MARICOPA COUNTY BENEFITS PLAN 11TH EXHIBIT C.PDF

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Maricopa County

The Maricopa County Benefits Plan
(Eleventh Amendment and Restatement)

This plan document, when executed, will constitute a legal
instrument with important tax and legal implications. Before
you adopt it, you should verify its accuracy, and your legal
advisor(s) should confirm and approve it.

C.- 3-a 00S “KW
PREAMBLE AND EXECUTION

WHEREAS, Maricopa County ("the County") maintains The Maricopa County Benefits Plan
(Tenth Amendment and Restatement), the Maricopa County Dependent Care Flexible Spending
Account Plan (Fifth Amendment and Restatement), the Maricopa County Health Care Flexible
Spending Account Plan (Fifth Amendment and Restatement), and the Maricopa County Limited
Scope Flexible Spending Account Plan (Second Amendment and Restatement); and

WHEREAS, the County desires to amend, restate, consolidate, and supersede the above listed
plans into this Maricopa County Benefits Plan (Eleventh Amendment and Restatement);

NOW, THEREFORE, by virtue and in exercise of the power reserved to the Maricopa County
Board of Supervisors, this Maricopa County Benefits Plan (Eleventh Amendment and
Restatement) (the “Maricopa County Benefits Plan” or the Plan") is hereby approved and
adopted effective September 2, 2020.

IN WITNESS WHERI Oia the County, has caused the Plan to be executed by its duly authorized
representative this day of er, 2020.

MARICOPA COUNTY
Vf OCT 29 2020
Chairman, Board of Su ors Date
ATTEST:
2 und hull OCT 29 2020
Clerk of the Board 090220 Date
APPROVED AS TO FORM:

Sun. Hoses Mo [oft [3020

Deputy County Attorney Date

TABLE OF CONTENTS

ARTICEE PLAN: ESTABLISHMENT sccnsrcca ranma ccnnssinapicctiin sa Saat 1
5 | bincive Oates ett ea ais a eas 1
1.2 Purpose enn HRS 65556555 SiS Es ERR eS 1
1.3 Qualification ood
1.4 CN ces Sos snepcetnrtth=aronrnentitnmsnidieattionneiematonnneneenean nse tiemnencssmmetnemnemmsaneel
ARTICLE II DEFINITIONS
24
2.2 Benefits Trust.....
2.3 Board of Supervisors
2.4 Board of Trustees.....
2.5 Change in Status ..
2.6 Claim Administrator ..
2.7 COde .....eesesereeeee
2.8 COBRA
2.9 COM cccssesssscesss

2.10 Covered Employee...
211 Covered Person...
2.12 Dependent
2.13 Dependent Care Spending Account Plan...
2.14 Effective Date
2.15 Employee.
2.16 Employer..
2:17 ERISA..

2.18 Ly 0, ee eee
2.19 Health Care Spending AGcoumnt Plat sicisccs.ccicccssiecsctessccscsssssetetisscepssssasssatosseceescsen 7
2.20 Aenea a: Sinai cpa: PR inst neat acetic bicaeieciaaaeeaitastinn 7
2.21 HIPAA ssc ay
2.22 8
2.23 Limited Purpose Health Care Spending Account Plan 8
2.24 Outbreak Period...........ccccccecceceesrsseesersesseerseseeseeseses 8
2.25 Participating Employer. 8
2.26 a: | ee 8
2.27 Plan Administrator 8
2.28 Plan Sponsor ..... 8
2.29 Plan Year.... 8
2.30 Salary Deduction ......... Pa]
2.31 Salary Deduction Contributions . 9
2.32 Salary Reduction ..........0cccc 9
2.33 Salary Reduction Contributions . 9
2.34 OER NI csscsstcorscsza ceecietensientssenacanienesivisireceeicentiileuanitnineieiltntio vonguneecnsssalstnaiielcnndiipnts 9
ARTICLE Ill ELIGIBILITY, PARTICIPATION AND COVERAGE ...........:sssssseseesesesssesrsceseserersratenes 10
3.1 ERMINE 5 ssisiccccsssccsecccecoctercscteny seocnctexastetsis we
3.2 Participation
3.3 Coverage ...........0ee
3.4 Coverage under the Family and Medical Leave Act and Section 609 of

BEES ea aracsosevcsazauts ecsvsssesastssla Cotas squacs Geasecto deesticsagsimieeeceestatsacesuspatccguscatvems eaceats 13

3.5 Uniformed Services Employment and Reemployment Rights Act...............0:+
3.6 Health Insurance Portability and Accountability Act of 1996 .....
3.7 Coordination with State Medicaid Program ...............:::++
3.8 Mental Health Parity and Addiction Equity Act .....0...0...0..0. cece eects
3.9 Women’s Health and Cancer Rights Act .............0.......cecccccecccecceeeeeeseeeeeeeeesees
3.10 Newborns’ and Mothers’ Health Protection Act....
3.11 Genetic Information Nondiscrimination Act of 2008 ..................
3.12 Children’s Health Insurance Program Reauthorization Act of 2009 .. eh
3.13 Patient Protection and Affordable Care Act and Health Care and Education
PRECIP ai icc occa lac alc ea etc nat ac tbet 16
PERT VCLE: TC BEINE DT sais c crises seca eSeeIN eS aE NER 17
4.1 Benefits AL
4.2 Options a Fd
43 Unreduced Compensation Benefit AT
44 Elective Benefits .......0..0000.c 17
45 Non-Elective Benefits ......... Ps |
46 Limits for Certain Employees.............00 21
4.7 Notification of Premium Payment Amounts ...........::sccceseserseresensereereerenseeesres 22
48 Application 0 Quer Pate scsciceccsseicsccrccntiitec annie 22
PARTICLE BECTON tess cea as esas esate EAE 23
5.1 Enrollment for Non-Elective Benefits ... .23
5.2 Enrollment for Elective Benefits... 23
5.3 Salary Reductions/Deductions... .23
5.4 Forms and Agreements ...... 23
55 Default Benefits ........ 24
5.6 Deadlines..............2.00+. 24
5.7 SRI CROCRIONY FRONT OU sscscsissiccesiencscenseociratanneannnaaiaaamets seater anseaeteiaeitasanensiehnes 24
5.8 CT RIND DCR ccs cssccacsccicnascecesticteteasteisaniealienascedeoN Mtb aibi Rian 25
5.9 WADE: OF GOWOr ee essiisssis cess cecscccatences teste eee aha NS cat R SaaS 30
ARTICLE VI GOORDINATION. OF: BENEEITS isisccicatisscncasi inte Ry 31
6.1 Appa jis ssc d 31
6.2 COB Definitions ........ 31
6.3 Order of Benefit Determination Ru les. 32
6.4 Effect on the Benefits of this Plan..... 34
6.5 Disagreement on Order of Benefits ..
6.6 Limitation of Benefits
6.7 Right to Receive and Release Necessary COB Information .............0000cccee 35
6.8 Pacilty of Payment :.cssscccscassacnnannesiees 35
6.9 Right of Recovery...... 36
6.10 Governing Prowl session 36
ARTICLE VII COBRA CONTINUATION COVERAGE. .37
7.1 Eligibility for Continuation Coverage 37
7.2 TRO NG vsconesepeycecsannsyccaasaennevenanewenesaaneats 37
7.3 Loss of Eligibility for Continuation Coverage ..... 38
74 Termination of COBRA Continuation Coverage 38
75 Notice Requirements .......... 39
76 Govatage Avaliable for Cormtinictionn isis ciicicccsa cis ciccccnnctccsccenciicaicecattictenatiatend 40

7.7 IIT PN sors sesascerccrssnninmeencsinstnncggnenrecaninapeemcaiamensainecemamninenannaeicinata 41

7.8 Required Premium. 42
7.9 CONUS PI asics ccna ia aia nites aad 42
ARTICLE Vill CONTRIBUTIONS, FUNDING AND PLAN ASSETS. .........ccsessseseesseeeeeseeseeeeeeseaee 43
8.1 Contributions
8.2 Funding.......
8.3 Plan Assets
84 Treatment of Certain Policy Payments
ARTICLE IX CLAIM AND PAYMENT PROCEDUREG .............ssssscssssssssssssseeersceesesceasensersrasenseeseae! 45
9.1 General Claims Procedures........... +45
9.2 Claim Administrator ......... 45
9.3 Claims Administration ... --46
94 TER ER Se IR SE CEE SAT ER eat DETR SSNS ITN OO SIC DRA ECE SORRENTO ORY 46
9.5 Cae Fn aa aos cceaaccbsonsesinedennpuesdencaseosbopearasesodeuenatacepsinel 46
9.6 Deadline for Filing a Claim... 46
9.7 Proof of Claim............... 46
9.8 Decision on the Claim... 46
9.9 Right to Appeal ...............c:sscee iat
9.10 Right to an External Review of Claims . 08
9.11 Legal Remedy. 58
9.12 Subrogation, Reimbursement and Recovery for Third Party Liability... ...58
9.13 Penner’ Procedhtes 55 ae 61

ARTICLE X ADMINISTRATION
10.1 Plan Administrator ....
10.2 Plan Administrator's Duties..
10.3 Plan Administrator's Powers...

10.4 Finality of Decisions......................0 ae
10.5 Compensation and Bonding of Plan Administrator -- 64
10.7 Reseived Powers j.nccnnccnunmnnaasnnas ...64
10.8 bevbeoreperwenrramnenrsbel Agurenennenn te isis saisicacsiei it 64
ARTICLE XI AMENDMENT, TERMINATION OR MERGER OF PLAN ...66
11.1 Right to Amend the Plan..........ccccceseceeeteeeeteeeeeee ...66
11.2 Right to Terminate or Merge the Plan.......... ...66
11.3 Effect of Amendment, Termination or Merget...............0:.0ccccccccsecseeeeeeseeseeeeeeee 66
ARTICLE XIl. MISCELLANEOUS x ssscssccsnssvecsascescsssccsesscesvecssssvarsereuetesvasacsesesaanactenssatensaenes sede
12.1 No Employment Rights. ...67
12.2 Exclusive Rights ........ ...67
12.3 No Property Rights ....... 67
12.4 No Assignment of Benefits ................ ...67
12.5 Payments to Minors and Incompetents .-.68
12.6 Right to Offset Future Payments ....... ---68
12.7 Right to Recover Payments... 68
12.8 Misrepresentation or Fraud..
12.9 LIE ATION scsiccsscerciacnscuekccsinsacaet
12.10 Goventny LAW: siniiscinsiessissscsccessiescs
12.11 FOUN SONOCUON sc cssictseascasieceaseascceSN Gaeta TaN SLE CESS ESSER 69

12.12 CSOVGTIUEIT ISON cscs sccccsasgsstocsszansastisceemetsaacasatiattettet Tea aeateNeeaasa sees CetS 69

12.13 Savings Clause............ .69
12.14 Captions and Headings .. .69
12.15 i 70
12.16 -70
12.17 -70
12.18 -70
12.19 70
42:20: ‘INGENINNGALON is cccisisccnncnsiosescpusnn emer aMcREE 70
12.21 EATON Te COR IN isis se saccaa resin cnausbeacessosadeaasascstebieasatecctnasecsenaneaneen 71
12.22 Leaver: WSN sii ce cicccccces connec aaaee ai cietecessniamaatiaice 71
ARTICLE Xill HIPAA PRIVACY AND SECURITY ..cccccscccccccccccssssssscscscessoonccorsnsetavecsasecatessacoczasceee 72
13.1 TONNE SS cise 72
13.2 Definitions ............ccccceccess 72
13.3 Uses and Disclosures of P 73
13.4 Privacy Agreements of the Plan Sponsor... 73
13.5 Security Agreements of the Plan Sponsot............................-:ceecseceeeeeeceeseeeeeeees 75
APPENDIX A MARICOPA COUNTY DEPENDENT CARE SPENDING ACCOUNT PLAN............. 1
ARTIGLE LPLAN ESTABLISHMENT sais cssctscscosssaccssssessecacaneavessisetciaeastatactupenveczaaaancetaieaaeescea eee 1
1.1 Effective Date .... a |
4Z Purpose ......... aes |
1.3 Qualification .......... ed
1.4 Incorporation By Reference... me: |
1.5 Duration oo... cee ececcescesceceecesseecescenceseesesececeserseeaeeacsseacessseeaseacaseeteaseassceeteeesees 1
ARTICLE Il DEFINITIONS 20.....cccccc cece ccecseeeeeceeseeeeeessesesesecseseesesensesesaesesesaeseeaesessesenecsenenseseeaneeee 2
2.1 ANNES EIEIO ac ccursnnsiccenp eninnscnaneneaniontsexhaaiasunananbsnayaunebbeeunenaninrsonastaigecesanae 2
2.2 Dependent: Care EXpenis0siiiiisiescisscinsasssssssssccasacensesssacasssssessnscessaasnasuasevsassesaacicéa rd
2.3 Dependent Care Spending Account Plan... sade
2.4 Effective: Diatte asiscccccscicccscocsceanetecinnaates ste
2.5 Exctusionsiscsccsieeiiicsets wide
2.6 Maximum Annual Benefit... fa? a
2.7 WOM casntaatigecncaatentucvicracioaies ee 4
2.8 Qualifying Individual
ARTICLE Ill PARTICIPATION
3.1 Participation
3.2 PEATIREIIEE- G0 FG RIO ves csscsecis cceecenisss stnniccomenenieomeamennccnneansasieneneniesinmemneanes 4
ARTICLE IV DEPENDENT CARE REIMBURSEMENT BENEFIT ..............::sssscesesssseseseesesesesesreeeee 5
4.1 Right to Benefit rr
4.2 Maintonalice. of ACCOUNS i ccscccscesseetiss AR NR
43 Amount: Payette isco esas Ei BAER RE
44 Dependent Care Expenses. fe
45 LIMIES oe eee ceeeteeeeeeeeenseteesesseeseeseeeesseaecseeeeessseeeeeeseneeeeeeesscseecescaseseeeseneeee
ARTICLE V EXCLUSIONS .00....cececccceesesseseseeseseseeseseeesesetseseeeseseetseseeaeseesseeeeeeeneeeeeseseeeeeseaaesesenee

5.1 General Rules

5.2 SEISCING NCU ISN NEB ssscesssascesessas aces Na easesi URES USERRA NICHES taas 9

5.3 GConaditionial Exch rabies sissies 00SEC 10
ARTICEE Vi PROCEDURES tin ER OTRAS ROR CRN 11
6.1 Enrollment and Election Procedures Po,
6.2 Claim Procedures .......................... IM
6.3 Claim Administrator .. 11
64 Claims Administration... em
6.5 OIE II ic sscsantseeeniaiorcuasceane nstisnchais eaubiecayiisca unptcamnnatnnseneaanciaminkaanabaanaaasses 12
APPENDIX B MARICOPA COUNTY HEALTH CARE SPENDING ACCOUNT PLAN...............0.... 1
ARTICLE. CPLAN ESTABLISHED scccecsssscustzeecsassnsetsaec ees ts asBER OTR ESR 1
1.1 Effective Date .... is
1.2 Purpose ......
1.3 Qualification ................
1.4 Incorporation By Reference mt
1.5 IIE occ scp scrtrcpssseneonensuipnenscinieniinneen pnisennnaninemiieisaaititataaimeeenanienaaiinnacibeinctninieensinnne a
RECTICE TREE ING IONS is. vssistscssccasnseuccanecscaies vonensapissnsezeis catanssenenepsacemnsnaysansaathssstieeaseae cipecsnsageveaenats 2
| Covered Employes ee 4
2.2 Dependent......... 4
2.3 Effective Date . ce.
2.4 Exclusions ‘ele
25 Health Care Spending Account . 2
2.6 Maximum Annual Benefit........ 2
2.7 od |) crn 3
28 CHISET ying MaGiCel ExDONSGG siiscasenscsasscoressarscaxsscsessgeinesessspseanescarcxaunsesmeaacsoegsens 3
ARTICLE Ill PARTICIPATION ...........0cc0cc00 é zi 4
3.1 Participation... 4
3.2 TFennination Of. Pattichpaon ic ccisssistscesscceas asi sscs ai REN RRA 4
ARTICLE IV" MEDICAL EXPENSE BENER IT  iiaiiciitanc eine ene ERE 5
41 Right to Benefit............. oe]
4.2 Maintenance of Accoun a
4.3 Amount Payable ...........:000+ a
4.4 Qualifying Medical Expenses.. oe
4.5 SUIS ccsssccspnseises vacsscpenaenss usnsssseouepyseaescnsicsnedessnamnunsesuncacates tyapsonssh inauntosecsesaaesies 4
ARTICLE V EXCLUSIONS
5.1 General Rules..... 8
5.2 Specklic ExGMishone scsscrerws vss eeseeee esa RAE 8
ARTICLE VI PROCEDURES
6.1 Enrollment and E! oie
6.2 Claim Procedures ......................- 10
6.3 Claim Administrator ... 10
64 Claims Administration... ...10
6.5 PIONEER CO ssc sacssessncicrpcceccmncnsnccccieceanonetiaigniennebunsaias nail beicasonsusinenscesarencbacseabes 11

APPENDIX C MARICOPA COUNTY LIMITED PURPOSE HEALTH CARE SPENDING

PACCOUNT PLAN sscscccccccste eG RR RS 1
ARTICLE 1 PLAN ESTABLISHING o555550o5c55s hep es aerate eae SS NNN 1
1.1 Effective Date . |
‘ez Purpose ...... |
1.3 Qualification ..............0..... a: |
14 Incorporation By Reference |
1.5 FRI IIN scsases stesso ipa cmce Na cect sa oI AARNE 1
ARTICEE I DERINGTIONG css sissies cecssesescercscsuczctcasesascencecegsietecoceutcoreasestacensbosexcamteneeteeseupececeunseasestaty 2
2.1 Covered Employee... 2
22 Dependent......... 2
2.3 Effective Date mY 4
2.4 EXOMISIONG., ..nrscornessernosesssceasetecssonesecdanaenn isceasaboes sed
2.5 Limited Purpose Health Care Spe! . 2
26 Maximum Annual Benefit............::cccccceeseeeeeee 2
2.7 PD asvsscctessecincssassanaietnnaman 3
28 Qualifying Medical Expenses.

ARTICLE Ill PARTICIPATION

3.1 Participation....... 4
3.2 Tenmination:of Participation ssscisscesssasisccetss teen a RENE 4
ARTICLE IV MEDICAL: EXPENSE: BENEB GT scsccscctstscacisaineaie aise Saeac haa aaa cae 5
4.1 Att LLG] =. = 2) | Sea epee ORD SOMONE RET CEES DIST TEETH OPENER BUR opps AUST AN SSUES ERE 5
4.2 Maintenance of Accounts }
43 Amount Payable .............02. om)
44 Qualifying Medical Expenses. 6
45 VANES 50 sss csccsesssresovesnayessencecsnvenoscseesadessstenseon qpanaconcannstipeeeansvateessecs tennis 6
ARTICLE V EXCUcslOin ss se sscoscscsssxczossuss ceetescncnsasepansintevaaeettuania Mexcdettostepeepavans cateees yes toaapeevameaacNieeS
5.1 General Rules.... ie
5.2 SCH OM ISIN ES 5s eas Sioa SEL TPR RENE TE 7
ARTICLE Vi PROCEDURES saciiacnniiancianux a
6.1 Enrollment and Election Procedures 8
6.2 Claim Procedures ..........:csseseeceee 8
6.3 Claim Administrator .. 8
64 AAI PAIRTIAIENNO sss ecerseccnie sso mas psonnntanpensiens conmrenntnusacaesetiemeanpeccsnenpements 8
6.5 EOF OF CRAIN sc csssasscassosexsaconrerstsssnanseepesanaristeaeen erence unmenSEIIEEKEENR 9

vi

APPENDIX D APPLICABLE INCORPORATED DOCUMENTS. ..........c.c:cccccccessssstececeessceeeeesteeeeeeees 1

APPENDIX E EMPLOYEES OF THE EMPLOYER APPROVED TO HAVE ACCESS TO
PROTEGTED: HEALTH INFORMATION joi isisicssiciscescncssssscmisrcisicatanscisacciseceascieees 1

APPENDIX F PARTICIPATING EMPLOYERS

APPENDIX G MARICOPA COUNTY HEALTH SAVINGS ACCOUNT ....0.........0.cccceccceceeeeeeeeseseees 1
ARTICEE | PLAN ESTABLISHMENT siccscns sss geese ese eres Se cia ee ae 1
1.1 Trustee/Custodial AQreeMent..........esescsesseseseeeesetseseseeetsssstseseseeessseecseesesenecaeeeeeee 1
1.2 Health Savings Account Not Intended to be an ERISA Plan.......................02000+- 1
1.3 IPCONDOFAION: AV: RETST ORO oa scisconescssnsneuensnnvesocovessnsonassnsstenvpsnastnenesnnsnniessicscassaanacy 1
ARTICLE IL DEFINE IONS sresscscsscsssecesecsxccnesrecssauapmeanencsemmerticrencnatrcantmamnernsemematamuatane 2
2.1 GCOVETOR ENNOVOS sess sacecsseesosccsctceecerscccesacuicide csceseccs peu Sea saaanctctde seas eeE ie 2
2.2 Heatly Savings Account tric) ssicsccnccsnonascccaianseasanne 2.
ARTICLE MGPARTIGIRA THON sis s555 20552050 BREE I SSS TOIT =
a1 PERT ERCHCRUNON 55555556 SSSR a ar 3
ARTICLE IV HEALTH SAVINGS ACCOUNT BENEFIT ...........cccccsssssssesessesessseesessesesescesseseseseeaseeeee a

vii

1.1

1.2

1.3

ARTICLE |
PLAN ESTABLISHMENT

Effective Date

The Maricopa County Benefits Plan ("the Plan") is amended and restated effective
upon execution.

Purpose and History

Effective January 1, 1985, the Board of Supervisors of Maricopa County, Arizona
(the “County”), adopted The Maricopa County Cafeteria Plan, pursuant to section
125 of the Code, in order to establish a “cafeteria plan” to provide to the County's
employees certain health, welfare and other benefits. The County also adopted
and established certain other benefit plans (previously referred to as “Benefits")
which, subject to the eligibility requirements set forth in each plan, became
available to the County's employees for the purpose of providing the benefits
described therein. Effective as of January 1, 1988, the County also amended and
restated the Dependent Health Care Payment Plan in its entirety by adopting The
Maricopa County Accident and Health Insurance Plan (the “A&H Plan”). Effective
as of January 1, 2006, the Cafeteria Plan and the A&H Plan were amended and
restated to incorporate all prior amendments made to those Plans since their
original Effective Date, and to make such other amendments as determined by the
County to be in the best interests of those Plans and their participants. Effective
June 22, 2011, the Second Amendment and Restatement of the Cafeteria Plan
and Third Amendment and Restatement of the A&H Plan were implemented.
Effective July 1, 2013, the Maricopa County Benefits Plan (Third Amendment and
Restatement) was amended and consolidated the Maricopa County Cafeteria Plan
(Second Amendment and Restatement) and the A&H Plan (Third Amendment and
Restatement) into one plan. The Plan has since been amended from time to time.
The Plan is now amended effective as of the Effective Date to incorporate all prior
amendments and to make additional amendments required to comply with federal
and state laws and/or amendments which have been determined by the County to
be in the best interests of the Plan and its Covered Persons. The Plan is also
intended to give Covered Employees, as defined in Article Il, means to exchange
all or part of their compensation for other Plan benefits they select in order to allow
Covered Employees to maximize their tax savings to the greatest extent permitted
by law, as contemplated by sections 105, 106 and 125 of the Internal Revenue
Code of 1986, as amended (the “Code’).

Qualification

The Plan is not subject to the Employee Retirement Income Security Act of 1974,
as amended ("ERISA"). Any references in this document to sections of ERISA, or
statutes or rules commonly understood to be related to ERISA, are for
administrative ease, and do not subject the Plan to ERISA's jurisdiction.

To the extent this Plan provides permitted taxable benefits and qualified benefits
under Section 125 of the Code, it is intended to qualify as a cafeteria plan under
Section 125 of the Code. This document is intended to satisfy the written plan

1.4

document requirements of Department of Treasury Proposed Regulations
Section 1.125-1(c). The portions of the plan that constitute the cafeteria plan and
the term “Cafeteria Plan” shall mean those provisions of this document that are
necessary or appropriate to the implementation and administration of Employee
elections among the following listed benefits to the extent pre-tax elections are
available: the unreduced compensation benefit, the Medical Premium Payment
Benefit, Dental Premium Payment Benefit, Vision Premium Payment Benefit,
Health Care Spending Account Premium Payment Benefit, Limited Purpose Health
Care Spending Account Premium Payment Benefit, Dependent Care Spending
Account Premium Payment Benefit, and Health Savings Account Premium
Payment Benefit. This Plan is also intended to qualify as an “accident and health
plan” maintained under Sections 105 and 106 of the Code and regulations issued
thereunder and to offer benefits on a tax-free basis in accordance with the Code.
This Plan shall be interpreted, construed and administered in accordance with
such intent. In no event shall this Plan be administered or construed to constitute
a plan of deferred compensation. The cafeteria plan is for Covered Employees

only.

The Dependent Care Spending Account Plan, as defined in Article II and set forth
in Appendix A, is part of this Plan and is intended to qualify as a dependent care
assistance program under Section 129 of the Code. Appendix A is intended to
satisfy the written plan document requirement of Code Section 129(d)(1).

The Health Care Spending Account Plan, as defined in Article II and set forth in
Appendix B, is part of this Plan. The Health Care Spending Account Plan is
intended to qualify as a health plan under Section 105(e) of the Code. Appendix B
is also intended to satisfy the written plan document requirement of Department of
Treasury regulation Section 1.105-11(b)(1)(i).

The Limited Purpose Health Care Spending Account Plan, as defined in Article |!
and as set forth in Appendix C, is part of this Plan. The Limited Purpose Health
Care Spending Account Plan is intended to qualify as a health plan under

Section 105(e) of the Code. Appendix C is also intended to satisfy the written plan
document requirement of Department of Treasury regulation Section 1.105-

11(b)(1)(i).
Duration

The Plan is established with the intention of being maintained for an indefinite
period of time; however, the County, as defined in Article II, in its sole discretion
and in accordance with the provisions of Article Xl may amend or terminate the
Plan or any provision of the Plan at any time.

2.1

2.2

2.3

2.4

2.5

ARTICLE Il
DEFINITIONS

The following words and phrases, when capitalized, shall have the following
meanings. Words and phrases not defined in this Article shall have the meaning
set forth in an applicable Incorporated Document, and if not defined in an
applicable Incorporated Document, then such words and phrases shall have the
meaning customarily given them by the applicable insurance company, third party
administrator, or other service provider, as the case may be.

Benefits

Benefits mean the health and welfare coverages provided under the Plan and as
described in the Incorporated Documents. Certain benefits are provided to any
Employee who meets the eligibility requirements of Section 3.1, while certain other
benefits are provided only upon selection by an Employee who meets the eligibility
requirements of Section 3.1.

Benefits Trust

Benefits Trust refers to the Maricopa County, Arizona Self-Insured Benefits Trust
Fund authorized under A.R.S. § 11-981 and established by the Board of
Supervisors pursuant to the Revised and Restated Declaration of Trust for
Maricopa County, Arizona Self-Insured Benefits Trust Fund, for purposes of
collecting and maintaining contributions from Employees, the County, and
authorized Participating Employers, and funding the Plan.

Board of Supervisors

Board of Supervisors means the Board of Supervisors of Maricopa County.

Board of Trustees

Board of Trustees means the Trustees described in and appointed pursuant to the
Revised and Restated Declaration of Trust for Maricopa County, Arizona Self-
Insured Benefits Trust Fund.

Change in Status

Change in Status means:

A. A “special enrollment” event under HIPAA,

B. The Covered Employee's marriage, divorce, legal separation, or annulment,

C. The birth, adoption, placement for adoption, or change in dependency or
custody of a Covered Employee's child,

D. The death of the Employee's Spouse or Dependent child,

A change in employment status by the Covered Employee, Spouse or
Dependent child, including commencement or termination of employment, a
change in work shift, a change in worksite, a reduction or increase in hours of
employment including changing from part-time to full-time employment
status, a strike or lockout,

Commencement or return from an unpaid leave of absence by the Employee,
Spouse or Dependent child,

A change in worksite or personal residence resulting in eligibility or loss of
eligibility of coverage for the Covered Employee, Spouse or Dependent child
under any health maintenance organization offered through the Plan,

A change in legal custody/guardianship (including the issuance of a Qualified
Medical Child Support Order) that affects a child’s eligibility for coverage
under this Plan or the plan of the child's other parent,

Entitlement or loss of entitlement to Medicare or Medicaid by the Employee,
Spouse or Dependent child,

Attainment by a Dependent child of limiting age for a benefit provided under
this Plan,

Loss of “qualifying individual” status, as defined in Article II of the Dependent
Care Spending Account Plan,

Experiencing a change in employment that does not otherwise affect
eligibility for coverage under the Plan, after which the Covered Employee is
reasonably expected to average less than 30 hours of service per week, if
the Covered Employee (and any Dependents also revoking coverage)
intend(s) to enroll in another plan that provides minimum essential coverage
effective no later than the first day of the second month after the date that
Plan coverage is revoked. This rule permits the Covered Employee to revoke
group health plan Benefits only, for the Covered Employee and his or her
Dependents, and does not apply to Health Care Spending Account or Limited
Purpose Health Care Spending Account elections,

Eligibility for special enrollment in a qualified health plan (QHP) through the
public Marketplace, or seeking to enroll in a QHP offered through the public
Marketplace during the Marketplace’s annual open enrollment. This rule
permits the Covered Employee to revoke group health plan Benefits only, for
the Covered Employee and his or her Dependents, and must correspond
with the intended enrollment of the Covered Employee and his or her
Dependents in a QHP effective beginning no later than the day immediately
following the last day of the of the Plan coverage that is revoked. This rule
does not apply to Health Care Spending Account or Limited Purpose Health
Care Spending Account elections, or

Any other event the Plan Administrator determines permits revocation of an
election without violating the Code.

2.6

2.7

2.8

2.9

2.10

2.11

2.12

Claim Administrator

Claim Administrator means the person(s) or entity (or entities) authorized and
responsible for receiving and reviewing claims for benefits under the Plan;
determining what amount, if any, is due and payable; making appropriate
disbursements to persons entitled to benefits under the Plan; and reviewing and
determining denied claims and appeals.

Code

Code means Internal Revenue Code of 1986, as amended, and regulations issued
thereunder or pursuant thereto by the United States Internal Revenue Service
(IRS).

COBRA

COBRA means the Consolidated Omnibus Budget Reconciliation Act of 1985
(Public Law 99-272, Title X), as amended, and the regulations issued thereunder
or pursuant thereto.

County

County means Maricopa County, Arizona.

Covered Employee

Covered Employee means an Employee who satisfies the eligibility, participation,
and coverage requirements of Article Ill and who has made an election to
participate in the benefits described in Article IV.

Covered Person

Covered Person means a Covered Employee or Dependent who has satisfied the
eligibility and enrollment provisions of Article Ill or, if applicable, the provisions of

Article Vil.

A Covered Person may have Plan coverage with respect to certain benefits, but
not all benefits, as hereinafter described in the Plan.

Dependent

Dependent means a Spouse or dependent child of an Employee who is a Covered
Person as determined under the applicable Incorporated Document.

Regardless of whether a Dependent is eligible for a Benefit under this Plan, a
Covered Employee may only make Salary Reduction Contributions for Benefits for
an Employee’s dependent who is a Covered Person as follows:

A. Spouse,

B. dependent as defined in Code Section 152 (without regard to (b)(1), (b)(2),
and (d)(1)(B)), or

2.13

2.14

2.15

C. for health Benefits for the Covered Employee's child as defined in Code
Section 152(f)(1) who has not attained age 27 as of the end of the taxable
year.

“Dependent” will be construed in accordance with applicable federal, state, and
local law, including, but not limited to, surviving spouses and dependents of law
enforcement officers killed in the line of duty or that died from injuries suffered
while in the line of duty and who are eligible pursuant to Arizona Statute.

A Dependent may be eligible for coverage with respect to certain benefits, but not
all benefits, as hereinafter described in the Plan.

Dependent Care Spending Account Plan

Dependent Care Spending Account Plan means the plan set forth in Appendix A,

which amends, restates, and supersedes the Maricopa County Dependent Care

Flexible Spending Account Plan (Fifth Amendment and Restatement) as of the

Effective Date.

Effective Date

Effective Date means the date the Plan becomes operative, as set forth in Article I.

Employee

For purposes of this Plan only, the term Employee means a common law

employee of the Employer or the Superior Court in and for Maricopa County

(whose compensation is paid by the County or through the County payroll).

Employee shall also mean an individual or group of individuals eligible for

employee benefits coverage offered by the County to its employees pursuant to

the terms of a contract with the County (including Intergovernmental Agreements

such as those described in Section 10.7).

The term Employee includes, but is not limited to, a person who is:

A. aleased employee, as defined in Code Section 414(n),

B. anonresident alien who receives earned income (within the meaning of Code
Section 911(d)(2)) from an Employer that constitutes income from sources
within the United States, as defined in Code Section 861(a)(3), or

C.  acollectively bargained employee.

Subject to the above, the term Employee does not mean:

D. aself-employed individual, as defined in Code Section 401(c)(1)(A),

E. aperson whom the Plan Administrator determines has been engaged by the
Employer as an independent contractor, or

F. aperson whom the Plan Administrator determines has been engaged by the
Employer as a consultant or advisor on a retainer or fee basis.

2.16

2.17

2.18

2.19

2.20

2.21

A person the Plan Administrator determines is not an “Employee” as defined
above shall not be eligible to participate in the Plan regardless of whether such
determination is upheld by a court or tax or regulatory authority having jurisdiction
over such matters. However, a person the County determines is not an
“Employee” as defined above and who later is required to be reclassified as an
Employee shall be eligible to participate in the Plan benefits under the Plan
prospectively only, provided that the Employee is otherwise eligible pursuant to
Section 3.1.

Employer

Employer means the County and its elected officials and any subsidiary or
affiliated organization and any successor(s) of any of them which, with the
approval of the County, and subject to such conditions as the County may impose,
adopts the Plan, including any Participating Employer.

For purposes of satisfying the nondiscrimination requirements of Code

Section 125(b), Sections 105(h) and 129(d), the term “Employer” shall include any
other corporation or other business entity which must be aggregated with the
Employer under Sections 414(b), (c), (m) or (0) of the Code, but only for such
period of time when the Employer or such other corporation or other business
entity must be aggregated as aforesaid.

ERISA

ERISA means the Employee Retirement Income Security Act of 1974, as
amended, and the regulations issued thereunder or pursuant thereto. As stated in
Section 1.3, the Plan is not subject to ERISA. Any references to ERISA are for
administrative ease and do not subject the Plan in any way to ERISA's jurisdiction.

FMLA

FMLA means the Family and Medical Leave Act of 1993, as amended, and the
regulations issued thereunder or pursuant thereto.

Health Care Spending Account Plan

Health Care Spending Account Plan means the plan set forth in Appendix B, which
amends, restates, and supersedes the Maricopa County Flexible Spending
Account Plan (Fifth Amendment and Restatement) as of the Effective Date.

Health Savings Account

Health Savings Account means an individual savings account described in
Appendix G.

HIPAA

HIPAA means the Health Insurance Portability and Accountability Act of 1996, as
amended, and the regulations issued thereunder or pursuant thereto.

2.22

2.23

2.24

2.25

2.26

2.27

2.28

2.29

Incorporated Document

Incorporated Document means any insurance policy, administrative services
agreement, plan, trust, certificate of coverage, evidence of coverage, summary
plan description or other document incorporated by reference, together with any
exhibits, supplements, addendums or amendments thereto. The Incorporated
Documents are listed in Appendix D, which may be updated from time to time by
the County and/or Plan Administrator.

Limited Purpose Health Care Spending Account Plan

Limited Purpose Health Care Spending Account Plan means the plan set forth in
Appendix C, which amends, restates, and supersedes the Maricopa County
Limited Scope Flexible Spending Account Plan (Second Amendment and
Restatement) as of the Effective Date.

Outbreak Period

Outbreak Period means the period from March 1, 2020, through 60 days after the
announced end of the COVID-19 “National Emergency” (or such other time as the
applicable agencies may announce in the future) as described in relevant federal
guidance issued in response to the COVID-19 National Emergency.
Participating Employer

Participating Employer means an Employer who has adopted the Plan pursuant to
Section 10.7 and as listed in Appendix F.

Plan

Plan means The Maricopa County Benefits Plan as herein set forth and as
amended from time to time.

Plan Administrator

The County is the Plan Administrator. An employee(s) who serves in the position
of Benefits Manager and is authorized to perform day-to-day management and
administration of this Plan, including oversight of the administration of the direct
payment of benefits, losses, and claims pursuant to this Plan and in accordance
with the Benefits Trust. Certain administrative functions may be delegated to third-
party administrators under contract with the County.

Plan Sponsor

Plan Sponsor means the County.

Plan Year

Plan Year means the 12-month period beginning July 1 and ending June 30.

2.30

2.31

2.32

2.33

2.34

Salary Deduction

Salary Deduction means the authorization to the Employer by the Employee to
reduce such Employee’s compensation by an amount on an after-tax basis for
selected Plan benefits.

Salary Deduction Contributions

Salary Deduction Contributions means the contributions taken from the Covered
Employee’s compensation on an after-tax basis, pursuant to a Salary Deduction.

Salary Reduction

Salary Reduction means the authorization to the Employer by the Employee to
reduce such Employee’s compensation by an amount on a before-tax basis for
selected Plan benefits.

Salary Reduction Contributions

Salary Reduction Contributions means the contributions taken from the Covered
Employee's compensation on a before-tax basis, pursuant to a Salary Reduction.

Spouse

Spouse means, for purposes of this Plan only, a person recognized as married to
the Covered Employee by a state, possession, or territory of the United States in
which the marriage is entered into, regardless of domicile, provided such person is
not legally separated from the Employee. Where the marriage was entered into in
a foreign jurisdiction, a person is recognized as married to the Covered Employee
if the relationship is recognized as marriage under the laws of at least one state,
possession or territory of the United States, regardless of domicile.

3.1

3.2

ARTICLE Ill
ELIGIBILITY, PARTICIPATION AND COVERAGE

Eligibility

An Employee who is classified by the Employer as regularly scheduled to work at
least 20 hours per week shall become eligible for Plan participation in the benefits
identified in Article IV on the later of the Effective Date or the first of the month next
following his or her date of hire.

The following Employees are not eligible to participate in the Plan:
A. Employees regularly scheduled to work fewer than 20 hours per week;

B. Employees who are hired on a temporary basis, with the classification
temporary meaning any Employee hired to fill a job vacancy for a limited
time, as designated by the Plan Administrator;

C. Employees who are hired on a seasonal basis, with the classification
seasonal meaning hired to fill a job vacancy relating to or occurring during a
particular season, as designated by the Plan Administrator;

D. Leased employees, as defined in Code Section 414(n);

E. Employees in an employee unit covered by a collective bargaining
agreement between Employee representatives and one or more Employers if
this Plan’s benefits were the subject of good faith bargaining between the
Employee representatives and the Employer, unless such agreement
provides for coverage for such bargaining employees in the Plan;

F. Nonresident aliens who receive no earned income (within the meaning of the
Code Section 911(d)(2)) from an Employer that constitutes income from
sources within the United States, as defined in Code Section 861(a)(3); and

G. Employees employed pursuant to a contract that does not permit
participation in the Plan.

Specific eligibility requirements for certain benefits shall be set forth in Article IV or
in the applicable Incorporated Documents.

Participation
Employees become Covered Employees with respect to non-elective Benefits
(Section 4.5) on the date they satisfy the eligibility requirements of Section 3.1.

Employees become Covered Employees with respect to elective Benefits on the
date they also satisfy the enrollment and election requirements of Section 5.4.

10

3.3

Coverage
A. Date Coverage Begins

The provisions and requirements describing when and how Employees and
Dependents become Covered Persons, the conditions and limitations to coverage,
and the circumstances wherein coverage terminates shall be set forth as
applicable in the Incorporated Documents by reference under Section 4.1. In
addition, coverage is governed by the rules stated below and in Section 5.8.

B. Coverage During Leave of Absence
1. Paid Leave

During a paid leave of absence, a Covered Employee continues to
participate in all benefits—except that participation in the Dependent Care
Spending Account Plan is suspended on the last day of the pay period in
which the Covered Employee's paid leave began.

2. Unpaid Leave

For Plan benefits not requiring Employee contributions, a Covered
Employee remains covered for such benefits during an unpaid leave of
absence for four (4) pay periods, unless otherwise required by the FMLA.

Except as otherwise provided below, for Plan benefits requiring an
Employee contribution, coverage for a Covered Employee on an approved
unpaid leave of absence is suspended on the last date of coverage for
which a premium payment benefit has been paid. The terms of the plan to
which the Covered Person's selected premium payment benefits were paid
control whether and to what extent coverage and benefits under that plan
continue. Coverage is otherwise suspended after four (4) pay periods of
unpaid leave.

To the extent the Covered Employee may continue coverage during an
unpaid leave, and except as required below, the Covered Employee is
required to pay for coverage on an after-tax basis.

If the unpaid leave of absence is taken pursuant to FMLA, Covered
Employees continue participation in all premium payment benefits
described in Sections 4.4 except 4.4(D), (E), (F), and (K) by either

(i) paying premium payment benefits during the FMLA leave on an after-tax
basis, or to the extent possible on a before-tax basis, or (ii) paying on a
before-tax basis upon return from the leave the premium payment benefits
for coverage during the leave, and adjusting the Salary Reduction
Contribution accordingly for the balance of the Plan Year. Benefits
described in Section 4.4(D), (E), (F), and (K) are suspended.

With respect to premium payment benefits described in Section 4.4(D), (E),

and (F), no expenses incurred during the leave shall be reimbursed. Upon
return from leave, the Employee can either: i) elect to be reinstated in the

11