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HomeMy WebLinkAboutResolution No 03 14 ExhibitEMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN ADOPTION AGREEMENT Plan Number: 8 Er ,yer Retirement Health Savings Plan Name: CITY OF UNIVERSITY PARK I. Employer Name: CITY OF UNIVERSITY PARK State: TEXAS II. The Employer hereby attests that it is a unit of a state or local government or an agency or instrumentality of one or more units of a state or local government. III. The Effective Date of the Plan: 01/01/0~, IV. The Employer intends to utilize the Trust to fund only welfare benefits pursuant to the following welfare ben- efit plan(s) established by the Employer: RETIREE MEDICAL AND DENTAL EXPENSE REIMBURSEMENT PLAN V. Eligible Groups and Participant Eligibility Requirements A. The following group or groups of Employees are eligible to participate in the VantageCare Retirement Health Savings Plan: All Employees All Full-Time Employees Non-Union Employees Public Safety Employees -- Police Public Safety Employees -- Firefighters General Employees Collectively-Bargained Employees (Specify unit) Other (specify below) The group specified must correspond to a group of the same designation that is defined in the statutes, ordi- nances, rules, regulations, personnel manuals or other material in effect in the state or locality of the Employer. If this box is checked, in lieu of mandatory participation, the Employer provides for a one-time irrevoca- ble election by eligible Employees to participate in RHS. Until such time as the election is made, the Employee shall not participate in the Plan or receive contributions pursuant to Section VI. Newly eligible Employees shall be provided an election window of 60 days (no more than 60 calendar days) from the date of initial eligibility during which they may make the election to participate. Participation may begin no earlier than the calendar month following the end of the election window. If the Employee does not make the election in the year of initial eligibility, the election to participate may- be made in a later year. An annual election window of 60 days (no more than 60 calendar days) shall be provided during which the election may be made. The election window shall run from NOV. I to DEC. 3 ! (insert your annual time frame for the election window, e.g. October I to November 29). Participation may begin no earlier than the calendar year following the year of the elec- tion. Once made, the election is irrevocable and may not be revoked while the participant is a member of the group covered by the RHS plan. If ti ~ployer's underlying welfare benefit plan or funding under this VantageCare Retirement Health Savings Plan ,~ in whole or part a non-collectively bargained, self-insured plan, the nondiscrimination requirements of Internal Revenue Code (IRC) Section 105(h) will apply. These rules may impose taxation on the benefits received 11 by highly compensated Employees if the Plan discriminates in favor of highly compensated Employees in terms of eligibility or benefits. The Employer should discuss these rules with appropriate counsel. B. Participant Eligibility Minimum period of service required for participation is ~te or to elect to participate immediately upon employment). 2. Minimum age required for eligibility to participate is VI.Contribution Sources and Amounts A. Mandatory Contributions ~ 1. Direct Employer Contributions The Employer shall contribute on behalf of each Participant__ Year. (write N/A if an Employee is eligible to partici- (write N/A if no minimum age is required). % of earnings or $ for the Plan Definition of earnings: -'! 2. Mandatory Leave Contributions The Employer will make mandatory contributions of leave as follows: Accrued Sick Leave* :__~ Yes [~1 No Accrued Vacation* ~1 Yes [~1 No Other* (describe) [~ Yes [~1 No * Please provide the formula for determining the Accrued Leave contribution: An Employee shall not have the right to discontinue or vary the rate of annual leave contributions. _--I 3. Mandatory Employee Compensation Contributions The Employer will make mandatory contributions of Employee compensation as follows: _--I_ Reduction in Salary - % of earnings (as defined in VI.A.I.) or $. will be contributed for the Plan Year. Decreased Merit or Pay Plan Adjustment - All or a portion of the Employees' annual merit or pay plan adjustment will be contributed as follows: An Employee shall not have the right to discontinue or vary the rate of mandatory contributions of Employee compensation. 12 B. Elective Contributions 1. Elective Pre-Tax Contributions · 'I .mployer will permit each Employee to make the following elections to make pre-tax contributions to the Plan: a. Irrevocable Election for Pre-Tax Contributions from Compensation: A one-time, irrevocable election of the amount of Employer contributions of compensation made on his or her behalf. The Employer limits the amount elected to either a fixed percentage or a range of percentage,s of an Employee's earnings :[ % of earnings (as defined in VI.A.1.) or up to VI.A.1) for the Plan Year. % of earnings (as defined in Newly eligible Employees shall be provided an election window of 60 days (no more than 60) from the date of initial eligibility during which they may make the election to contribute. Contributions may begin no earlier than the calendar month following the end of the election window. If the Employee does not make the election in the year of initial eligibility, the election to contribute may be made in a later year. An annual election window of 60 days (no more than 60) shall be provided during which the election may be made. The election window shale run from NO¥ [ to DEC. 3[ (insert your annual time frame for the election window). Contributions may begin no ear- lier than the calendar year following the year of the election. Once made, the election is irrevocable and may not be revoked. b. Irrevocable Election for Pre-Ta, x Contributions of Accrued Leave: A one-time, irrevocable election ofI the amount of employer contributions of Employee accrued ~ sick [~ vacation ~ otheCOHPENSA?OR_~desCribe) leave made on his or her behalf. TIME I~1 Yes [~1 No The Employer limits the amount elected as shown beloW: UP TO ] 00% Newly eligible Employees shall be provided an election windOw of 60 days (no rflore than 60 calendar days) from the date of initial eligibility during which they may make the election to contribute. Contributions may begin no earlier than the calendar month following the end of the election window. If the Employee does not make the election in the year of initial eligibility, the election to contribute may be made in a later year. An annual election window of 60 days (no more than 60 calendar days) shall be provided during which the election may be made. The election window shall run from NOV. [ to DEC. 31 (insert your annual time frame for the election window). Contributions may begin no earlier than the calendar year following the year·of'the election. Once made, the election is irrevocable and m'ay not be revoked. c. Annual Prospective Election for Pre-Tax Contributions o[ leave: An annual, irrevocable election to have his or her [~1 sick ~1 vacation [~ other (describe) leave to be accrued in the next calendar year contributed to the Plan on his or her behalf. 13 The Employer Contributions of future leave accrual [~1 as earned [~ at'the end of-the ( The election to contribute must be .made ir begin. Once made, the election shall apPly to revoked by the Employee on an annual basis; year in' which contributions arb to se revised or An annual election window of days (no more than 60 calendar days) is provided during which eligible Employees may make the election to contribute. Th'e~election window shall run from to ., · · . , . .,,,~?~.~.:~ ~,. ~ · :~,, ~ (~nsert your annual t~me frame for the electlo'ni~wl~}~?~?,,,:~.-? , ~ In adopting section a, b, and/or c, the Employ~'r ~,g'~;~'at the In,~[na~;Reve~ue Se~me has ngt ruled on irrevocable election contribut ons m an I~teg~ I,p~K t[q~t; ICMA~RC hes obtained,the advice of counsel that such contributions are allowable unde~.t~e'cond~t~ons outhned m thru Adoption Agreement· The Employer should discuss this issue with appropriate counsel. 2. Voluntary After-Tax Contributions Each Employee may contribute up to 2_5_ % of earnings~(a~defined~in VI.A.1.) or $- for the Plan Year on a voluntary after-tax bas~s. In no event may aggregate;EmploYee voluntary after-tax contnbutmns exceed 25~ of total contributions in any Plan Year. An Employee shall have the right to discontinue or vary the rate of elective after-tax contributions of Employee earnings. By adopting th~s section, the Employer acknowledges ~that~e~Internel Revenue Se~ce hasdecl~ned to rule on ~ployee after tax contributions in an integral pa~ trUSt., :I~A~Rc ~as obtainedthe advice Of.counsel that such ~ontnbut~ons are allowable ~n an insubstantial amount;(~e..:no mo~e than 25 ~ of total contributions m any~lan Year). The Employer should d~scuss th~s ~ssue;:.wJt~pp~9.p~rja~counsel; C. Limits on Total Contributions The total contribution on behalf of each Participant (including both Mandatory and Elective Contributions) for each Plan Year shall not exceed the following limit(s): % of earnings (as defined in VI.A.1.). There is no Plan-defined limit on the percentage or dollar amount of earnings that may be contributed. Limits on individual contribution types are defined within the appropriate section above. See Section V.A. for a discussion of nondiscrimination rules that may apply to non-collectively bargained self- insured Plans. 14 VII. Vesting Schedule A. The account is 100% vested at all times, unless specified otherwise in B. below. P The following vesting schedule applies to Direct Employer Contributions outlined in VI.A.I' Years of Service Completed Specified Percent Vesting % % % % % % % % C. The account will become 100% vested upon the death, disability, retirement, or attainment of benefit eligibility by a Participant. Definition of retirement: RETIREMENT FROM EITHER TEXAS MUNICIPAL RETIREMENT SYSTEM OR FIREMENS RELIEF AND RETIREMENT FUND D. Any period of service by a Participant prior to a rehire of the Participant by the Employer shall not count toward the vesting schedule outlined in B. above. VIII. Forfeiture Provisions Upon separation from the service of the Employer or upon reversion to the Trust of a Participant's account as=,~ts remaining upon the participant's death (as outlined in Section XI), a Participant's non-vested funds shall: Remain in the Trust to be reallocated among all Plan Participant's as Direct Employer Contributions for the next and succeeding contribution cycle(s). Remain in the Trust to be reallocated on an equal dollar basis among all Plan Participants. Remain in the Trust to be reallocated among all Plan Participants based upon Participant account bal- ances. Revert to the Employer. In the case of separation from service, the Participant's non-vested funds shall be applied as shown above. In the case of reversion due to the Participant's death under Section XI, the remaining account'assets shall be applied as shown above. IX. Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health Savings Plan A. A Participant is eligible to receive benefits: X At retirement only (as defined in Section VII.C.) At separation from service with the following restrictions At age only At retirement and age At retirement or age 15 B. Termination prior to general benefit eligibility: A Participant who separates from the service of the Employer prior to attaining benefit eligibility as outlined in Section IX.A. or C. will be eligible to receive benefits: ~ Immediately upon separation from service. [~1 At age C. A Participant who dies or becomes totally and permanently disabled (as defined by the Social Security Administration) will become immediately eligible to receive medical benefit payments from his/her VantageCare Retirement Health Savings Plan account. X. Permissible Medical Benefit Payments Benefits eligible for payment consist of: A. × All Medical Expenses eligible under IRC Section 213' other than direct long-term care expenses, OR B. The following Medical Expenses (select only the expenses you wish to cover under the VantageCare Retirement Health Savings Plan): Medical Insurance Premiums Medical Out-of-Pocket Expenses* Medicare Part B Insurance Premiums Medicare Supplement Insurance Premiums COBRA Premiums Dental Insurance Premiums Dental Out-of-Pocket Expenses* Long Term Care Insurance Premiums Other (Must be eligible under IRC Section 213)* * See Section V.A. for a discussion of nondiscrimination rules which may apply to non-collectively bargained, self-insured Plans. Xl. Death Benefit In the event of a Participant's death, the following shall apply: Account Transfer: The surviving spouse and/or surviving eligible dependents (as defined in Section XIII.F. of the deceased Participant are immediately eligible to maintain the account and utilize it to fund eligible medical bene- fits specified in Section X above. Upon notification of a Participant's death, the Participant's account balance will be transferred into the Vantagepoint Money Market Fund*. The account balance may be reallocated by the surviving spouse or dependents. * Please read the current prospectus carefully prior to investing. An investment in this fund is neither insured nor guaranteed and there can be no assurance that the Fund will be able to maintain a stable net asset value of $1.00 per share. Vantagepoint Mutual Funds are distributed by ICMA-RC Services, LLC, a controlled affiliate of ICMA Retirement Corporation. Member NASD/SlPC. If a Participant's account balance has not been fully utilized upon the death of the eligible spouse, the account balance may continue to be utilized to pay benefits of eligible dependents. Upon the death of all eligible depend- ents, the balance will be available for medical benefits for the designated beneficiary of the last dependent or · 'oouse to die. Assets remaining upon the death of a designated beneficiary shall be available for medical bene- ~ of the beneficiary's designated beneficiary. If there is no living beneficiary(les), the account will revert to the r'lan to be applied as specified in Section VIII. 16 There will be no elective withholding of federal, state, or local taxes for medical benefit payments to the Participant's spouse's or dependent's designated beneficiary(les). If there are no living spouse or dependents at the time of death of the Participant, the account will be available fo- edical benefits for the designated beneficiary(les) of the Participant. Assets remaining upon the death of all ~ated beneficiaries shall be available for medical benefits of the beneficiary's beneficiary. If there is no liv- ing beneficiary(ies), the account will revert to the Plan to be applied as specified in Section VIII. There will be no elective withholding of federal, state, or local taxes for medical benefit payments to the Participant's beneficiary(ies) or any beneficiary's beneficiary. Xll, De Minimis Accounts Upon separation from the service of the Employer prior to a Participant becoming eligible for medical benefits from a VantageCare Retirement Health Savings Plan account, Participant accounts that are considered de min- imis as specified below will be paid to the Participant. ~ The de minimis account value shall be $5,000 or less. ~ The de minimis account value shall be $ $5,000) or less. [] The Plan shall not allow de minimis account distributions. Xlll. The Plan will operate according to the following provisions: A. Employer Responsibilities .(insert dollar amount between $0 and 1. The Employer will submit all VantageCare Retirement Health Savings Plan contribution data via electronic submission. 2. Participant status updates and/or changes or personal information updates and/or changes (Participants' termination dates, Participants' benefit eligibility dates, etc.') will be provided via electronic submission. B. Participant account administration fees will be paid through the redemption of Participant account shares, unless agreed upon otherwise in the Administrative Services Agreement. C. Employer plan fees will be paid by the Employer as outlined in the Administrative Services Agreement. D. Assignment of benefits is not permitted. E. Payments to an alternate payee (payee other than a Participant) are not permitted with the exception of reim- bursement of health insurance premiums to the Employer. E An eligible dependent is the Participant's lawful spouse and any other individual who is a person described in IRC Section 152(a). G. The Employer will be responsible for withholding, reporting and remitting any applicable taxes, as outlined in the VantageCare Retirement Health Savings Plan Employer Manual. XlV. The Employer hereby acknowledges it understands that failure to properly fill out this Employer VantageCare Retirement Health Savings Plan Adoption Agreement may result in the loss of tax exemption of the Trust and/or loss of tax-deferred status for Employer contributions. 17 EMPLOYER By: Title: -~ttest: Accepted: Vantagepoint Transfer Agents, LLC Corporate Treasurer 18