Welfare Summary Plan Description

5.20 HEALTH REIMBURSEMENT ARRANGEMENT (HRA)

The Plan has established a Health Reimbursement Arrangement ("HRA") to give Participants additional flexibility to meet their families' health care needs. Under the Health Reimbursement Arrangement, Eligible Employees and Retired Participants can have accounts ("HRA Accounts") maintained by the Plan that can be used to fund certain health expenses.

HRA Contributions
The Plan's Health Reimbursement Arrangement is funded by Contributing Employers that contribute an extra amount to this Plan under the terms of their collective bargaining agreements or Written Agreements, designated as contributions for the HRA accounts of covered employees ("HRA Contributions").

HRA Account Eligibility
An Employee is eligible to have HRA Contributions made on his or her behalf deposited into an HRA Account if the contributions have been properly made and he or she is currently eligible for medical benefits under this Plan. A person who has had HRA Contributions made on his or her behalf but who is not currently eligible for medical benefits under the Plan will have those HRA Contributions held by the Plan until the time that he or she becomes eligible for medical benefits under the Plan.

An HRA Account is limited to a maximum of $2,500 at any given time.

If you are a Participant and have had funds deposited into an HRA Account, you will remain eligible to use the HRA account for eligible HRA expenses for as long as there is still money in your HRA account. Funds in the HRA Account remain in the HRA Account if unused.
If you have an HRA Account as an Active Employee and terminate coverage, retire, or transition to Retiree coverage, the HRA Account will remain in place as long as you maintain a balance in the Account.

If you die with an HRA Account balance and have a Spouse or Dependent(s) covered by the Plan, their eligible HRA expenses may continue to be paid out of your HRA Account for expenses incurred while they remain covered by the Plan.

Eligible HRA Expenses
A Participant's HRA account may be used to reimburse any qualified medical, prescription drug, dental, or vision expenses under Internal Revenue Code Section 213(d) ("Qualified Medical Expenses") for the Participant and his or her dependents covered by the Plan, including deductibles and copayments for Plan coverage as well as Qualified Medical Expenses not otherwise covered by the Plan. It may also be used to make self-payments or COBRA payments to maintain coverage under this Plan for the Participant and his or her dependents covered by the Plan. Any payments from the HRA Account will be limited to the balance of the Account, with no further payments made when the HRA Account is at a zero balance.

You must notify the Administrative Office if you wish to use your HRA Account to make any payment or partial payment of COBRA premiums or self-payments for Active or Retiree coverage.

Time Limits for Payments from Your HRA Account
In order to be payable, claims for reimbursement of Eligible HRA Expenses, like all other covered Plan expenses under Section 15.14, must be submitted within one year of the date the expense was incurred. In addition, the HRA Account may only be used to cover expenses incurred on or after January 1, 2016, and after the date your HRA Account was established.

Expenses for Spouses and Dependents No Longer Covered by the Plan
If your Spouse or Dependent terminates coverage under the Plan for any reason (including divorce of a Spouse), the HRA Account can only be used to reimburse expenses for that person incurred before the loss of coverage.

How to Use the HRA Account
Once your HRA Account has been established, you will receive a debit card that can be used for payment of certain expenses payable under the HRA. You can use the debit card to pay for copayments, deductibles, and for other out-of-pocket medical or prescription drug expenses for you and your Dependents covered under the Plan. By using your debit card for a medical or prescription drug co-payment, deductible, or other out-of-pocket medical or prescription drug expenses, you are certifying that the copayment, deductible, or other medical care expense was incurred for you or a Dependent covered under the Plan and that it is Qualified Medical Expense as defined in Section 213(d) of the Internal Revenue Code.

For dental and vision claims as well as medical and Prescription Drug claims for which you do not use your debit card, you must complete a claim form to receive reimbursement. When you submit a claim for reimbursement, you will be asked to include written statements and/or bills from an independent third party describing the service or product, the amount of the expense, and the date of the service or sale. Depending on the circumstances, this could include an invoice, prescription, an affidavit, and/or other documentation required by the Administrative Office. Cash register receipts alone are not an acceptable form of proof to allow reimbursement from an HRA Account. (Further details about required documentation are on the claim form.)

The Administrative Office may also provide options for submitting HRA reimbursement claims electronically.

HRA Account Amounts and Charges
Your HRA Account is the amount of HRA Contributions actually and properly made on your behalf, less reimbursements paid out of the account, and less administrative charges or other expenses incurred. The Plan will assess an administrative charge of $4.50 per month to maintain your HRA Account, payable from your HRA Account balance.

Opt-Out
You may permanently opt out of participation in the HRA at any time, in which case your HRA Account will be closed and no further HRA reimbursements will be available to you. This will not affect HRA Contributions made on your behalf, which may still be made to the Plan but will no longer be credited to your HRA Account. Notify the Administrative Office if you'd like to opt out.