall not be required to reduce benefits provided to "highly compensated individuals" (as defined in Code Section 105(h)) in order to assure compliance with this Section. Any act taken by the Administrator under this Section shall be carried out in a uniform and nondiscriminatory manner. 3.3 Health Reimbursement Arrangement Claims (a) The Administrator shall direct the reimbursement to each eligible Participant for all Qualifying Medical Expenses. All Qualifying Medical Expenses eligible for reimbursement pursuant to Section 3.1(b) shall be reimbursed during the Coverage Period, even though the submission of such a claim occurs after his participation hereunder ceases; but provided that the Qualifying Medical Expenses were incurred during a Coverage Period. Claims must include receipts or documentation that the expense being incurred is eligible for reimbursement, in order to claim reimbursement. Expenses may be reimbursed in subsequent Coverage Period, subject to the provisions of Number 21 on the Adoption Agreement and Section 3.3(c) below. However, a Participant may not submit claims incurred prior to beginning participation in the Plan and /or the Effective Date of the Plan, whichever is earlier. (b) Notwithstanding the foregoing, if elected in the Adoption Agreement, Qualifying Medical Expenses shall not be reimbursable under this Plan if eligible for reimbursement and claimed under the Employer's Health Flexible Spending Account or Health Savings Account, if applicable. (c) Claims for the reimbursement of Qualifying Medical Expenses incurred in any Coverage Period shall be paid as soon after a claim has been filed as is administratively practicable. However, if a Participant fails to submit a claim within the period elected at Question 21 on the Adoption Agreement immediately following the end of the Coverage Period or calendar year, as selected, those Medical Expense claims shall not be considered for reimbursement by the Administrator. (d) Reimbursement payments under this Plan shall be made directly to the Participant. (e) If the maximum amount available for reimbursement for a Coverage Period is not utilized in its entirety, such remainder shall be carried forward to another Coverage Period or forfeited, as elected in the Adoption Agreement. 3.4 Debit and Credit Cards (a) Participants may, subject to a procedure established by the Administrator and applied in a uniform nondiscriminatory manner, use debit and /or credit (stored value) cards ( "cards ") provided by the Administrator and the Plan for payment of Qualifying Medical Expenses, subject to the following terms: © Copyright 2005 SunGard Inc. (b) Each Participant issued a card shall certify that such card shall only be used for Medical Expenses. The Participant shall also certify that any Medical Expense paid with the card has not already been reimbursed by any other plan covering health benefits and that the Participant will not seek reimbursement from any other plan covering health benefits. (c) Such card shall be issued upon the Participant's Effective Date of Participation and reissued for each Coverage Period the Participant remains a Participant in the Health Reimbursement Arrangement. Such card shall be automatically cancelled upon the Participant's death or termination of employment, or if such Participant withdraws from the Health Reimbursement Arrangement. (d) The dollar amount of coverage available on the card shall be the amount elected by the Participant for the Plan Year. The maximum dollar amount of coverage available shall be the maximum amount for the Plan Year as set forth on the Adoption Agreement. (e) The cards shall only be accepted by such merchants and service providers as have been approved by the Administrator. (f) The cards shall only be used for Medical Expense purchases at these providers, including, but not limited to, the following: (i) Co- payments for doctor and other medical care; (ii) Purchase of drugs; (iii) Purchase of medical items such as eyeglasses, syringes, crutches, etc. (g) Such purchases by the cards shall be subject to substantiation by the Administrator, usually by submission of a receipt from a merchant or service provider describing the service or product, the date of the purchase and the amount. Some charges shall be considered substantiated at the time of charge by the nature of the charge, such as co- payments. Some charges shall be considered substantiated due to their "recurring" nature, in which the expenses match expenses previously approved as to amount, provider, and time period. At point of sale, the service provider or merchant can provide information to the Administrator to substantiate the charge. All charges shall be conditional pending confirmation and substantiation. (h) If such purchase is later determined by the Administrator to not to be a Qualifying Medical Expense, the Administrator, in its discretion, shall use the one of the following correction methods to make the Plan whole. Until the amount is repaid, the Administrator shall take further action to ensure that further violations of the terms of the card do not occur, up to and including denial of access to the card. (i) Repayment of the improper amount by the Participant; (ii) Withholding the improper payment from the Participant's wages or other compensation to the extent consistent with applicable federal or state law; © Copyright 2005 SunGard Inc. (iii) Claims substitution or offset of future claims until the amount is repaid. ARTICLE IV ERISA PROVISIONS 4.1 Claim for Benefits Any claim for Benefits shall be made to the Administrator. The following timetable for claims and rules below apply: Notification of whether claim is accepted or denied 30 days Extension due to matters beyond the control of the Plan 15 days Insufficient information on the Claim: Notification of Response by Participant Review of claim denial 15 days 45 days 60 days The Administrator will provide written or electronic notification of any claim denial. The notice will state: (1) The specific reason or reasons for the denial. (2) Reference to the specific Plan provisions on which the denial was based. (3) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary. (4) A description of the Plan's review procedures and the time limits applicable to such procedures. This will include a statement of the right to bring a civil action under section 502 of ERISA following a denial on review. (5) A statement that the claimant is entitled to receive, upon request and free of charge reasonable access to, and copies of, all documents, records, and other information relevant to the Claim. © Copyright 2005 SunGard Inc. 7 (6) If the denial was based on an internal rule, guideline, protocol, or other similar criterion, the specific rule, guideline, protocol, or criterion will be provided free of charge. If this is not practical, a statement will be included that such a rule, guideline, protocol, or criterion was relied upon in making the denial and a copy will be provided free of charge to the claimant upon request. When the Participant receives a denial, the Participant shall have 180 days following receipt of the notification in which to appeal the decision. The Participant may submit written comments, documents, records, and other information relating to the Claim. If the Participant requests, the Participant shall be provided, free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claim. The period of time within which a denial on review is required to be made will begin at the time an appeal is filed in accordance with the procedures of the Plan. This timing is without regard to whether all the necessary information accompanies the filing. A document, record, or other information shall be considered relevant to a Claim if it: (1) was relied upon in making the claim determination; (2) was submitted, considered, or generated in the course of making the claim determination, without regard to whether it was relied upon in making the claim determination; (3) demonstrated compliance with the administrative processes and safeguards designed to ensure and to verify that claim determinations are made in accordance with Plan documents and Plan provisions have been applied consistently with respect to all claimants; or (4) constituted a statement of policy or guidance with respect to the Plan concerning the denied claim. The review will take into account all comments, documents, records, and other information submitted by the claimant relating to the Claim, without regard to whether such information was submitted or considered in the initial claim determination. The review will not afford deference to the initial denial and will be conducted by a fiduciary of the Plan who is neither the individual who made the adverse determination nor a subordinate of that individual. © Copyright 2005 SunGard Inc. 4.2 Named Fiduciary The "named Fiduciaries" of this Plan are (1) the Employer and (2) the Administrator. The named Fiduciaries shall have only those specific powers, duties, responsibilities, and obligations as are specifically given them under the Plan including, but not limited to, any agreement allocating or delegating their responsibilities, the terms of which are incorporated herein by reference. In general, the Employer shall have the sole responsibility for providing benefits under the Plan; and shall have the sole authority to appoint and remove the Administrator; and to amend the elective provisions of the Adoption Agreement or terminate, in whole or in part, the Plan. The Administrator shall have the sole responsibility for the administration of the Plan, which responsibility is specifically described in the Plan. Furthermore, each named Fiduciary may rely upon any such direction, information or action of another named Fiduciary as being proper under the Plan, and is not required under the Plan to inquire into the propriety of any such direction, information or action. It is intended under the Plan that each named Fiduciary shall be responsible for the proper exercise of its own powers, duties, responsibilities and obligations under the Plan. Any person or group may serve in more than one Fiduciary capacity. 4.3 General Fiduciary Responsibilities The Administrator and any other fiduciary under ERISA shall discharge their duties with respect to this Plan solely in the interest of the Participants and their beneficiaries and (a) for the exclusive purpose of providing Benefits to Participants and their beneficiaries and defraying reasonable expenses of administering the Plan; (b) with the care, skill, prudence and diligence under the circumstances then prevailing that a prudent man acting in like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims; and (c) in accordance with the documents and instruments governing the Plan insofar as such documents and instruments are consistent with ERISA. 4.4 Nonassignability of Rights The right of any Participant to receive any reimbursement under the Plan shall not be alienable by the Participant by assignment or any other method, and shall not be subject to the rights of creditors, and any attempt to cause such right to be so subjected shall not be recognized, except to such extent as may be required by law. © Copyright 2005 SunGard Inc. ARTICLE v ADMINISTRATION 5.1 Plan Administration The operation of the Plan shall be under the supervision of the Administrator. It shall be a principal duty of the Administrator to see that the Plan is carried out in accordance with its terms, and for the exclusive benefit of Employees entitled to participate in the Plan. The Administrator shall have full power to administer the Plan in all of its details, subject, however, to the pertinent provisions of the Code. The Administrator's powers shall include, but shall not be limited to the following authority, in addition to all other powers provided by this Plan: (a) To make and enforce such rules and regulations as the Administrator deems necessary or proper for the efficient administration of the Plan; (b) To interpret the Plan, the Administrator's interpretations thereof in good faith to be final and conclusive on all persons claiming benefits under the Plan; (c) To decide all questions concerning the Plan and the eligibility of any person to participate in the Plan and to receive benefits provided under the Plan; (d) To limit benefits for certain highly compensated individuals if it deems such to be desirable in order to avoid discrimination under the Plan in violation of applicable provisions of the Code; (e) To approve reimbursement requests and to authorize the payment of benefits; and (f) To appoint such agents, counsel, accountants, consultants, and actuaries as may be required to assist in administering the Plan. (g) To establish and communicate procedures to determine whether a medical child support order is qualified under ERISA Section 609. Any procedure, discretionary act, interpretation or construction taken by the Administrator shall be done in a nondiscriminatory manner based upon uniform principles consistently applied and shall be consistent with the intent that the Plan shall continue to comply with the terms of Code Section 105(h) and the Treasury regulations thereunder. 5.2 Examination of Records The Administrator shall make available to each Participant, Eligible Employee and any other Employee of the Employer such records as pertain to their interest under the Plan for examination at reasonable times during normal business hours. © Copyright 2005 SunGard Inc. 10 5.3 Indemnification of Administrator The Employer agrees to indemnify and to defend to the fullest extent permitted by law any Employee serving as the Administrator or as a member of a committee designated as Administrator (including any Employee or former Employee who previously served as Administrator or as a member of such committee) against all liabilities, damages, costs and expenses (including attorney's fees and amounts paid in settlement of any claims approved by the Employer) occasioned by any act or omission to act in connection with the Plan, if such act or omission is in good faith. ARTICLE VI AMENDMENT OR TERMINATION OF PLAN 6.1 Amendment The Employer, at any time or from time to time, may amend any or all of the provisions of the Plan without the consent of any Employee or Participant. 6.2 Termination The Employer is establishing this Plan with the intent that it will be maintained for an indefinite period of time. Notwithstanding the foregoing, the Employer reserves the right to terminate the Plan, in whole or in part, at any time. In the event the Plan is terminated, no further reimbursements shall be made. ARTICLE VII MISCELLANEOUS 7.1 Plan Interpretation All provisions of this Plan shall be interpreted and applied in a uniform, nondiscriminatory manner. This Plan shall be read in its entirety and not severed except as provided in Section 7.11. 7.2 Gender and Number Wherever any words are used herein in the masculine, feminine or neuter gender, they shall be construed as though they were also used in another gender in all cases where they would so apply, and whenever any words are used herein in the singular or plural form, they shall be construed as though they were also used in the other form in all cases where they would so apply. 7.3 Written Document This Plan, in conjunction with any separate written document which may be required by law, is intended to satisfy the written Plan requirement of Code Section 105 and any Treasury regulations thereunder. © Copyright 2005 SunGard Inc. 11 7.4 Exclusive Benefit This Plan shall be maintained for the exclusive benefit of the Employees who participate in the Plan. 7.5 Participant's Rights This Plan shall not be deemed to constitute an employment contract between the Employer and any Participant or to be a consideration or an inducement for the employment of any Participant or Employee. Nothing contained in this Plan shall be deemed to give any Participant or Employee the right to be retained in the service of the Employer or to interfere with the right of the Employer to discharge any Participant or Employee at any time regardless of the effect which such discharge shall have upon him as a Participant of this Plan. 7.6 Action by the Employer Whenever the Employer under the terms of the Plan is permitted or required to do or perform any act or matter or thing, it shall be done and performed by a person duly authorized by its legally constituted authority. 7.7 No Guarantee of Tax Consequences Neither the Administrator nor the Employer makes any commitment or guarantee that any amounts paid to or for the benefit of a Participant under the Plan will be excludable from the Participant's gross income for federal or state income tax purposes, or that any other federal or state tax treatment will apply to or be available to any Participant. It shall be the obligation of each Participant to determine whether each payment under the Plan is excludable from the Participant's gross income for federal and state income tax purposes, and to notify the Employer if the Participant has reason to believe that any such payment is not so excludable. Notwithstanding the foregoing, the rights of Participants under this Plan shall be legally enforceable. 7.8 Indemnification of Employer by Participants If any Participant receives one or more payments or reimbursements under the Plan that are not for a permitted Medical Expense such Participant shall indemnify and reimburse the Employer for any liability it may incur for failure to withhold federal or state income tax or Social Security tax from such payments or reimbursements. However, such indemnification and reimbursement shall not exceed the amount of additional federal and state income tax (plus any penalties) that the Participant would have owed if the payments or reimbursements had been made to the Participant as regular cash compensation, plus the Participant's share of any Social Security tax that would have been paid on such compensation, less any such additional income and Social Security tax actually paid by the Participant. © Copyright 2005 SunGard Inc. 12 7.9 Funding Unless otherwise required by law, amounts made available by the Employer need not be placed in trust, but may instead be considered general assets of the Employer. Furthermore, and unless otherwise required by law, nothing herein shall be construed to require the Employer or the Administrator to maintain any fund or segregate any amount for the benefit of any Participant, and no Participant or other person shall have any claim against, right to, or security or other interest in, any fund, account or asset of the Employer from which any payment under the Plan may be made. 7.10 Governing Law This Plan and Trust shall be construed and enforced according to the Code, ERISA, and the laws of the state or commonwealth in which the Employer's principal office is located (unless otherwise designated in the Adoption Agreement), other than its laws respecting choice of law, to the extent not pre - empted by ERISA. 7.11 Severability If any provision of the Plan is held invalid or unenforceable, its invalidity or unenforceability shall not affect any other provisions of the Plan, and the Plan shall be construed and enforced as if such provision had not been included herein. 7.12 Headings The headings and subheadings of this Plan have been inserted for convenience of reference and are to be ignored in any construction of the provisions hereof. 7.13 Continuation of Coverage Notwithstanding anything in the Plan to the contrary, in the event any benefit under this Plan subject to the continuation coverage requirement of Code Section 4980B becomes unavailable, each qualified beneficiary (as defined in Code Section 498013) will be entitled to continuation coverage as prescribed in Code Section 4980B. 7.14 Family and Medical Leave Act Notwithstanding anything in the Plan to the contrary, in the event any benefit under this Plan becomes subject to the requirements of the Family and Medical Leave Act and regulations thereunder, this Plan shall be operated in accordance with Regulation 1.125 -3. 7.15 Health Insurance Portability and Accountability Act Notwithstanding anything in this Plan to the contrary, this Plan shall be operated in accordance with HIPAA and regulations thereunder. © Copyright 2005 SunGard Inc. 13 7.16 Uniformed Services Employment and Reemployment Rights Act Notwithstanding any provision of this Plan to the contrary, contributions, benefits and service credit with respect to qualified military service shall be provided in accordance with USERRA and the regulations thereunder. 7.17 HIPAA Privacy Standards (a) If this Plan is subject to the Standards for Privacy of Individually Identifiable Health Information (45 CFR Part 164, the "Privacy Standards "), then this Section shall apply. (b) The Plan shall not disclose Protected Health Information to any member of Employer's workforce unless each of the conditions set out in this Section are met. "Protected Health Information" shall have the same definition as set forth in the Privacy Standards but generally shall mean individually identifiable information about the past, present or future physical or mental health or condition of an individual, including information about treatment or payment for treatment. (c) Protected Health Information disclosed to members of Employer's workforce shall be used or disclosed by them only for purposes of Plan administrative functions. The Plan's administrative functions shall include all Plan payment functions and health care operations. The terms "payment" and "health care operations" shall have the same definitions as set out in the Privacy Standards, but the term "payment" generally shall mean activities taken to determine or fulfill Plan responsibilities with respect to eligibility, coverage, provision of benefits, or reimbursement for health care. (d) The Plan shall disclose Protected Health Information only to members of the Employer's workforce who are authorized to receive such Protected Health Information, and only to the extent and in the minimum amount necessary for that person to perform his or her duties with respect to the Plan. "Members of the Employer's workforce" shall refer to all employees and other persons under the control of the Employer. The Employer shall keep an updated list of those authorized to receive Protected Health Information. (1) An authorized member of the Employer's workforce who receives Protected Health Information shall use or disclose the Protected Health Information only to the extent necessary to perform his or her duties with respect to the Plan. (2) In the event that any member of the Employer's workforce uses or discloses Protected Health Information other than as permitted by this Section and the Privacy Standards, the incident shall be reported to the Plan's privacy officer. The privacy officer shall take appropriate action, including: © Copyright 2005 SunGard Inc. 14 (i) investigation of the incident to determine whether the breach occurred inadvertently, through negligence or deliberately; whether there is a pattern of breaches; and the degree of harm caused by the breach; (ii) appropriate sanctions against the persons causing the breach which, depending upon the nature of the breach, may include oral or written reprimand, additional training, or termination of employment; (iii) mitigation of any harm caused by the breach, to the extent practicable; and (iv) documentation of the incident and all actions taken to resolve the issue and mitigate any damages. (e) The Employer must provide certification to the Plan that it agrees to: (1) Not use or further disclose the information other than as permitted or required by the Plan documents or as required by law; (2) Ensure that any agent or subcontractor, to whom it provides Protected Health Information received from the Plan, agrees to the same restrictions and conditions that apply to the Employer with respect to such information; (3) Not use or disclose Protected Health Information for employment- related actions and decisions or in connection with any other benefit or employee benefit plan of the Employer; (4) Report to the Plan any use or disclosure of the Protected Health Information of which it becomes aware that is inconsistent with the uses or disclosures permitted by this Section, or required by law; (5) Make available Protected Health Information to individual Plan members in accordance with Section 164.524 of the Privacy Standards; (6) Make available Protected Health Information for amendment by individual Plan members and incorporate any amendments to Protected Health Information in accordance with Section 164.526 of the Privacy Standards; (7) Make available the Protected Health Information required to provide an accounting of disclosures to individual Plan members in accordance with Section 164.528 of the Privacy Standards; © Copyright 2005 SunGard Inc. 15 (8) Make its internal practices, books and records relating to the use and disclosure of Protected Health Information received from the Plan available to the Department of Health and Human Services for purposes of determining compliance by the Plan with the Privacy Standards; (9) If feasible, return or destroy all Protected Health Information received from the Plan that the Employer still maintains in any form, and retain no copies of such information when no longer needed for the purpose for which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible; and (10) Ensure the adequate separation between the Plan and members of the Employer's workforce, as required by Section 164.504(f)(2)(iii) of the Privacy Standards and set out in (d) above. 7.18 HIPAA Electronic Security Standards If this Plan is subject to the Security Standards for the Protection of Electronic Protected Health Information (45 CFR Part 164.300 et. seq., the "Security Standards "), then this Section shall apply as follows: (a) The Employer agrees to implement reasonable and appropriate administrative, physical and technical safeguards to protect the confidentiality, integrity and availability of Electronic Protected Health Information that the Employer creates, maintains or transmits on behalf of the Plan. "Electronic Protected Health Information" shall have the same definition as set out in the Security Standards, but generally shall mean Protected Health Information that is transmitted by or maintained in electronic media. (b) The Employer shall ensure that any agent or subcontractor to whom it provides Electronic Protected Health Information shall agree, in writing, to implement reasonable and appropriate security measures to protect the Electronic Protected Health Information. (c) The Employer shall ensure that reasonable and appropriate security measures are implemented to comply with the conditions and requirements set forth in Section 7.17. (d) The Plan shall not disclose Protected Health Information to any member of Employer's workforce unless each of the conditions set out in this Section are met. "Protected Health Information" shall have the same definition as set forth in the Privacy Standards but generally shall mean individually identifiable information about the past, present or future physical or mental health or condition of an individual, including information about treatment or payment for treatment. © Copyright 2005 SunGard Inc. 16 (e) Protected Health Information disclosed to members of Employer's workforce shall be used or disclosed by them only for purposes of Plan administrative functions. The Plan's administrative functions shall include all Plan payment functions and health care operations. The terms "payment" and "health care operations" shall have the same definitions as set out in the Privacy Standards, but the term "payment" generally shall mean activities taken to determine or fulfill Plan responsibilities with respect to eligibility, coverage, provision of benefits, or reimbursement for health care. (f) The Plan shall disclose Protected Health Information only to members of the Employer's workforce, who are authorized to receive such Protected Health Information, and only to the extent and in the minimum amount necessary for that person to perform his or her duties with respect to the Plan. "Members of the Employer's workforce" shall refer to all employees and other persons under the control of the Employer. The Employer shall keep an updated list of those authorized to receive Protected Health Information. (1) An authorized member of the Employer's workforce who receives Protected Health Information shall use or disclose the Protected Health Information only to the extent necessary to perform his or her duties with respect to the Plan. (2) In the event that any member of the Employer's workforce uses or discloses Protected Health Information other than as permitted by this Section and the Privacy Standards, the incident shall be reported to the Plan's privacy officer. The privacy officer shall take appropriate action, including: (i) investigation of the incident to determine whether the breach occurred inadvertently, through negligence or deliberately; whether there is a pattern of breaches; and the degree of harm caused by the breach; (ii) appropriate sanctions against the persons causing the breach which, depending upon the nature of the breach, may include oral or written reprimand, additional training, or termination of employment; (iii) mitigation of any harm caused by the breach, to the extent practicable; and (iv) documentation of the incident and all actions taken to resolve the issue and mitigate any damages. © Copyright 2005 SunGard Inc. 17 (g) The Employer must provide certification to the Plan that it agrees to: (1) Not use or further disclose the information other than as permitted or required by the Plan documents or as required by law; (2) Ensure that any agent or subcontractor, to whom it provides Protected Health Information received from the Plan, agrees to the same restrictions and conditions that apply to the Employer with respect to such information; (3) Not use or disclose Protected Health Information for employment- related actions and decisions or in connection with any other benefit or employee benefit plan of the Employer; (4) Report to the Plan any use or disclosure of the Protected Health Information of which it becomes aware that is inconsistent with the uses or disclosures permitted by this Section, or required by law; (5) Make available Protected Health Information to individual Plan members in accordance with Section 164.524 of the Privacy Standards; (6) Make available Protected Health Information for amendment by individual Plan members and incorporate any amendments to Protected Health Information in accordance with Section 164.526 of the Privacy Standards; (7) Make available the Protected Health Information required to provide an accounting of disclosures to individual Plan members in accordance with Section 164.528 of the Privacy Standards; (8) Make its internal practices, books and records relating to the use and disclosure of Protected Health Information received from the Plan available to the Department of Health and Human Services for purposes of determining compliance by the Plan with the Privacy Standards; (9) If feasible, return or destroy all Protected Health Information received from the Plan that the Employer still maintains in any form, and retain no copies of such information when no longer needed for the purpose for which disclosure was made, except that, if such return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction of the information infeasible; and (10) Ensure the adequate separation between the Plan and members of the Employer's workforce, as required by Section 164.504(fl(2)(iii) of the Privacy Standards and set out in (d) above. © Copyright 2005 SunGard Inc. 18 Attachment B COUNTY OF ROANOKE HEALTH REIMBURSEMENT ARRANGEMENT SUMMARY PLAN DESCRIPTION © Copyright 2005 SunGard Inc. 08/01/05 TABLE OF CONTENTS 0 I ELIGIBILITY 1. What Are the Eligibility Requirements for Our Plan?, ---------------------------------------------------- - - - - - 1 2. When is My Entry Date?--------------------------------------------------------------------------------------------------- - - - - -1 3. Are There Any Employees Who Are Not Eligible? -------------------------------------------------------- - - - - - II BENEFITS 1. What Benefits Are Available? 1 ----------------------------------------------------------------------------------------- - - - - -- 2. When Must Expenses Be Incurred?---------------------------------------------------------------------------------- - - - - -2 3. When Will I Receive Payment From the Plan? -------------------------------------------------------------------- 2 4. What Happens If I Terminate Employment ?____ _________ _________ _________ _________ _________ _____________3 5. Family and Medical Leave Act (FMLA) ----------- _________ _________ _________ _________ _________ _____________3 6. Uniformed Services Employment and Reemployment Rights Act (USERRA) -- _____________3 7. Newborn and Mothers Health Protection Act 3 ---------------------------------------------------------------- - - - - -- 8. Qualified Medical Child Support Order -------------------------------------------------------------------------- - - - - - III GENERAL INFORMATION 1. General Plan Information 4 ------------------------------------------------------------------------------------------------------- 2. Employer Information------------------------------------------------------------------------------------------------------- - - - - -4 3. Plan Administrator Information 4 --------------------------------------------------------------------------------------------- 4. Third Party Claims Administrator Information -------------------------------------------------------------- - - - - -- 4 5. Service of Legal Process -------------------------------------------------------------------------------------------------- - - - - -- 5 6. Type of Administration----------------------------------------------------------------------------------------------------- - - - - -5 IV ADDITIONAL PLAN INFORMATION 1. Your Rights Under ERISA----------------------------------------------------------------------------------------------- - - - - -- 5 2. How to Submit a Claim 6 ---------------------------------------------------------------------------------------------------- - - - - -- V CONTINUATION COVERAGE RIGHTS UNDER COBRA 1. What is COBRA Continuation Coverage? ______________________________________________ ______________________________8 2. Who Can Become a Qualified Beneficiary ?_____ _________ _________ _________ _________ _________ ______________9 3. What is a Qualifying Event? ------------ - - - - -- --- - - - - -- --- - - - - -- --- - - - - -- --- - - - - -- --- - - - - -- --- - - - - -- --------- - - - - 4. What Factors Should Be Considered When Determining to Elect COBRA Continuation Coverage ------------------------------------------------------------------------------------------------------ - - - - © Copyright 2005 SunGard Inc. 08/01/05 5. What is the Procedure for Obtainin COBRA Continuation Covera ?____________________________ 11 6. What is the Election Period and How Lon Must It Last? ------------------------------------------------- 11 7. Is a Covered Emplo or Q ualified Beneficiar Responsible for Informin the Plan Administrator of the Occurrence of a Qualif Event?_____________ _______________________________ 12 8. Is a Waiver Before the End of the Election Period Effective to End a Q ualified Beneficiar Election Ri ----------------------------------------------------------------------------------------------- 13 9. Is COBRA Covera Available If a Q ualified Beneficiar Has Other Group Health Plan Covera or Medicare? -------------------------------------------------------------------------------------- 13 10. When Ma a Q ualified Beneficiar COBRA Continuation Covera Be Terminated? 13 11. What Are the Maximum Covera Periods for COBRA Continuation Covera ------------ 14 12. Under What Circumstances Can the Maximum Covera Period Be Expanded ?_____________ 15 13. How Does a Q ualified Beneficiar Become Entitled to a Disabilit Extension? ____________. 14. Does the Arran Re Pa for COBRA Continuation Covera ............. 15 15. Must the Arran Allow Pa for COBRA Continuation Covera to Be Made in Monthl Installments? ----------------------------------------------------------------------------------------- 16 16. What is Timel Pa for Pa for COBRA Continuation Covera --------------------- 16 17. Must a Q ualified Beneficiar Be Given the Ri to Enroll in a Conversion Health Plan at the End of the Maximum Covera Period for COBRA ContinuationCovera --------------------------------------------------------------------------------------------------------- 16 © Cop 2005 SunGard Inc. 08/01/05 HEALTH REIMBURSEMENT ARRANGEMENT INTRODUCTION We are pleased to establish this Health Reimbursement Arrangement to provide you with additional health coverage benefits. The benefits available under this Plan are outlined in this summary plan description. We will also tell you about other important information concerning the Plan, such as the rules you must satisfy before you become eligible and the laws that protect your rights. Read this summary plan description carefully so that you understand the provisions of our Plan and the benefits you will receive. You should direct any questions you have to the Administrator. There is a plan document on file, which you may review if you desire. In the event there is a conflict between this summary plan description and the plan document, the plan document will control. I ELIGIBILITY 1. What Are the Eligibility Requirements for Our Plan? You will be eligible to join the Plan if you are an employee working 40 or more hours per week. 2. When is My Entry Date? You can join the Plan on the same day you can enter our group medical plan. 3. Are There Any Employees Who Are Not Eligible? Yes, there are certain employees who are not eligible to join the Plan. They are: -- Employees who are part -time. A part -time employee is someone who works, or is expected to work, less than 40 hours a week. II BENEFITS 1. What Benefits Are Available? The plan allows you to be reimbursed for certain out -of- pocket medical expenses which are incurred by you and your dependents. The expenses, which qualify, are those permitted by Section 213(d) of the Internal Revenue Code. A list of some of the expenses that qualify is available from the Administrator. For Retirees, the plan allows you to be reimbursed by the Employer for any insurance premiums, which are incurred by you or your dependents, in addition to the expenses that fall under Section 213(d) of the Internal Revenue Code. © Copyright 2005 SunGard Inc. 1 08/01/05 The maximum allowed each year is $500.00 for single coverage and $1,000 for family coverage, plus any unused amounts from prior Coverage Periods. However, the lifetime maximum that can be carried forward to a later Coverage Period is $25,000. For example, suppose the maximum benefit for a Coverage Period is $500 (single) plus any unused amounts carried over from prior Coverage Periods. Also, assume that the overall lifetime maximum benefit (including unused amounts from prior Coverage Periods) is $25,000. If you did not incur any covered expenses for the first Coverage Period, then your maximum benefit for the next Coverage Period is $1,000. We will provide you with a debit or credit card to use to pay for your medical expenses. The Administrator will provide you with further details. Expenses are considered "incurred" when the service is performed, not necessarily when it is paid for. Any amounts reimbursed to you under the Plan may not be claimed as a deduction on your personal income tax return nor reimbursed by other health plan coverage including our health flexible spending account. You must first use all amounts in our health flexible spending account before submitting any claims to this plan. 2. When Must Expenses Be Incurred? You may submit expenses that you incur each "Coverage Period." A new "Coverage Period" begins each plan year starting from July 1 to June 30. 3. When Will I Receive Payments From the Plan? During the course of the Coverage Period, you may submit requests for reimbursement of expenses you have incurred. However, you must make your requests for reimbursements no later than 90 days after the end of the Plan Year, if you are an active employee. If you retired during the Plan Year, you must make your requests for reimbursements no later than 365 days following your date of retirement. Upon death, the surviving spouse /executor has 6 months from date of death to make requests for reimbursements for eligible expenses incurred while retired but prior to death. The Administrator will provide you with acceptable forms for submitting these requests for reimbursement. In addition, you must submit to the Administrator proof of the expenses you have incurred and that they have not been paid by any other health plan coverage. If the request qualifies as a benefit or expense that the Plan has agreed to pay, you will receive a reimbursement payment soon thereafter. Remember, reimbursements made from the Plan are generally not subject to federal income tax or withholding. Nor are they subject to Social Security taxes. 4. What Happens If I Terminate Employment? If your employment is terminated during the Plan Year for any reason, your participation in the Plan will continue through the end of termination month unless you have chosen COBRA. You may submit requests for reimbursement of expenses you have incurred while being an active employee, however, you must make your request for reimbursements no later than 90 days following your date of termination. © Copyright 2005 SunGard Inc. 2 08/01/05 5. Family and Medical Leave Act (FMLA) If you take leave under the Family and Medical Leave Act, you may revoke or change your existing elections for health insurance. If your coverage in these benefits terminates, due to your revocation of the benefit while on leave or due to your non - payment of contributions, you will be permitted to reinstate coverage for the remaining part of the Plan Year upon your return. If you continue your coverage during your unpaid leave, you may pre -pay for the coverage, you may pay for your coverage on an after -tax basis while you are on leave, or you and your Employer may arrange a schedule for you to "catch up" your payments when you return. 6. Uniformed Services Employment and Reemployment Rights Act (USERRA) If you are going into or returning from military service, you may have special rights to health care coverage under your Health Reimbursement Arrangement under the Uniformed Services Employment and Reemployment Rights Act of 1994. These rights can include extended health care coverage. If you may be affected by this law, ask your Administrator for further details. 7. Newborn and Mothers Health Protection Act Group health plans generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). 8. Qualified Medical Child Support Order A medical child support order is a judgment, decree or order (including approval of a property settlement) made under state law that provides for child support or health coverage for the child of a participant. The child becomes an "alternate recipient" and can receive benefits under the health plans of the Employer, if the order is determined to be "qualified." You may obtain, without charge, a copy of the procedures governing the determination of qualified medical child support orders from the Plan Administrator. © Copyright 2005 SunGard Inc. 3 08/01/05 III GENERAL INFORMATION ABOUT OUR PLAN This Section contains certain general information, which you may need to know about the Plan. 1. General Plan Information County of Roanoke Health Reimbursement Arrangement is the name of the Plan. Your Employer has assigned Plan Number 503 to your Plan. The provisions of your Plan become effective on July 1, 2013. 2. Employer Information Your Employer's name, address, and identification number are: County of Roanoke P.O. Box 29800 Roanoke, VA 24018 54- 6001572 The Plan allows other employers to adopt its provisions. You or your beneficiaries may examine or obtain a complete list of employers, if any, who have adopted your Plan by making a written request to the Administrator. 3. Plan Administrator Information The name, address and business telephone number of your Plan's Administrator are: County of Roanoke P.O. Box 29800 Roanoke, VA (540) 772 -2018 The Plan Administrator keeps the records for the Plan and is responsible for the administration of the Plan. The Administrator will also answer any questions you may have about our Plan. The Plan Administrator has the exclusive right to interpret the appropriate plan provisions. Decisions of the Administrator are conclusive and binding. You may contact the Administrator for any further information about the Plan. 4. Third Party Claims Administrator Information The name, address and business telephone number of the Third Party Claims Administrator are: Flexible Benefit Administrators, Inc Post Office Drawer 8188 Virginia Beach, VA 23450 The Third Party Claims Administrator is responsible for the actual processing of claims on behalf of the Plan Administrator. © Copyright 2005 SunGard Inc. 4 08/01/05 5. Service of Legal Process The Employer is the Plan's agent for service of legal process. 6. Type of Administration The Plan is a health reimbursement arrangement and the administration is provided through a Third Party Claims Administrator. The Plan is not funded or insured. Benefits are paid from the general assets of the Employer. IV ADDITIONAL PLAN INFORMATION 1. Your Rights Under ERISA Plan Participants, eligible employees and all other employees of the Employer may be entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code. These laws provide that Participants, eligible employees and all other employees are entitled to: (a) Examine, without charge, at the Administrator's office, all Plan documents, including insurance contracts, collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor, and available at the Public Disclosure Room of the Employee Benefits Security Administration. (b) Obtain copies of all Plan documents and other Plan information upon written request to the Administrator. The Administrator may charge a reasonable fee for the copies. (c) Continue health care coverage for a Plan Participant, Spouse, or other dependents if there is a loss of coverage under the Plan as a result of a qualifying event. Employees or dependents may have to pay for such coverage. (d) Review this summary plan description and the documents governing the Plan on the rules governing COBRA continuation coverage rights. If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. If you have a claim for benefits, which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. Under ERISA there are steps you can take to enforce the above rights. For instance, if you request materials from the Plan and do not receive them within thirty (30) days, you may file suit in a Federal court. In such a case, the court may request the Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Administrator. If © Copyright 2005 SunGard Inc. 5 08/01/05 you have a claim for benefits, which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if a Plan Participant disagrees with the Plan's decision or lack thereof concerning the qualified status of a medical child support order, he or she may file suit in federal court. In addition to creating rights for Plan Participants, ERISA imposes obligations upon the individuals who are responsible for the operation of the Plan. The individuals who operate the Plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of the Plan Participants and their beneficiaries. No one, including the Employer or any other person, may fire a Plan Participant or otherwise discriminate against a Plan Participant in any way to prevent the Plan Participant from obtaining benefits under the Plan or from exercising his or her rights under ERISA. If it should happen that Plan fiduciaries misuse the Plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees; for example, if it finds your claim is frivolous. If you have any questions about the Plan, you should contact the Administrator. If you have any questions about this statement, or about your rights under ERISA or the Health Insurance Portability and Accountability Act (HIPAA), or if you need assistance in obtaining documents from the Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in the telephone directory or the Division of Technical Assistance and Inquiries, Pension and Welfare Benefits Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration. 2. How to Submit a Claim When you have a Claim to submit for payment, you must: (1) Obtain a claim form from the Plan Administrator. (2) Complete the Employee portion of the form. (3) Attach copies of all bills from the service provider for which you are requesting reimbursement. A Claim is defined as any request for a Plan benefit, made by a claimant or by a representative of a claimant that complies with the Plan's reasonable procedure for making benefit Claims. The times listed are maximum times only. A period of time begins at the time the Claim is filed. Decisions will be made within a reasonable period of time appropriate to the circumstances. "Days" means calendar days. © Copyright 2005 SunGard Inc. 6 08/01/05 Notification of whether Claim is accepted or denied 30 days Extension due to matters beyond the control of the 15 days Plan Insufficient information on the Claim: Notification of 15 days Response by Participant 45 days Review of Claim denial 60 days The Plan Administrator will provide written or electronic notification of any Claim denial. The notice will state: (1) The specific reason or reasons for the denial. (2) Reference to the specific Plan provisions on which the denial was based. (3) A description of any additional material or information necessary for the claimant to perfect the Claim and an explanation of why such material or information is necessary. (4) A description of the Plan's review procedures and the time limits applicable to such procedures. This will include a statement of your right to bring a civil action under Section 502 of ERISA following a denial on review. (5) A statement that the claimant is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claim; and (6) If the denial was based on an internal rule, guideline, protocol, or other similar criterion, the specific rule, guideline, protocol, or criterion will be provided free of charge. If this is not practical, a statement will be included that such a rule, guideline, protocol, or criterion was relied upon in making the denial and a copy will be provided free of charge to the claimant upon request. When you receive a denial, you will have 180 days following receipt of the notification in which to appeal the decision. You may submit written comments, documents, records, and other information relating to the Claim. If you request, you will be provided, free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Claim. The period of time within which a denial on review is required to be made will begin at the time an appeal is filed in accordance with the procedures of the Plan. This timing is without regard to whether all the necessary information accompanies the filing. A document, record, or other information shall be considered relevant to a Claim if it: (1) was relied upon in making the Claim determination; © Copyright 2005 SunGard Inc. 7 08/01/05 (2) was submitted, considered, or generated in the course of making the Claim determination, without regard to whether it was relied upon in making the Claim determination; (3) demonstrated compliance with the administrative processes and safeguards designed to ensure and to verify that Claim determinations are made in accordance with Plan documents and Plan provisions have been applied consistently with respect to all claimants; (4) or constituted a statement of policy or guidance with respect to the Plan concerning the denied Claim. The review will take into account all comments, documents, records, and other information submitted by the claimant relating to the Claim, without regard to whether such information was submitted or considered in the initial Claim determination. The review will not afford deference to the initial denial and will be conducted by a fiduciary of the Plan who is neither the individual who made the adverse determination nor a subordinate of that individual. V CONTINUATION COVERAGE RIGHTS UNDER COBRA Under federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), certain employees and their families covered under this Arrangement will be entitled to the opportunity to elect a temporary extension of health coverage (called "COBRA continuation coverage ") where coverage under the Arrangement would otherwise end. This notice is intended to inform Participants and beneficiaries, in summary fashion, of their rights and obligations under the continuation coverage provisions of COBRA, as amended and reflected in final and proposed regulations published by the Department of the Treasury. This notice is intended to reflect the law and does not grant or take away any rights under the law. The Plan Administrator or its designee is responsible for administering COBRA continuation coverage. Complete instructions on COBRA, as well as election forms and other information, will be provided by the Plan Administrator or its designee to Participants who become Qualified Beneficiaries under COBRA. The Arrangement itself can provide group health benefits and may also be used to provide health benefits through insurance. Whenever "Arrangement' is used in this section, it means any of the health benefits under this Plan. 1. What is COBRA Continuation Coverage? COBRA continuation coverage is the temporary extension of group health plan coverage that must be offered to certain Participants and their eligible family members (called "Qualified Beneficiaries ") at group rates. The right to COBRA continuation coverage is triggered by the occurrence of a life event that results in the loss of coverage under the terms of the Arrangement (the "Qualifying Event "). The coverage must be identical to the coverage that the Qualified Beneficiary had immediately before the Qualifying Event, or if the coverage has been changed, the coverage must be identical to the coverage provided to similarly situated active employees who have not experienced a Qualifying Event (in other words, similarly situated non -COBRA beneficiaries). © Copyright 2005 SunGard Inc. 8 08/01/05 2. Who Can Become a Qualified Beneficiary? In general, a Qualified Beneficiary can be: (1) Any individual who, on the day before a Qualifying Event, is covered under the Arrangement by virtue of being on that day either a covered Employee, the Spouse of a covered Employee, or a Dependent child of a covered Employee. If, however, an individual who otherwise qualifies as a Qualified Beneficiary is denied or not offered coverage under the Arrangement under circumstances in which the denial or failure to offer constitutes a violation of applicable law, then the individual will be considered to have had the coverage and will be considered a Qualified Beneficiary if that individual experiences a Qualifying Event. (2) Any child who is born to or placed for adoption with a covered Employee during a period of COBRA continuation coverage, and any individual who is covered by the Arrangement as an alternate recipient under a qualified medical support order. If, however, an individual who otherwise qualifies as a Qualified Beneficiary is denied or not offered coverage under the Arrangement under circumstances in which the denial or failure to offer constitutes a violation of applicable law, then the individual will be considered to have had the coverage and will be considered a Qualified Beneficiary if that individual experiences a Qualifying Event. (3) A covered Employee who retired on or before the date of substantial elimination of health coverage which is the result of a bankruptcy proceeding under Title 11 of the U.S. Code with respect to the Employer, as is the Spouse, surviving Spouse or Dependent child of such a covered Employee if, on the day before the bankruptcy Qualifying Event, the Spouse, surviving Spouse or Dependent child was a beneficiary under the Arrangement. The term "covered Employee" includes any individual who is provided coverage under the Arrangement due to his or her performance of services for the employer sponsoring the Arrangement. However, this provision does not establish eligibility of these individuals. Eligibility for Plan coverage shall be determined in accordance with Plan Eligibility provisions. An individual is not a Qualified Beneficiary if the individual's status as a covered Employee is attributable to a period in which the individual was a nonresident alien who received from the individual's Employer no earned income that constituted income from sources within the United States. If, on account of the preceding reason, an individual is not a Qualified Beneficiary, then a Spouse or Dependent child of the individual will also not be considered a Qualified Beneficiary by virtue of the relationship to the individual. A domestic partner is not a Qualified Beneficiary. Each Qualified Beneficiary (including a child who is born to or placed for adoption with a covered Employee during a period of COBRA continuation coverage) must be offered the opportunity to make an independent election to receive COBRA continuation coverage. 3. What is a Qualifying Event? A Qualifying Event is any of the following if the Arrangement provided that the participant would lose coverage (i.e., cease to be covered under the same terms and conditions as in © Copyright 2005 SunGard Inc. 9 08/01/05 effect immediately before the Qualifying Event) in the absence of COBRA continuation coverage: (1) The death of a covered Employee. (2) The termination (other than by reason of the Employee's gross misconduct), or reduction of hours, of a covered Employee's employment. (3) The divorce or legal separation of a covered Employee from the Employee's Spouse. If the Employee reduces or eliminates the Employee's Spouse's Plan coverage in anticipation of a divorce or legal separation, and a divorce or legal separation later occurs, then the divorce or legal separation may be considered a Qualifying Event even though the Spouse's coverage was reduced or eliminated before the divorce or legal separation. (4) A covered Employee's enrollment in any part of the Medicare program. (5) A Dependent child's ceasing to satisfy the Arrangement's requirements for a Dependent child (for example, attainment of the maximum age for dependency under the Arrangement). (6) A proceeding in bankruptcy under Title 11 of the U.S. Code with respect to an Employer from whose employment a covered Employee retired at any time. If the Qualifying Event causes the covered Employee, or the covered Spouse or a Dependent child of the covered Employee, to cease to be covered under the Arrangement under the same terms and conditions as in effect immediately before the Qualifying Event (or in the case of the bankruptcy of the Employer, any substantial elimination of coverage under the Arrangement occurring within 12 months before or after the date the bankruptcy proceeding commences), the persons losing such coverage become Qualified Beneficiaries under COBRA if all the other conditions of COBRA are also met. For example, any increase in contribution that must be paid by a covered Employee, or the Spouse, or a Dependent child of the covered Employee, for coverage under the Arrangement that results from the occurrence of one of the events listed above is a loss of coverage. The taking of leave under the Family and Medical Leave Act of 1993 ( "FMLA ") does not constitute a Qualifying Event. A Qualifying Event will occur, however, if an Employee does not return to employment at the end of the FMLA leave and all other COBRA continuation coverage conditions are present. If a Qualifying Event occurs, it occurs on the last day of FMLA leave and the applicable maximum coverage period is measured from this date (unless coverage is lost at a later date and the Arrangement provides for the extension of the required periods, in which case the maximum coverage date is measured from the date when the coverage is lost.) Note that the covered Employee and family members will be entitled to COBRA continuation coverage even if they failed to pay the employee portion of premiums for coverage under the Arrangement during the FMLA leave. 4. What Factors Should Be Considered When Determining to Elect COBRA Continuation Coverage? You should take into account that a failure to continue your group health coverage will affect your rights under federal law. First, you can lose the right to avoid having © Copyright 2005 SunGard Inc. 10 08/01/05 pre - existing condition exclusions applied by other group health plans if there is more than a 63 -day gap in health coverage and election of COBRA continuation coverage may help you avoid such a gap. Second, if you do not elect COBRA continuation coverage and pay the appropriate premiums for the maximum time available to you, you will lose the right to convert to an individual health insurance policy, which does not impose such pre - existing condition exclusions. Finally, you should take into account that you have special enrollment rights under federal law (HIPAA). You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your Spouse's employer) within 30 days after Plan coverage ends due to a Qualifying Event listed above. You will also have the same special right at the end of COBRA continuation coverage if you get COBRA continuation coverage for the maximum time available to you. 5. What is the Procedure for Obtaining COBRA Continuation Coverage? The Arrangement has conditioned the availability of COBRA continuation coverage upon the timely election of such coverage. An election is timely if it is made during the election period. 6. What is the Election Period and How Long Must It Last? The election period is the time period within which the Qualified Beneficiary must elect COBRA continuation coverage under the Arrangement. The election period must begin not later than the date the Qualified Beneficiary would lose coverage on account of the Qualifying Event and must not end before the date that is 60 days after the later of the date the Qualified Beneficiary would lose coverage on account of the Qualifying Event or the date notice is provided to the Qualified Beneficiary of her or his right to elect COBRA continuation coverage. Note: If a covered employee who has been terminated or experienced a reduction of hours qualifies for a trade readjustment allowance or alternative trade adjustment assistance under a federal law called the Trade Act of 2002, and the employee and his or her covered dependents have not elected COBRA coverage within the normal election period, a second opportunity to elect COBRA coverage will be made available for themselves and certain family members, but only within a limited period of 60 days or less and only during the six months immediately after their group health plan coverage ended. Any person who qualifies or thinks that he or she and /or his or her family members may qualify for assistance under this special provision should contact the Plan Administrator or its designee for further information. The Trade Act of 2002 also created a new tax credit for certain TAA- eligible individuals and for certain retired employees who hare receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC) (eligible individuals). Under the new tax provisions, eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including continuation coverage. If you have questions about these new tax provisions, you may call the Health Coverage Tax Credit Consumer Contact Center toll -free at 1- 866 - 628 -4282. TTD /TTY callers may call toll -free at 1 -866- 626 -4282. More information about the Trade Act is also available at www.doleta.gov/tradeact/2002act-index.asp. © Copyright 2005 SunGard Inc. 11 08/01/05 7. Is a Covered Employee or Qualified Beneficiary Responsible for Informing the Plan Administrator of the Occurrence of a Qualifying Event? The Arrangement will offer COBRA continuation coverage to Qualified Beneficiaries only after the Plan Administrator or its designee has been timely notified that a Qualifying Event has occurred. The Employer will notify the Plan Administrator or its designee of the Qualifying Event within 30 days following the date coverage ends when the Qualifying Event is: (1) the end of employment or reduction of hours of employment, (2) death of the employee, (3) commencement of a proceeding in bankruptcy with respect to the Employer, or (4) enrollment of the employee in any part of Medicare, IMPORTANT: For the other Qualifying Events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for coverage as a dependent child), you or someone on your behalf must notify the Plan Administrator or its designee in writing within 60 days after the Qualifying Event occurs, using the procedures specified below. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator or its designee during the 60 -day notice period, any spouse or dependent child who loses coverage will not be offered the option to elect continuation coverage. You must send this notice to the Plan Administrator or its designee. NOTICE PROCED URES: Any notice that you provide must be in writing Oral notice, including notice by telephone, is not acceptable. You must mail, fax or hand - deliver your notice to the person, department or firm listed below, at the following address: County of Roanoke, P. O. Box 29800, Roanoke, VA 24018 If mailed, your notice must be postmarked no later than the last day of the required notice period. Any notice you provide must state: • the name of the plan or plans under which you lost or are losing coverage, • the name and address of the employee covered under the plan, • the name(s) and address(es) of the Qualified Beneficiary(ies), and • the Qualifying Event and the date it happened. If the Qualifying Event is a divorce or legal separation, your notice must include a copy of the divorce decree or the legal separation agreement. Be aware that there are other notice requirements in other contexts, for example, in order to qualify for a disability extension. © Copyright 2005 SunGard Inc. 12 08/01/05 Once the Plan Administrator or its designee receives timely notice that a Qualifying Event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each Qualified Beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage for their spouses, and parents may elect COBRA continuation coverage on behalf of their children. For each Qualified Beneficiary who elects COBRA continuation coverage, COBRA continuation coverage will begin on the date that coverage would otherwise have been lost (if under your coverage the COBRA period begins on the date of the Qualifying Event, even though coverage actually ends later (e.g., at the end of the month) substitute the appropriate language, e.g. "on the date of the Qualifying Event'). If you or your spouse or dependent children do not elect continuation coverage within the 60 -day election period described above, the right to elect continuation coverage will be lost. 8. Is a Waiver Before the End of the Election Period Effective to End a Qualified Beneficiary's Election Rights? If, during the election period, a Qualified Beneficiary waives COBRA continuation coverage, the waiver can be revoked at any time before the end of the election period. Revocation of the waiver is an election of COBRA continuation coverage. However, if a waiver is later revoked, coverage need not be provided retroactively (that is, from the date of the loss of coverage until the waiver is revoked). Waivers and revocations of waivers are considered made on the date they are sent to the Plan Administrator or its designee, as applicable. 9. Is COBRA Coverage Available If a Qualified Beneficiary Has Other Group Health Plan Coverage or Medicare? Qualified Beneficiaries who are entitled to elect COBRA continuation coverage may do so even if they are covered under another group health plan or are entitled to Medicare benefits on or before the date on which COBRA is elected. However, a Qualified Beneficiary's COBRA coverage will terminate automatically if, after electing COBRA, he or she becomes entitled to Medicare or becomes covered under other group health plan coverage (but only after any applicable preexisting condition exclusions of that other plan have been exhausted or satisfied). 10. When May a Qualified Beneficiary's COBRA Continuation Coverage Be Terminated? During the election period, a Qualified Beneficiary may waive COBRA continuation coverage. Except for an interruption of coverage in connection with a waiver, COBRA continuation coverage that has been elected for a Qualified Beneficiary must extend for at least the period beginning on the date of the Qualifying Event and ending not before the earliest of the following dates: (1) The last day of the applicable maximum coverage period. (2) The first day for which Timely Payment is not made to the Arrangement with respect to the Qualified Beneficiary. (3) The date upon which the Employer ceases to provide any group health plan (including a successor plan) to any employee. © Copyright 2005 SunGard Inc. 13 08/01/05 (4) The date, after the date of the election, that the Qualified Beneficiary first becomes covered under any other Plan that does not contain any exclusion or limitation with respect to any pre- existing condition, other than such an exclusion or limitation that does not apply to, or is satisfied by, the Qualified Beneficiary. (5) The date, after the date of the election that the Qualified Beneficiary first enrolls in the Medicare program (either part A or part B, whichever occurs earlier). (6) In the case of a Qualified Beneficiary entitled to a disability extension, the later of: (a) (i) 29 months after the date of the Qualifying Event, or (ii) the first day of the month that is more than 30 days after the date of a final determination under Title II or XVI of the Social Security Act that the disabled Qualified Beneficiary whose disability resulted in the Qualified Beneficiary's entitlement to the disability extension is no longer disabled, whichever is earlier; or (b) the end of the maximum coverage period that applies to the Qualified Beneficiary without regard to the disability extension. The Arrangement can terminate for cause the coverage of a Qualified Beneficiary on the same basis that the Arrangement terminates for cause the coverage of similarly situated non -COBRA beneficiaries, for example, for the submission of a fraudulent claim. In the case of an individual who is not a Qualified Beneficiary and who is receiving coverage under the Arrangement solely because of the individual's relationship to a Qualified Beneficiary, if the Arrangement's obligation to make COBRA continuation coverage available to the Qualified Beneficiary ceases, the Arrangement is not obligated to make coverage available to the individual who is not a Qualified Beneficiary. 11. What Are the Maximum Coverage Periods for COBRA Continuation Coverage? The maximum coverage periods are based on the type of the Qualifying Event and the status of the Qualified Beneficiary, as shown below. (1) In the case of a Qualifying Event that is a termination of employment or reduction of hours of employment, the maximum coverage period ends 18 months after the Qualifying Event if there is not a disability extension and 29 months after the Qualifying Event if there is a disability extension. (2) In the case of a covered Employee's enrollment in the Medicare program before experiencing a Qualifying Event that is a termination of employment or reduction of hours of employment, the maximum coverage period for Qualified Beneficiaries other than the covered Employee ends on the later of: (a) 36 months after the date the covered Employee becomes enrolled in the Medicare program; or (b) 18 months (or 29 months, if there is a disability extension) after the date of the covered Employee's termination of employment or reduction of hours of employment. © Copyright 2005 SunGard Inc. 14 08/01/05 (3) In the case of a bankruptcy Qualifying Event, the maximum coverage period for a Qualified Beneficiary who is the covered retiree ends on the date of the retiree's death. The maximum coverage period for a Qualified Beneficiary who is the covered Spouse, surviving Spouse or Dependent child of the retiree ends on the earlier of the Qualified Beneficiary's death or 36 months after the death of the retiree. (4) In the case of a Qualified Beneficiary who is a child born to or placed for adoption with a covered Employee during a period of COBRA continuation coverage, the maximum coverage period is the maximum coverage period applicable to the Qualifying Event giving rise to the period of COBRA continuation coverage during which the child was born or placed for adoption. (5) In the case of any other Qualifying Event than that described above, the maximum coverage period ends 36 months after the Qualifying Event. 12. Under What Circumstances Can the Maximum Coverage Period Be Expanded? If a Qualifying Event that gives rise to an 18 -month or 29 -month maximum coverage period is followed, within that 18- or 29 -month period, by a second Qualifying Event that gives rise to a 36- months maximum coverage period, the original period is expanded to 36- months, but only for individuals who are Qualified Beneficiaries at the time of and with respect to both Qualifying Events. In no circumstance can the COBRA maximum coverage period be expanded to more than 36- months after the date of the first Qualifying Event. The Plan Administrator must be notified of the second qualifying event within 60 days of the second qualifying event. This notice must be sent to the Plan Administrator or its designee and in accordance with the procedures above. 13. How Does a Qualified Beneficiary Become Entitled to a Disability Extension? A disability extension will be granted if an individual (whether or not the covered Employee) who is a Qualified Beneficiary in connection with the Qualifying Event that is a termination or reduction of hours of a covered Employee's employment, is determined under Title II or XVI of the Social Security Act to have been disabled at any time during the first 60 days of COBRA continuation coverage. To qualify for the disability extension, the Qualified Beneficiary must also provide the Plan Administrator with notice of the disability determination on a date that is both within 60 days after the date of the determination and before the end of the original 18 -month maximum coverage. This notice must be sent to the Plan Administrator or its designee and in accordance with the procedures above. 14. Does the Arrangement Require Payment for COBRA Continuation Coverage? For any period of COBRA continuation coverage under the Arrangement, Qualified Beneficiaries who elect COBRA continuation coverage may be required to pay up to 102% of the applicable premium and up to 150% of the applicable premium for any expanded period of COBRA continuation coverage covering a disabled Qualified Beneficiary due to a disability extension. Your Plan Administrator will inform you of any costs. The Arrangement will terminate a Qualified Beneficiary's COBRA continuation coverage as of the first day of any period for which timely payment is not made. © Copyright 2005 SunGard Inc. 15 08/01/05 15. Must the Arrangement Allow Payment for COBRA Continuation Coverage to Be Made in Monthly Installments? Yes. The health coverage is also permitted to allow for payment at other intervals. 16. What is Timely Payment for Payment for COBRA Continuation Coverage? Timely Payment means a payment made no later than 30 days after the first day of the coverage period. Payment that is made to the Arrangement by a later date is also considered Timely Payment if either under the terms of the Arrangement, covered employees or Qualified Beneficiaries are allowed until that later date to pay for their coverage for the period or under the terms of an arrangement between the Employer and the entity that provides benefits on the Employer's behalf, the Employer is allowed until that later date to pay for coverage of similarly situated non -COBRA beneficiaries for the period. Notwithstanding the above paragraph, the Arrangement does not require payment for any period of COBRA continuation coverage for a Qualified Beneficiary earlier than 45 days after the date on which the election of COBRA continuation coverage is made for that Qualified Beneficiary. Payment is considered made on the date on which it is postmarked to those providing coverage. If Timely Payment is made to the Arrangement in an amount that is not significantly less than the amount the Arrangement requires to be paid for a period of coverage, then the amount paid will be deemed to satisfy the Arrangement's requirement for the amount to be paid, unless the Arrangement notifies the Qualified Beneficiary of the amount of the deficiency and grants a reasonable period of time for payment of the deficiency to be made. A "reasonable period of time" is 30 days after the notice is provided. A shortfall in a Timely Payment is not significant if it is no greater than the lesser of $50 or 10% of the required amount. 17. Must a Qualified Beneficiary Be Given the Right to Enroll in a Conversion Health Plan at the End of the Maximum Coverage Period for COBRA Continuation Coverage? If a Qualified Beneficiary's COBRA continuation coverage under a group health plan ends as a result of the expiration of the applicable maximum coverage period, the Arrangement will, during the 180 day period that ends on that expiration date, provide the Qualified Beneficiary with the option of enrolling under a conversion health plan if such an option is otherwise generally available to similarly situated non -COBRA beneficiaries under the Arrangement. If such a conversion option is not otherwise generally available, it need not be made available to Qualified Beneficiaries. © Copyright 2005 SunGard Inc. 16 08/01/05 IF YOU HAVE QUESTIONS If you have questions about your COBRA continuation coverage, you should contact the Plan Administrator or its designee. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's Web site at www.dol.gov /ebsa. KEEP YOUR PLAN ADMINISTRATOR INFORMED OF ADDRESS CHANGES In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator or its designee. © Copyright 2005 SunGard Inc. 17 08/01/05 ACTION NO. A- 051413 -2 . b ITEM NO. H -3 AT A REGULAR MEETING OF THE BOARD OF SUPERVISORS OF ROANOKE COUNTY, VIRGINIA HELD AT THE ROANOKE COUNTY ADMINISTRATION CENTER MEETING DATE: AGENDA ITEM: SUBMITTED BY: May 14, 2013 Request to approve an agreement with the Yakama Nation to resolve pending litigation Paul M. Mahoney County Attorney COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: In June 2011, the Confederated Tribes and Bands of the Yakama Nation ( "Yakama Nation ") initiated a lawsuit (Confederated Tribes and Bands of the Yakama Nation v. Eric Holder, et al., a lawsuit pending in U.S. District Court for the Eastern District of Washington under Cause No. CV -11- 3028 -RMP) against each of the Settling Defendants (County of Marshall, Mississippi, the City of Tupelo, Mississippi, the County of Roanoke, Virginia, the City of Martinsville, Virginia, the Town of Vinton, Virginia, the County of Benton, Washington) and various federal law enforcement agencies and employees ( "Federal Defendants "), in relation to a federal law enforcement entry upon Yakama Reservation trust lands on February 16, 2011. The parties wish to avoid costly and lengthy litigation and to settle and compromise any and all claims and disputes of any kind or nature between the parties, relating to this entry. The parties enter into this Agreement without admitting any liability. This Agreement shall not be construed as an admission of any wrongdoing, liability, any fact, or evidence of such or admission of any violation of law by any of the parties. By entering into this Agreement, no party is making any concessions about its rights, powers, authorities or responsibilities, or otherwise expressing any conclusions about the sovereignty, Treaty- interpretation, constitutional or other legal issues in the Lawsuit involving the parties to this Agreement or other individuals and entities. Attached to this report you will find a copy of this Agreement. The proposed Agreement will end this lawsuit as to Roanoke County. Page 1 of 2 It is requested that the Board approve this Agreement in substantially the form and content submitted; however, it is also requested that the County Attorney be authorized to make modifications to the Agreement so long as those modifications do not alter essential elements outlined herein. FISCAL IMPACT: No direct fiscal impact arising from this Agreement, although significant staff time and resources have been expended in defending this lawsuit. The County Attorney retained the services of Meriwether D. (Mike) Williams in the Spokane, Washington law firm of Winston & Cashatt to represent the County in this lawsuit. ALTERNATIVES: 1. Approve the proposed Agreement. 2. Refuse to approve the Agreement, and continue this litigation, and incur additional outside legal counsel expenses over the next several years. STAFF RECOMMENDATION: It is recommended that the Board authorizes the County Administrator, or any Assistant County Administrator, to execute the Agreement on behalf of Roanoke County in substantially the form and content as attached and subject to approval as to form by the County Attorney. VOTE: Supervisor Altizer moved to approve the staff recommendation. Motion approved. cc: Paul M. Mahoney, County Attorney Page 2 of 2 Yes No Absent Ms. Moore � ❑ ❑ Mr. Flora � ❑ ❑ Mr. Church � ❑ ❑ Mr. Elswick � ❑ ❑ Mr. Altizer � ❑ ❑ cc: Paul M. Mahoney, County Attorney Page 2 of 2 ACTION NO. A- 051413 -2 . c ITEM NO. H -4 AT A REGULAR MEETING OF THE BOARD OF SUPERVISORS OF ROANOKE COUNTY, VIRGINIA HELD AT THE ROANOKE COUNTY ADMINISTRATION CENTER MEETING DATE: May 14, 2013 AGENDA ITEM: Request to appropriate $26,677.80 to the Clerk of the Circuit Court from the Commonwealth of Virginia for fiscal year 2012/2013 SUBMITTED BY: Steven A. McGraw Clerk of Circuit Court APPROVED BY: B. Clayton Goodman III County Administrator COUNTY ADMINISTRATOR'S COMMENTS: SUMMARY OF INFORMATION: Technology Trust Funds, representing fees collected by the Roanoke County Circuit Court Clerk's Office, have been received from the State in the amount of $26,677.80. These funds have been earmarked for the purpose of maintenance and postage needs. These funds need to be appropriated to the Clerk of Circuit Court. FISCAL IMPACT: One hundred percent (100 %) State funds. Funds are to be appropriated as follows 102817 -5850: $26,586.80 and 331000 -5210: $91.00. STAFF RECOMMENDATION: Staff recommends appropriating $26,677.80 to the Clerk of Circuit Court for the fiscal year 2012/2013. Page 1 of 2 VOTE: Supervisor Altizer moved to approve the staff recommendation. Motion approved. cc: Steven A. McGraw, Clerk of Circuit Court Rebecca Owens, Director of Finance Page 2 of 2 Yes No Absent Ms. Moore � ❑ ❑ Mr. Flora � ❑ ❑ Mr. Church � ❑ ❑ Mr. Elswick � ❑ ❑ Mr. Altizer � ❑ ❑ cc: Steven A. McGraw, Clerk of Circuit Court Rebecca Owens, Director of Finance Page 2 of 2 AT A REGULAR MEETING OF THE BOARD OF SUPERVISORS OF ROANOKE COUNTY, VIRGINIA, HELD AT THE ROANOKE COUNTY ADMINISTRATION CENTER ON TUESDAY, MAY 14 RESOLuTIGN 051413 -3 CERTIFYING THE CLOSED MEETING WAS HELD IN CONFORMITY wiTH THE CODE of VIRGINIA WHEREAS, the Board of Supervisors of Roanoke county, Virginia has convened a closed meeting on this date pursuant to an affirmative recorded vote and in accordance with the provisions of The Virginia Freedom of Information Act; and WHEREAS, Section 2.2-3712 of the Code of Virginia requires a certification by the Board of Supervisors of Roanoke County, Virginia, that such closed meeting was conducted in conformity with Virginia law. NOW, THEREFORE, BE IT RESOLVED, that the Board of Supervisors of Roanoke County, Virginia, hereby certifies that, to the best of each member's knowledge: 1. Only public business matters lawfully exempted from open meeting requirements by Virginia law were discussed in the closed meeting which this certification resolution applies; and 2. Only such public business matters as were identified in the motion convening the closed meeting were heard, discussed or considered by the Board of Supervisors of Roanoke county, Virginia. On motion of Supervisor Flora to adopt the resolution, and carried by the following roll call and recorded vote: AYES: Supervisors Moore, Flora, Church, Elswick, Altizer NAYS: None A COPY TESTE: L� Deborah C. JacKs Clerk to the Board dWupervisors Page 1 of 1