5.1 FY 2020-21 EMPLOYEE BENEFITS PLAN REDLINED EXHIBIT A.PDF

Exhibit A 
THE 
MARICOPA COUNTY 
BENEFITS PLAN 
(TENTHNINTH AMENDMENT AND RESTATEMENT) 
 
ARTICLE I 
 
HISTORY OF THE PLAN 
 
 
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 the “Benefit Plans”) 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 Maricopa County Benefits Plan (also referred 
to as the “Plan”) has since been amended from time to time.  This Maricopa County Benefits Plan 
(Ninth Tenth Amendment and Restatement) is amended effective July 1, 2019 2020 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 Participants.   
 
ARTICLE II 
 
DEFINITIONS 
 
 
Unless otherwise required by context, the capitalized terms used in this Plan shall have the 
meanings set forth in the following sections of this Article.  The masculine gender, when used 
herein, shall include the feminine and, unless context indicates otherwise, the singular shall include 
the plural and the plural the singular. 
 
 
2.1 
Approved Leave.  An Employee’s absence from assigned work, which absence is 
approved by the Employee’s Appointing Authority in accordance with applicable laws, policies or 
procedures.   
 
 
2.2 
Benefit Plans.  The benefits afforded to Participants under the following plans:  this 
Plan and its related Health Plans, The Maricopa County Health Care Flexible Spending Account 
Plan (as amended), The Maricopa County Limited Scope Flexible Spending Account Plan (as

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amended), and The Maricopa County Dependent Care Flexible Spending Account Plan (as 
amended).  The term “Benefit Plans” shall include any other employee benefit plans designated 
by the Board as a benefit plan within the meaning of this Section.  However, it does not include 
the short-term disability plan, the basic life insurance plan, the basic accidental death and 
dismemberment plan or any other voluntary benefit plans, which are paid for solely by the 
Employee or by the County. 
 
 
2.3 
Benefits Effective Date.  For Employees, the first day of the month following date 
of hire or the Benefits Eligible Date.  For COBRA Beneficiaries, the first day following their 
Benefits Termination Date provided a new Benefits Purchase Order is made within the time period 
prescribed in this Plan. 
 
 
2.4 
Benefits Eligible Date.  The Employee’s date of hire or appointment or the date the 
Employee is eligible to enroll in benefits (e.g., date of position change from temporary to part-
time or full-time, or start date of employment contract). 
 
 
2.5 
Benefits Funding Account.  The account maintained pursuant to Article V hereof 
on behalf of a Participant and his eligible Dependents, as such account is adjusted from time to 
time in accordance herewith.  Also commonly known as a Salary Reduction Account for 
Employees who become Participants. 
 
 
2.6 
Benefits Purchase Order.  An Employee’s selection of benefits, authorization to 
reduce his Compensation in accordance with Article V and purchase benefits under this Plan or 
any other Benefit Plan maintained by the County, or waive participation in this Plan, or 
authorization to continue coverage in a Benefit Plan as a COBRA Beneficiary and be directly 
billed for the associated costs.  Also known as a Salary Reduction Order for Employees who 
become Participants.  A Benefits Purchase Order may also be used by Employees to purchase other 
voluntary healthcare or insurance benefits on an after-tax basis not subject to this Plan (for 
example, short-term disability insurance, additional life insurance, etc.).  Social Security Numbers 
or IRS-issued Tax Payer Identification Numbers may be required from Employees, Dependents 
and COBRA Beneficiaries in order to comply with the terms of the Code (defined below) and/or 
other state or federal law, as well as provide for the orderly and efficient operation of the Benefit 
Plans. 
 
2.7 
Benefits Termination Date.  The date on which a Participant’s benefits eligibility 
ceases as defined in this Plan or in Board-approved County leave policies or procedures. 
 
 
2.8 
Benefits Trust.  Maricopa County, Arizona Self-Insured Benefits Trust Fund 
established pursuant to the Revised and Restated Declaration of Trust for Maricopa County, 
Arizona Self-Insured Benefits Trust Fund, or such other Fund as the Board may establish for 
purposes of collecting and maintaining contributions from Employees and the County and 
authorized participating employers. 
 
 
2.9 
Board.  The Board of Supervisors of Maricopa County. 
 
 
2.10 
Board of Trustees.  The Trustees described in and appointed pursuant to the Revised 
and Restated Declaration of Trust for Maricopa County, Arizona Self-Insured Benefits Trust Fund.

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2.11 
COBRA Beneficiary.  An individual who is authorized to participate in this Plan 
under Section 4.10. 
 
 
2.12 
Code.  The Internal Revenue Code of 1986, as amended from time to time. 
 
 
2.13 
Compensation.  An Employee’s total taxable remuneration for the performance of 
services during each Plan Year in which he is a Participant as reflected on Form W-2, including, 
but not limited to, his basic wages or salary, commissions, overtime pay, bonuses or other forms 
of compensation required to be reported on Form W-2, such compensation to be determined before 
any reduction on account of any withholding, such as Federal or State income taxes, Social 
Security, insurance premiums or voluntary elective contributions to this Plan or to any applicable 
deferred compensation plan, but excluding the value of any benefits provided an Employee 
through any qualified employee pension plan and any compensation paid in kind.  (Note: this 
definition does not apply to life insurance or accidental death and dismemberment insurance, 
which are excluded from this Plan.) 
 
 
2.14 
County.  Maricopa County, Arizona. 
 
 
2.15 
Dependent.   An Employee’s legally married spouse, not legally separated; an 
Employee’s dependent child (ren); and an Employee’s young adult(s) up to age 26 (regardless of 
marital, student, residency or tax dependency status).  Child/young adult includes the Employee’s 
natural child, stepchild, legally adopted child, child placed with the Employee by court order or by 
state statute for adoption or child for whom the Employee has been awarded legal guardianship; 
additionally, a child who is permanently and totally disabled at any age provided he or she was 
medically certified as being permanently and totally disabled prior to his or her 26th birthday.  
“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 are eligible 
pursuant to Arizona Statute.  
 
 
2.16 
Employee.  Any person who (i) is employed by the County or the Superior Court 
in and for Maricopa County (whose compensation is paid by the County or through the County 
payroll) to work at least 19 20 hours per week on a regular basis and is eligible for employee 
benefits offered by the County to its employees; or (ii) is 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 7.4).   
 
 
2.17 
Health Plan.  All insured and/or self-funded medical, dental, vision, 
pharmaceutical, and behavioral health plans maintained by the County on behalf of Participants 
and under which Employees and COBRA Beneficiaries are provided with the option of electing 
from such Health Plans to receive health benefits for him/herself and eligible Dependents.  In no 
event shall the term “Health Plan” include any product which is advertised, marketed or offered as 
long-term care insurance. 
  
 
2.18 
Participant.  An Employee who is eligible to participate in this Plan who has 
executed a Benefits Purchase Order and who has reached the Benefits Effective Date.  Also a

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COBRA Beneficiary who is eligible to participate in this Plan and any applicable Benefit Plan and 
has elected such participation through a Benefits Purchase Order.  Participants must also meet all 
separate eligibility conditions of the applicable Benefit Plan(s) or Health Plan(s) in order to be 
entitled to benefits under such plans. 
 
 
2.19 
Plan.  The plan set forth under this Maricopa County Benefits Plan (Seventh 
Amendment and Restatement). 
 
 
2.20 
Plan Administrator.  The County employee 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.  References to the 
Plan Administrator include the Plan Administrator’s designated agent(s), as applicable.  
 
 
2.21 
Plan Year.  The 12 consecutive month period beginning on July 1 and ending on 
June 30.  
 
 
2.22 
Qualified Health Plan.  A health plan that has been certified by the Health Insurance 
Marketplace as meeting the requirements of the Patient Protection and Affordable Care Act, as 
defined at 42 U.S.C. § 18021. 
 
 
2.23 
Severance Date.  The date on which an Employee’s employment ends on account 
of resignation, dismissal, death, retirement or conclusion of contract. 
 
 
2.24 
Unpaid Status.  An Employee who is not receiving any earnings from the County 
or pay from other sources via the County payroll system, such as vacation or sick leave.

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ARTICLE III 
 
ESTABLISHMENT OF THE PLAN 
 
 
 
3.1 
Purpose.  The purpose of this Plan is to allow Employees who become Participants 
in the Plan to participate in this Plan and other Benefit Plans maintained by the County and to elect 
any combination of the benefits offered under any of such Benefit Plans, so as to best meet each 
Participant’s individual needs, and to allow Participants to choose, to the greatest extent permitted 
by law, between cash and non-taxable benefits, as contemplated by sections 105, 106 and 125 of 
the Code.  Participants in the Plan who are Employees shall elect between cash and non-taxable 
benefits by making a Benefits Purchase Order hereunder and electing to apply such contributions 
to the Benefit Plans or to the purchase of benefits provided by the Health Plans maintained by the 
County on a tax free basis.  This Plan shall also provide healthcare benefits to Participants who are 
eligible COBRA Beneficiaries. 
 
 
3.2 
Intention.  This Plan is intended to qualify as a “cafeteria plan” maintained under 
Section 125 of the Code and regulations issued thereunder.  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. 
 
 
3.3 
Effect upon Other Plans.  Nothing in this Plan shall be construed to affect the 
provisions of any other Benefit Plan or Health Plan which is intended to comply with the 
requirements of any other provision of the Code, except to the extent that this Plan permits 
Participants to purchase benefits provided under any such other Benefit or Health Plan by 
authorized salary reductions obtained hereunder. 
 
 
3.4 
Effect of this Amendment and Restatement.  The purpose of this amendment and 
restatement is to incorporate all amendments made to the Plan since its most recent amendment 
and restatement and to make such other amendments as determined by the County to be in the best 
interests of the Plan and its Participants.

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ARTICLE IV 
 
ELIGIBILITY, PARTICIPATION AND COVERAGE 
 
 
4.1 
Eligibility.  Subject to all applicable criteria set forth in this Plan and any applicable 
Benefit Plan or Health Plan, the following individuals are eligible to participate in this Plan: 
 
 
4.1.1 Employees and their added Dependents 
 
 
4.1.2 COBRA Beneficiaries 
 
4.2 
Participation.  Except as provided in the following sentence, an Employee shall 
become a Participant in this Plan on the first day of the month following date of hire or Employee’s 
Benefits Eligible Date, by the execution of a Benefits Purchase Order that elects benefits 
participation and submittal to the Plan Administrator within thirty (30) calendar days of his/her 
Benefits Eligible Date.  The Benefits Purchase Order shall be made and effective as provided in 
Article V. 
 
4.3 
Election to Purchase Benefits. Each Employee may elect between cash and non-
taxable benefits.  An Employee who would otherwise be eligible to participate hereunder may elect 
to receive cash from the County by not electing to participate in this Plan and therefore not 
providing health coverage for himself and his eligible Dependents through this Plan.  Such 
Employee shall have elected an amount of cash equal to the amount of his current taxable 
Compensation that he could have contributed to his Benefits Funding Account for the purchase of 
benefits hereunder.  Each Employee who is eligible to participate hereunder may elect a non-
taxable benefit as described in Sections 105 and 106 of the Code by electing to participate in this 
Plan and requiring the County to pay the payments due from a Participant to provide coverage for 
and on behalf of himself and his eligible Dependents as hereinafter provided. 
 
4.4 
Waiver of Coverage. An Employee may choose to waive coverage under this Plan.  
Any waiver of coverage must be made by the Employee on a Benefits Purchase Order in the same 
manner and at the same time specified in Article V.  If an Employee waives coverage, the County 
may authorize such Employee to receive an amount of cash from the County on a monthly, 
quarterly or annual basis or a credit to his Health Care Flexible Spending Account maintained 
under The Maricopa County Health Care Flexible Spending Account Plan, as determined by the 
County.  In order to receive such payment or credit, if authorized, the County may require the 
Participant to demonstrate other coverage, such as coverage under a Qualified Health Plan or group 
health plan (as defined in the Public Health Service Act) including Medicare and the plan 
maintained by the Bureau of Indian Affairs (but not including AHCCCS). 
 
4.5 
Failure to Make Elections. If a Participant fails to submit a Benefits Purchase Order 
to participate in this Plan or waives coverage, such Participant shall participate in such one or more 
or no Health Plan(s) as may be determined from time to time by the Board. 
 
 
4.6 
Effect of Participation.  Participation in the Plan shall only entitle a Participant to 
obtain the benefits provided under the Benefit Plans for each Plan Year in which he is a Participant, 
subject to the limitations of Article V, and then only to the extent authorized by each such Benefit 
Plan.  Participation in this Plan shall not entitle an Employee to participate in any Benefit Plan 
unless the Employee also meets the eligibility and participation requirements of such Benefit Plan.

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4.7 
Suspension of Participation.  If a Participant is called to active military service leave 
or on an Approved Leave in an Unpaid Status for a period of more than thirty (30) calendar days, 
such Participant may elect to suspend participation in any Benefit Plan in which he is enrolled 
unless otherwise provided in such Benefit Plan.  No benefits coverage will exist during the time 
of suspension.  If the Participant chooses to suspend his benefits election, when the Participant 
returns to work he must complete a Benefits Purchase Order within thirty (30) calendar days of his 
return to work in order to resume participation.  If the Participant returns to work during the same 
Plan Year, the Participant shall return to the same benefits elections authorized in his prior Benefits 
Purchase Order for that Plan Year.  If the Participant returns to work during a subsequent Plan 
Year, such Participant shall be entitled to make new elections consistent with those that were made 
available to Employees during the Open Enrollment period.  If the Benefits Purchase Order is 
received within thirty (30) calendar days of the Participant’s return to work, the effective date of 
the resumed participation for benefits eligibility will be the Participant’s return to work date. 
 
 
4.8 
Cessation of Participation.  An Employee and his eligible Dependents shall cease 
to be eligible to participate in this Plan on the last day of the month within which occurs his 
Severance Date or within which he becomes ineligible for benefits under the terms of this Plan.   
 
 
4.9 
Reinstatement of Participation.   In no event shall an Employee be permitted to 
execute a new Benefits Purchase Order during the Plan Year which includes his Severance Date if 
such severance of employment was not bona fide and in which the principal purpose of the 
severance of employment was to alter the Participant’s Benefits Purchase Order.  In addition, if an 
Employee resumes employment within thirty (30) calendar days following his Severance Date and 
without any other intervening event(s) that would permit a change in his Benefits Purchase Order, 
such Employee shall return to the elections in effect prior to his Severance Date and benefits 
coverage shall be retroactive to the Severance Date.  Premiums will be collected in arrears by 
doubling the Participant’s premium charges each pay period until paid in full. 
 
 
4.10 
Continuation of Coverage. 
Anything 
in 
this 
Plan 
to 
the 
contrary 
notwithstanding, to the extent any Benefit Plan (or any specific benefit provided thereunder) is a 
group health plan as described in the continuation of coverage rules contained in section 10003 of 
the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) which were added to 
the Public Health Service Act, as amended (the “Act”), the continuation of coverage rules 
described in the Act shall apply, and a Participant who terminates employment or whose benefit 
coverage is otherwise terminated shall be eligible to continue to participate in this Plan or such 
Benefit Plan (or such specific benefit provided thereunder) only to the extent and for the minimum 
period (including no period) provided in the Act, as interpreted by the Internal Revenue Service 
under corresponding provisions of the Code and the Treasury Regulations issued thereunder or 
any other applicable law and only to the extent of their participation while actively employed or 
benefits eligible.  COBRA Beneficiaries shall only be eligible to continue in the Benefit Plans in 
which they were previously enrolled. 
 
4.11 
Significant Cost or Coverage Changes.  Subject to such limitations as the Board 
may adopt, if the cost under a Benefit Plan significantly increases, a Participant and his affected 
Dependents may, within thirty (30) calendar days of the effective date of such significant increase 
of cost, either make a corresponding change in his Benefits Purchase Order or revoke his elections.

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In addition, if the coverage under a Benefit Plan is significantly curtailed or ceases during a period 
of coverage, all affected Participants and Dependents may, within thirty (30) calendar days of the 
effective date of such curtailment or cessation of coverage, either make a corresponding change or 
revoke their elections under the applicable Benefit Plans.  This Section shall apply to The Maricopa 
County Dependent Care Flexible Spending Account Plan only if the cost change is imposed by a 
dependent care provider who is not a relative of the Participant (within the meaning of section 152 
of the Code).  The Plan Administrator shall implement the provisions of this Section consistent 
with the rules contained in section 125 of the Code and the regulations issued thereunder.  Subject 
to such limitations as the Plan Administrator may adopt, if an Employee or his/her Dependents 
have other benefits coverage outside of this Plan, which has a significant cost or coverage change, 
such Employee and eligible Dependents may become Participants in this Plan by the Employee 
completing a Benefits Purchase Order. 
 
 
4.12 
Change in Status.   
 
 
 
(a) 
Subject to such limitations as the Plan Administrator may adopt, a 
Participant may change, suspend or reauthorize his Benefits Purchase Order effective as of a date 
other than the first day of the succeeding Plan Year if such change, suspension or reauthorization 
is on account of and consistent with a Change in Status.  The Plan Administrator shall approve 
Changes in Status which are consistent with the change in status rules promulgated by the Internal 
Revenue Service as published in such Treasury Regulations issued under section 125 of the Code 
and authorized by this Plan.  In order for any Change in Status to be effective other than on the 
first day of the succeeding Plan Year, the change must be reported by the Participant to the Plan 
Administrator within thirty (30) calendar days from the effective date of the event causing the 
Change in Status.   
 
 
 
(b) 
A Change in Status includes the following: (1) marriage; (2) divorce; 
(3) legal separation or annulment; (4) death of a Dependent; (5) birth or adoption of a child; (6) 
placement of a child for adoption; (7) a change in dependency or custody of a child (including a 
change in legal guardianship pursuant to court order or state statute)court-ordered legal 
guardianship (specific court order or authorized by state statute); (8) attainment by a  Dependent 
child of limiting age for benefit provided under this ceasing to be a Dependent or otherwise not 
continuing to qualify for benefits under a Benefit Plan; (9) change in the place of work or residence 
resulting in eligibility or loss of eligibility for of the Employee or Dependent under any health 
maintenance organization;provided that the change in place of residence affects the eligibility for 
the Employee’s or Dependent’s coverage under a Benefit Plan; (10) change in employment status 
by the Employee or Dependent 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; which changes eligibility for benefits 
under any Benefit Plan; (11) termination, change or acquisition of employment of a Dependent 
which affects benefits coverage; (12) a change made during the open enrollment period of a 
Dependent to coverage provided by the Dependent’s employer; (13) changes in a former spouse’s 
employment which will affect coverage provided by such former spouse to the children of the 
Participant;  (11) entitlement or loss of entitlement to Medicare or Medicaid by the Employee or 
Dependent; (12) loss of “qualifying individual” status, as defined in Article II of the Dependent 
Care Spending Account Plan,; (13) 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

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Marketplace during the Marketplace’s annual open enrollment;* or (14) a change in legal custody 
(including the issuance of a Qualified the entry or modification by a court of competent jurisdiction 
of mMedical Child Ssupport Order) that affects the child’s eligibility for coverage under this Plan 
or the plan of the child’s other parent;requirements for the children of the Participant; (15) change 
in employment that does not otherwise affect eligibility for coverage under the Plan, after which 
status such that the Employee is no longer reasonably expected to average less than thirty (30) 
hours of service per week, yet does not lose eligibility under the Planif the 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;** (16) involuntary loss of other non-Plan coverage that is qualified as 
minimum essential coverage under the Patient Protection and Affordable Care Act; or (17) a 
“special enrollment” event under HIPAA; or (18) any other Change in Status authorized by the 
Board that does not violate Section 125 of the Code.  Involuntary loss of other non-Plan coverage 
does not include loss on account of the insured cancelling the plan or failing to pay the premiums. 
 
* This rule permits the Participant to revoke his or her Benefits Purchase Order for the 
Benefits Plan only, for the Participant and his or her Dependents, and must correspond with the 
intended enrollment of the Participant and his or her Dependents in a QHP effective beginning no 
later than the day immediately following the last day of the of the Benefits Plan coverage that is 
revoked. This rule does not apply to Health Care Spending Account or Limited Purpose Health 
Care Spending Account elections. 
 
**This rule permits the Covered Employee to revoke his or her Benefits Purchase Order 
for the Benefits Plan only, for the Participant and his or her Dependents, and does not apply to 
Health Care Spending Account or Limited Purpose Health Care Spending Account election. 
 
 
 
(c) 
A Participant shall advise the Plan Administrator within thirty (30) calendar 
days after any Change in Status unless a longer time period is required by state or federal law.  The 
Participant shall further advise the Plan Administrator of the relationship of such Change in Status 
to any requested change, suspension or reauthorization of his Benefits Purchase Order.  Requested 
changes to Benefits Purchase Orders must be consistent with the qualifying Change in Status in 
order to be approved.  The Plan Administrator shall approve or deny the change, suspension or 
reauthorization in his or her sole discretion, such discretion to be applied in a uniform and 
nondiscriminatory manner in accordance with such rules, regulations or procedures as it may 
adopt.  The Plan Administrator will make the change in the Participant’s Benefits Purchase Order 
effective as of the date which is commensurate with the applicable date of the Change in Status 
(i.e., date of the event).   
 
(d) 
An Employee who adds a Dependent to coverage must submit verification 
to the Plan Administrator of the Dependent’s eligibility subject to the foregoing.  Satisfactory 
verification must be submitted not later than forty-five (45) calendar days from the date of the 
Change in Status. Dependent will be added to coverage retroactively to the date of the Change in 
Status upon satisfactory verification submission and approval. Any request to extend this time 
limit due to exceptional circumstances (such as severe health condition causing incapacitation of 
Employee, acts of God or natural disaster) must be directed to the Plan Administrator, who shall 
approve or deny the request in his or her sole discretion, such discretion to be applied in a uniform 
and nondiscriminatory manner in accordance with such rules, regulations or procedures as it may 
adopt. Decisions of the Plan Administrator to grant or deny an extension are final.  An Employee 
shall not be permitted to re-add such Dependent to coverage until the Plan’s next Open Enrollment

10 
period or until there is a Change in Status that allows for the Dependent to be re-added to coverage 
and satisfactory verification of eligibility is submitted.   
 
(e) 
If the Plan Administrator, the Board of Trustees or the Board becomes 
aware of a Dependent ceasing to be a Dependent or otherwise not continuing to qualify for benefits 
under a Benefit Plan, regardless whether the Participant has given notice to the Plan Administrator 
within the 30-day period set forth above, benefits under the Plan for such Dependent shall cease, 
effective as of the last day of the month in which the Dependent ceased to be a Dependent or 
otherwise failed to continue to qualify for benefits under a Benefit Plan.  In addition, the Plan 
Administrator may seek redress pursuant to any and all available remedies afforded under the 
Patient Protection and Affordable Care Act and other applicable state and federal law.      
 
 
4.13 
Participant in Benefit Plans.  
 
With the exception of dual enrollment, which is prohibited, any Participant who has a 
Benefits Purchase Order in effect shall be entitled to purchase benefits provided under any of the 
Benefit Plans, in accordance with the terms thereof.  All Benefit Plans shall provide that benefits 
must irrevocably be elected and such election may only be changed or suspended as of the first 
day of the succeeding Plan Year, except for a significant cost or coverage change (described in 
Section 4.11) or a qualifying Change in Status (described in Section 4.12).  A Participant shall not 
be entitled to substitute a benefit under one Benefit Plan for a benefit under another Benefit Plan 
during a Plan Year following his irrevocable election.  In all cases, the selection of benefits under 
the Benefit Plans shall be limited to the extent necessary to maintain this Plan and the Benefit 
Plans as a “cafeteria plan” under section 125 of the Code and the regulations thereunder. 
 
 
4.14 
Benefits.  The benefits under the Plan shall be identical to those described in, and 
shall be paid pursuant to the terms of, the applicable overview of benefits document, commonly 
referred to as the “Summary Plan Description (SPD),” which describes the health benefits 
available to Participants and their enrolled eligible Dependents.  The provisions of the Summary 
Plan Descriptions, as amended from time to time, are incorporated herein by reference, and the 
rights and conditions with respect to the benefits payable under the Plan shall be determined from 
the applicable Summary Plan Description; provided, however, that in the event of an inconsistency 
between such Summary Plan Description and the Plan, the terms of the Plan will control.

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ARTICLE V 
 
BENEFITS PURCHASE ORDERS AND BENEFITS FUNDING ACCOUNTS 
 
 
5.1 
Benefits Purchase Order. 
 
(a) 
Subject to the limitations of paragraph (c) hereof, an Employee who is eligible to 
participate in this Plan may execute a Benefits Purchase Order authorizing the County to purchase 
benefits on behalf of himself and his eligible Dependents, and to reduce his Compensation by the 
dollar amount stated in such Benefits Purchase Order, if applicable, or to waive participation in 
this Plan.  The amount of Compensation to be reduced may be specified as a whole dollar amount 
or an amount equal to the cost of benefits purchased under the selected Benefit Plan.  A COBRA 
Beneficiary who is eligible to participate in this Plan may execute a Benefits Purchase Order 
authorizing the County to purchase benefits on behalf of himself and his eligible Dependents and 
to be directly billed for the costs of such benefits. 
   
(b) 
Upon executing a Benefits Purchase Order and providing any required Social 
Security Numbers or IRS-issued Tax Payer Identification Numbers, an Employee and his eligible 
Dependents, if applicable, shall become a Participant in this Plan as of the Benefits Effective Date.  
Employees shall be entitled to participate and purchase benefits under this Plan and any other 
Benefit Plans maintained by the County in accordance with the terms thereof, so long as the 
Employee is and continues to be a Participant hereunder. 
 
(c) 
The maximum reduction of Compensation an Employee may authorize in a 
Benefits Purchase Order(s) during any Plan Year shall not exceed the sum of the maximum 
limitations contained in the Benefit Plans maintained by the County.  In no event shall a 
Participant’s total reduction of Compensation under a Benefits Purchase Order(s) for any Plan 
Year exceed the Participant’s Compensation for that Plan Year. 
 
(d) 
Dual enrollment is prohibited.  Participants who have more than one source of 
eligibility for enrollment in the Benefit Plans (called “dual eligibility”) are limited to one 
enrollment. 
 
 
5.2 
Time of Benefits Purchase Order.  At the time an Employee is eligible to participate 
in the Plan, the Plan Administrator shall provide each Employee with a form of Benefits Purchase 
Order pursuant to which such Employee may authorize the County to reduce his Compensation by 
the amount specified by such Benefits Purchase Order, not to exceed the limitations specified in 
Section 5.1(c).  The Plan Administrator, in its sole discretion, from time to time, shall determine 
the form, content and means of communication and distribution of such Benefits Purchase Order.  
A Benefits Purchase Order must be filed by the Employee with the Plan Administrator within 
thirty (30) calendar days following his Benefits Eligible Date.  A Benefits Purchase Order shall be 
effective as of the Benefits Effective Date.   
 
 
5.3 
Payment for Benefits.  The benefits which are purchased and payable hereunder 
shall be paid by the Plan Administrator on behalf of the Participant directly to the insurance carrier, 
administrator or other authorized person under the applicable Benefit or Health Plans.

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5.4 
Failure to File Benefits Purchase Order.  If the Employee fails to file the Benefits 
Purchase Order with the Plan Administrator within thirty (30) calendar days following his Benefits 
Eligible Date, the Employee will be treated as not having elected to participate in this Plan and the 
Medical, Behavioral Health and Pharmacy Plans (as defined in such Benefit Plans).  Such 
Participant will be treated as having made an irrevocable waiver of coverage subject to change 
only as set forth in Sections 4.11 and 4.12. 
 
 
 
 
5.5 
Election Amendments Required by the Board.  Any provision of this Plan to the 
contrary notwithstanding, either prior to or during any Plan Year, the Board may require all or any 
class of Participants to amend the amount of any Benefits Purchase Order then in effect as to future 
reductions in salary if the Board, in its discretion, determines that such reduction is necessary or 
advisable in order to (i) satisfy the non-discrimination requirements applicable to the Plan under 
provision of the Code, including, without limitation, section 125 thereof; (ii) maintain the non-
taxable status of benefits payable under any Benefit Plan; or (iii) maintain the orderly and efficient 
operation of the Plan or the Trust.  The Board may divide Participants into two or more classes for 
purposes of administering this Section, provided that any such classification shall be non-
discriminatory.  Any change of a Participant’s Benefits Purchase Order made pursuant to this 
Section shall be made in accordance with such rules, regulations and procedures as the Board may, 
in their discretion, adopt from time to time. 
 
 
5.6 
Changes or Suspension of Benefits Purchase Order.  Except as provided in Sections 
4.11 or 4.12, a Participant may not change his Benefits Purchase Order during a Plan Year and 
such Benefits Purchase Order shall be effective for the entire Plan Year to which it relates.  A 
Participant may change or suspend his Benefits Purchase Order effective as of the first day of a 
succeeding Plan Year.  An instruction directing the Plan Administrator to change or suspend a 
Benefits Purchase Order shall be in writing or authorized by valid electronic signature.  Except as 
the Plan Administrator may otherwise provide by rule or regulation, a Participant’s direction to 
change or suspend a Participant’s Benefits Purchase Order shall be effective only if received by 
the Plan Administrator before the end of the Open Enrollment dates published by the Plan 
Administrator.  Any provision of this Plan to the contrary notwithstanding, the Plan Administrator 
may limit a Participant’s right to change a Benefits Purchase Order to the extent necessary to 
maintain this Plan as a “cafeteria plan” under section 125 of the Code and the regulations 
thereunder. 
 
 
5.7 
Reauthorization of Suspended Benefits Purchase Order.  Subject to such limitations 
as the Plan Administrator may adopt, a Participant who has suspended his Benefits Purchase Order 
pursuant to Section 4.7 must notify the Plan Administrator within thirty (30) calendar days of his 
return to work that he wants to reinstate benefits by completing a Benefits Purchase Order.  The 
Participant’s Benefits Purchase Order shall be reinstated to the same elections if the return to work 
is made in the same Plan Year or may deliver a new Benefits Purchase Order authorizing his 
Compensation to be reduced if his return to work occurs in a subsequent Plan Year.  A Benefits 
Purchase Order which reauthorizes salary reductions shall be effective as of the date the Participant 
returns to work.  If the Participant owes in arrears, such Participant agrees to have his 
Compensation reduced by the County in double the amount of the regular premium charges until 
the full amount of the arrearage is paid, provided the Participant’s Compensation in any bi-weekly 
pay period does not fall below statutory minimum wage.  Failure to notify the Plan Administrator 
within thirty (30) calendar days of return to work that the Participant wishes to reinstate benefits

13 
coverage elections shall make the Participant ineligible for coverage for the remainder of the Plan 
Year.   
 
 
5.8 
Effect of Cessation of Participation.  If a Participant’s benefits terminate under any 
Benefit Plan or a Participant’s eligibility for benefits otherwise ends (such as described under 
Section 4.8), and the Participant (and his affected Dependents) is eligible to continue to participate 
in the Plan for the period allowed under COBRA as identified in Section 4.10, the Participant must 
continue to make contributions to his Benefits Funding Account as provided herein.  Such 
contributions shall be equal in amount to the reduction in Compensation authorized by the 
Participant’s Benefits Purchase Order immediately prior to the Participant’s Severance Date or 
Benefits Termination Date and any amounts the County was contributing toward the insurance 
premium of other benefits provided under the Benefit Plans, plus any COBRA administrative costs 
allocated thereto.  These costs are subject to change if COBRA coverage continues into a new Plan 
Year.  These costs must be paid by the Participant on a monthly basis in advance of the month for 
continuation of coverage. 
 
 
 
5.9 
Approved Leave Without Pay.  Provided that an Employee makes contributions to 
his Benefits Funding Account in the same amounts as required by his Benefits Purchase Order, an 
Employee on Approved Leave that is in or comes in to Unpaid Status while on Approved Leave 
may continue participation in the Plan, subject to the following: 
 
(a) 
For an Employee on Approved Leave for any reason other than FMLA or 
military service leave, benefits may be continued for a total of 2 months in a rolling 12-month 
period.  After the completion of 2 months of Unpaid Status, the Employee must elect continuation 
of coverage under COBRA if he wishes to continue coverage in the Plan. 
 
(i) 
An Employee on Approved Leave under the FMLA (defined in Section 
7.5) shall have benefits continued in accordance with the provisions 
contained in the Family Medical Leave Act.  After the exhaustion of 
FMLA leave, the Employee must elect continuation of coverage under 
COBRA if he wishes to continue coverage in the Plan. 
 
(ii) 
An Employee on Approved Leave for military service may elect to 
continue benefits coverage under the Plan for up to 12 months in a 
rolling 12-month period while on military service leave.  After the 
exhaustion of 12 months of military service leave, the Employee must 
elect continuation of coverage under COBRA if he wishes to continue 
coverage in the Plan. 
 
5.10 
Health Savings Accounts.   
 
 
(a) 
A Participant who has elected to participate in the County’s high deductible 
health plan (“HDHP”) may elect to participate in a health savings account as described in section 
223 of the Code (“HSA”) by electing to pay the contributions on a pre-tax salary reduction basis 
to the Participant’s HSA established and maintained outside the Plan by a trustee/custodian to 
which the County can forward contributions to be deposited (this funding feature constitutes the 
HSA benefits offered under this Plan).  The minimum and maximum Compensation a Participant 
may elect to contribute to his HSA in accordance with this Plan during any Plan Year shall not

14 
exceed the amount set by the Board for the Plan Year or the permissible amounts under the Code.  
An election to make a contribution to an HSA shall be made by the Participant executing a Benefits 
Purchase Order.  In no event shall a Participant’s total reduction of Compensation under a Benefits 
Purchase Order for any Plan Year exceed the Participant’s Compensation for that Plan Year.  
Subject to any minimum and maximum contribution requirements set by the Board, the Benefits 
Purchase Order can be made, increased, decreased or revoked at any time on a prospective basis 
in accordance with the payroll cycle.  Such election changes shall be effective on the first day of 
the next payroll period following the date that the election change was filed with and received by 
the Plan Administrator so long as received by the payroll cut-off date.  No other elections under 
this Plan for other Benefit Plans can occur as a result of a change in an HSA election except as 
otherwise provided in this Plan.  
 
 
(b) 
A Participant who has elected to contribute to an HSA during a Plan Year 
may participate in the County’s Limited Scope Flexible Spending Account Plan (“LSFSA Plan”), 
but will only be eligible for reimbursement of benefits which constitute Limited Scope Covered 
Health Expenses (as defined in the LSFSA Plan) incurred by the Participant or his Dependents 
during the Plan Year, as more fully set forth in the LSFSA Plan. 
 
 
 
(c) 
The amount that a Participant can contribute to his or her HSA during the 
Participant’s taxable year may not exceed the maximum permitted under section 223 of the Code, 
including any catch-up contributions, as in effect from time to time.  
 
 
 
(d) 
To the extent the County makes any employer contributions to the HSAs 
maintained by its employees, such employer contributions shall be considered made through this 
Plan for purposes of any comparability or non-discrimination rules applicable to this Plan. 
 
 
 
(e) 
The HSA is not an employer-sponsored employee Benefit Plan; rather, the 
HSA is an individual savings account, trust or custodial account separately established and 
maintained by a trustee/custodian outside the Plan to be used primarily for reimbursement of 
“qualified eligible medical expenses” as set forth in section 223(d)(2) of the Code.  The HSA 
benefits under this Plan consist solely of the ability of the Participants to make contributions to 
their HSAs on a pre-tax salary reduction basis.  Consequently, the HSA trustee/custodian, not the 
County, will establish and maintain the HSA.  The HSA trustee/custodian will be selected by the 
insurance company maintaining the HDHP in which the Participant has elected to participate.  The 
selection of the HSA trustee/custodian by the insurance company maintaining the HDHP is not an 
endorsement by the County of any particular HSA provider.  The Plan Administrator will maintain 
records to monitor the amount of HSA contributions a Participant makes to his or her HSA 
pursuant to the Participant’s Benefits Purchase Order under this Plan, but the Plan Administrator 
will not create a separate fund or otherwise segregate assets for this purpose.  The County has no 
authority or control over the funds deposited in a HSA.  The terms and conditions of coverage and 
benefits (e.g., eligible medical expenses, claims procedures, etc.) will be provided by and are set 
forth in any applicable HSA documents, not this Plan.

15 
 ARTICLE VI 
 
MAINTENANCE OF BENEFITS FUNDING ACCOUNTS 
 
 
6.1 
Maintenance of Benefits Funding Accounts; Adjustments to Accounts. 
 
 
 
(a) 
The Plan Administrator shall maintain a Benefits Funding Account for each 
Participant who delivers a Benefits Purchase Order to the Plan Administrator in accordance with 
Article V hereof.  Such account shall be maintained in the Benefits Trust. 
 
 
 
(b) 
For each month or part thereof during which a Participant has a Benefits 
Purchase Order in effect, such Participant’s Benefits Funding Account shall reflect:  
 
(i) 
For Employees who are Participants: (a) the amount by which such 
Participant’s Compensation is reduced during such month, in 
accordance with his Benefits Purchase Order, plus (b) any credit(s) 
reflected in such Benefits Funding Account as of the close of the 
prior month. 
 
(ii) 
For COBRA Beneficiaries: (a) the amount paid by the Participant 
for such month, plus (b) any credit(s) reflected in such Benefits 
Funding Account as of the close of the prior month. 
 
 
 
(c) 
There shall be charged against a Participant’s Benefits Funding Account for 
each month (i) the value of any benefits purchased by the Participant and paid by the County under 
any Benefit Plan maintained by the County to or on behalf of a Participant and his  Dependents, 
plus (ii) any amounts chargeable to such account under paragraph (e) hereof, plus (iii) the value of 
any benefits that the County pays for and on behalf of a Participant for any benefits purchased 
under any Benefit Plan maintained by the County as required under this Plan. 
 
 
 
(d) 
No interest shall be credited to or accrue on any positive or negative balance 
of a Participant’s Benefits Funding Account. 
 
 
 
(e) 
The Plan Administrator is authorized to make such additional adjustments 
(charges or credits) to a Participant’s Benefits Funding Account as may be authorized under the 
terms of any Benefit Plan maintained by the County or as may be required to reflect the correct 
balance of such account. 
 
 
6.2 
Benefits Unfunded.  The credit balance of any Participant’s Benefits Funding 
Account at any time shall evidence only an unfunded obligation of the County to pay benefits 
provided under any Benefit Plan maintained by the County from time to time, in accordance with 
the terms of such Benefit Plans and subject to the limitations set forth in any such Benefit Plan and 
this Plan.  The County’s obligation to pay the benefits provided to any Participant, Dependent or 
other person under any Benefit Plan shall be an unsecured obligation of the County, and the County 
shall not be obligated to fund such benefits provided under any of the Benefit Plans through any 
trust, insurance contract or any other means.  The interest of any Participant or Dependent under a 
Benefit Plan or in any benefits provided through such Benefit Plans shall be only that of a general,

16 
unsecured creditor of the County, and no greater.  No Participant, Spouse or Dependent of a 
Participant (or any other person claiming through any such person) shall have any right or claim 
to any specific property of the County to satisfy any claim for benefits hereunder.  Notwithstanding 
the foregoing, the County may, in the County’s sole discretion, elect to transfer all or any portion 
of a Participant’s Benefits Funding Account to the Benefits Trust or other trust fund the County 
has created pursuant to Arizona Revised Statutes § 11-981.  Any amounts transferred to such trust 
shall be held under the provisions of the trust, but shall be subject to the payment of benefits under 
this Plan and the Benefit Plans maintained hereunder.  Any amounts transferred to such trust shall 
not be considered “funded” for purposes of the Code, this Plan or any Benefit Plan since the County 
can terminate such trust at any time and revert all funds held thereunder to the County, subject 
only to the payment of benefits by the County as required under this Plan and the Benefit Plans. 
 
 
6.3 
Adjustment to Accounts.   
 
 
 
(a) 
If for any reason, including, without limitation, a mathematical or 
administrative error, the aggregate charges against a Participant’s Benefits Funding Account at 
any time during a Plan Year exceed the total amount of Compensation the Participant has 
authorized the County to withhold for the Plan Year as specified in the Participant’s Benefits 
Purchase Order for such Plan Year or the total amount the Participant has agreed to pay to the 
County for such Plan Year, such excess charges shall constitute an indebtedness of the Participant 
to the County.  Such indebtedness shall be payable to the County upon demand, and each 
Employee, by becoming a Participant in this Plan, authorizes the County in its sole discretion to 
withhold the amount of such indebtedness from the Participant’s Compensation in such amounts 
and at such times as may be determined by the County, provided Participant’s Compensation is 
not reduced below statutory minimum wage. 
 
 
 
(b) 
If for any reason, including, without limitation, a mathematical or 
administrative error, the charges against a Participant’s Benefits Funding Account are incorrect, 
the Participant’s Benefits Funding Account shall be adjusted to the correct amount; provided, 
however, that if the account has been overcharged, the correction shall be made only if the 
Participant notifies the Plan Administrator within six months of the first date the first overcharge 
occurred.   
 
 
6.4 
Forfeiture of Unused Benefits Funding Accounts.  Following each Plan Year after 
the time for submitting claims for the Plan Year has expired as provided under the terms of a 
Benefit Plan, the Plan Administrator shall aggregate the total amount of credit in the Participants’ 
Benefits Funding Accounts and, after all proper adjustments have been made in such Plan Year as 
provided in Section 6.1, all such amounts shall be forfeited by the Participants and they shall have 
no grounds claiming thereto.  Forfeited amounts may include unclaimed premium refunds.  The 
forfeited amounts shall become the property of the Benefits Trust, so long as it exists, and the 
County may use such amounts for any purpose authorized by the Trust; otherwise such amounts 
shall revert to the County.   
 
 
6.5 
Annual Accounting.  Upon request by a Participant, but not more often than 
annually, the Plan Administrator may notify the Participant for whom a Benefits Funding Account 
is maintained under the Plan of (i) the amount credited to his Benefits Funding Account during the 
Plan Year, (ii) the total amounts charged to such Benefits Funding Account for the purchase of

17 
benefits during the Plan Year under each Benefit Plan, and (iii) any amount, if any, which is to be 
forfeited as provided in Section 6.4. The Plan Administrator shall charge the Participant its costs 
in providing such annual accounting in a reasonable amount to be determined by the Plan 
Administrator in its sole discretion. 
 
 
6.6 
Effect of Benefit Plans.  Any provision of this Plan to the contrary notwithstanding, 
amounts credited to a Participant’s Benefits Funding Account shall only be applied to purchase 
benefits provided under the Benefit Plans; the purchase of such benefits by the County, and the 
Participant’s eligibility to purchase such benefits, shall be governed entirely by the terms and 
conditions of each such Benefit Plans. 
 
 
6.7 
No Deferred Compensation.  In no event shall this Plan be administered so as to 
constitute a plan of deferred compensation. 
 
 
6.8 
Reimbursement.  The Plan Administrator is authorized to pursue claims for 
reimbursement for charges incurred by the Plan as a result of error, mistake, overpayment, 
misrepresentation, or third-party liability (such as provided under A.R.S. § 12-962).

18 
ARTICLE VII 
 
ADMINISTRATION OF THE PLAN 
 
 
7.1 
Administration.  The Plan shall be administered by the Board, the Board of Trustees 
and the Plan Administrator as provided in the Benefits Trust.  
 
 
7.2 
Suspension, Termination and Amendment.  The County shall have: 
 
 
 
(a) 
The sole power to suspend or partially terminate or completely discontinue 
the benefits provided under the terms of this Plan; and 
 
 
 
(b) 
The power to amend the Plan as specified in Section 8.1. 
 
 
7.3 
Controlling Effect of Benefit Plans.  Anything in this Article VII to the contrary 
notwithstanding, all disputes or questions regarding eligibility or participation in any Benefit Plan, 
the right to receive benefits pursuant thereunder and the amount of benefits paid or payable 
thereunder shall be determined by the Plan Administrator in accordance with each such Benefit 
Plan and the Benefits Trust in the manner set forth therein. 
 
 
7.4 
Adoption by Special Districts.  The Board may allow a special district performing 
governmental functions within the County, such as, without limitation, providing health services, 
housing, libraries, flood control, parks and sporting facilities, to adopt this Plan and one or more 
of the Benefit Plans to provide cafeteria plan and certain welfare benefits to the employees of the 
special district.  The special district shall adopt this Plan pursuant to the terms of an 
intergovernmental agreement (IGA) entered into between the County and the special district on 
such terms as may be approved by the Board.  In all events, the special district shall be a 
governmental employer so that this Plan and all of the Benefit Plans maintained hereunder shall 
each be a “governmental plan” as defined in Section 3(32) of the Employee Retirement Income 
Security Act of 1974, as amended.  By adopting this Plan and any one or more of the Benefit Plans, 
the special district delegates to the Board the authority to terminate this Plan and the Benefit Plans 
at any time and to make such amendments and take such action as the Board deems necessary, and 
further delegates to the Plan Administrator the power to take all actions required or permitted of 
the Plan Administrator under this Plan and the Benefit Plans.  The County, Board, Board of 
Trustees and Plan Administrator shall have no liability or responsibility to any special district or 
any of its employees for any action taken or not taken under this Plan and the Benefit Plans.  The 
employees of the County and each special district shall be treated as employed by a separate 
employer for all purposes under this Plan and the Benefit Plans and any transfer of employment 
of an employee among the County and the special districts adopting this Plan shall be deemed 
termination of employment by such employee with the former employer and a new hire by the 
other employer but such change shall not be considered a qualifying Change in Status.  At any 
time following the adoption of this Plan and any Benefit Plans, the special district may withdraw 
and terminate its adoption of this Plan and any such Benefit Plans.  Any action taken by a special 
district hereunder shall be evidenced by resolution of the governing board of such special district. 
 
 
7.5 
The Family and Medical Leave Act of 1993, as amended.  The Plan Administrator 
shall interpret this Plan and all Benefit Plans and Health Plans to be consistent with the provisions

19 
contained in the Family and Medical Leave Act (“FMLA”).  To the extent any provisions in the 
FMLA or any regulations issued thereunder are inconsistent with the provisions of this Plan or any 
Health Plan, the rules contained in the FMLA and the regulations issued thereunder shall control 
and the terms of this Plan and the Health Plans shall be interpreted consistent therewith.  Benefits 
coverage during any approved FMLA absence shall be addressed by a Board-approved policy.   
 
7.6 
Health Insurance Portability and Accountability Act of 1996.  Solely to the extent 
required by the Health Insurance Portability and Accountability Act of 1996 (hereinafter 
“HIPAA”), an Employee shall be a Participant under the Plan no later than such time as required 
under HIPAA, and the Plan shall be subject to the special enrollment, pre-existing condition 
limitations and nondiscrimination in health status provisions of HIPAA. This Section 7.6 shall be 
interpreted and applied to give an Employee only those rights as prescribed under HIPAA and the 
rulings and regulations issued thereunder. 
 
7.7 
Coordination with State Medicaid Programs.  The fact that a Participant is eligible 
for coverage by, or is covered by, a State Medicaid program shall not affect the Participant’s 
eligibility to participate in the Plan or to receive benefits.  The payment of benefits under the Plan 
with respect to any Participant shall be made in accordance with any assignment of rights made by 
or on behalf of the Participant of a beneficiary of the Participant as required by any State Medicaid 
program.  To the extent a payment has been made to or with respect to a Participant pursuant to a 
State Medicaid program and the amount so paid is for a medical expense that the Plan has a legal 
liability to pay, the Plan will pay such expense in accordance with any State law that provides that 
the State has acquired the right with respect to the Participant to receive payment for such expense. 
 
7.8 
Women’s Health and Cancer Rights Act.  Solely to the extent required under the 
law of the Women’s Health and Cancer Rights Act (hereinafter “WHCRA”), the Plan shall provide 
certain benefits related to benefits received in connection with a mastectomy.  In the case of a 
Participant who is receiving benefits under the Plan in connection with a mastectomy and who 
elects breast reconstruction, the coverage shall be provided in a manner determined in consultation 
with the attending physician and the patient for reconstruction of the breast on which the 
mastectomy was performed; surgery and reconstruction of the other breast to produce a 
symmetrical appearance; and prostheses and treatment of physical complications at all stages of 
the mastectomy, including lymphedemas.  Such reconstructive benefits are subject to annual plan 
deductibles and coinsurance provisions such as other medical and surgical benefits covered under 
the Plan.  This Section 7.8 shall be interpreted and applied to give a Participant only those rights 
as prescribed under WHCRA, and the rulings and regulations issued thereunder. 
 
7.9 
Newborns’ and Mothers’ Health Protection Act.  Solely to the extent required by 
the Newborns’ and Mothers’ Health Protection Act (hereinafter “NMHPA”), the Plan shall provide 
that coverage for childbirth may not be limited to a hospital stay of less than 48 hours for normal 
delivery, or less than 96 hours for cesarean section, or require the provider to obtain approval for 
shorter hospital stays.  The requirement shall not apply if the attending provider, in consultation 
with the mother, decides to discharge the mother or newborn earlier than the time prescribed by 
the NMHPA.  This Section 7.9 shall be interpreted and applied to give Participants only those 
rights as prescribed under the NMHPA, and the rulings and regulations issued thereunder.

20 
7.10 
Genetic Information Nondiscrimination Act of 2008.  Solely to the extent required, 
the Plan shall comply with the Genetic Information Nondiscrimination Act of 2008 (hereinafter 
“GINA”).  This Section 7.10 shall be interpreted and applied to give Participants only those rights 
as prescribed under GINA, and the rulings and regulations issued thereunder. 
 
7.11 
Children’s Health Insurance Program Reauthorization Act of 2009.  The Plan shall 
also comply with the Children’s Health Insurance Program Reauthorization Act of 2009 
(hereinafter “CHIP”).  This Section 7.11 shall be interpreted and applied to give Participants only 
those rights as prescribed under CHIP, and the rulings and regulations issued thereunder. 
 
7.12 
Patient Protection and Affordable Care Act and Health Care and Education 
Reconciliation Act.  Effective the first plan year on or after September 23, 2010, the Plan shall 
also comply with the applicable provisions of Patient Protection and Affordable Care Act 
(PPACA) as amended by the Health Care and Education Reconciliation Act (HCERA).  This 
Section 7.12 shall be interpreted and applied to give Participants only those rights as prescribed 
under PPACA as amended by HCERA, and the rulings and regulations issued thereunder. 
 
7.13 
Michelle’s Law. Solely to the extent required, effective the first plan year on or 
after October, 9, 2009, the Plan shall also comply with Michelle’s Law (P.L. 110-381).  This 
Section 7.13 shall be interpreted and applied to give Participants only those rights as prescribed 
under Michelle’s Law, and the rulings and regulations issued thereunder. 
 
7.14 
Uniformed Services Employment and Reemployment Rights Act.  Solely to the 
extent required by the Uniformed Services Employment and Reemployment Rights Act 
(hereinafter the “USERRA”), a Participant who is an Employee who enters military service shall 
have the right to continue coverage under the Plan for the period prescribed under USERRA or 
such greater time as may be authorized by the Board.  Continuation of coverage shall be 
conditioned upon payment of any required premiums.  This Section 7.14 shall be interpreted and 
applied to give an Employee only those rights as are prescribed under USERRA and rulings and 
regulations issued thereunder or any greater rights authorized by the Board.

21 
ARTICLE VIII 
 
GENERAL PROVISIONS 
 
 
8.1 
Amendments.  The County reserves the right to, from time to time, make any 
amendments to the Plan it determines to be necessary or desirable, with or without retroactive 
effect, to maintain the qualifications of the Plan under sections 105, 106 and 125 of the Code, and 
any regulations thereunder, or to ensure the successful administration and operation of the Plan.  
The County shall make all amendments in writing.  Each amendment shall state the date to which 
it is either retroactively or prospectively effective. 
 
 
8.2 
Right to Terminate.  The County reserves the right to terminate or partially 
terminate the Plan in its discretion in accordance with applicable laws. 
 
 
8.3 
No Guarantee of Employment.  Neither the Plan nor any provisions contained in 
the Plan shall be construed to be a contract between the County and an Employee, or to be a 
consideration for, or an inducement of, the employment of any Employee.  Nothing contained in 
the Plan shall grant any Employee the right to continued employment or shall limit in any way the 
right of the County to discharge or to terminate the service of any Employee at any time. 
 
 
8.4 
Payments to Minors and Incompetents.  If a Participant or Beneficiary entitled to 
receive any benefits hereunder is a minor or is determined by the Plan Administrator, in its sole 
discretion to be incompetent, or is adjudged by a court of competent jurisdiction to be legally 
incapable of giving valid receipt and discharge for benefits provided under this Plan, such benefits 
may be paid to the duly appointed guardian or conservator of such person, or may be paid to any 
third party who is eligible to receive any benefit under any of the Benefit Plans for the account of 
such Participant, or may be held in trust by the County for the benefit of such person until 
distribution can be made to a duly appointed guardian or conservator or is ordered to be made by 
a court of competent jurisdiction.  Such payment shall, to the extent made, discharge the Plan 
Administrator and the County of any liability for such payment under the Plan. 
 
 
8.5 
Right to Benefits.  No Participant, or person claiming through such Participant, 
shall have any right to, or interest in, any benefits provided under this Plan upon termination of his 
employment or otherwise, except as provided under this Plan and any other Benefit Plan or Health 
Plan through which benefits are claimed. 
 
 
8.6 
Nonalienation of Benefits.  The County has created this Plan to provide certain 
“cafeteria” benefits to eligible Employees and their Dependents, in accordance with the terms of 
the other Benefit Plans.  Except as provided in Section 6.4(a), no interest in or benefit payable 
under the Plan shall be subject in any manner to anticipation, alienation, sale, transfer, assignment, 
pledge, encumbrance or charge, except as the Plan Administrator may otherwise permit by rule or 
regulation; and any action by a Participant to anticipate, alienate, sell, transfer, assign, pledge, 
encumber or charge the same shall be void and of no effect, nor shall any interest in or benefit 
payable under the Plan be in any way subject to any legal or equitable process, including, but not 
limited to, garnishment, attachment, levy or seizure or to the lien of any person.  This provision 
shall be construed to provide each Participant, or other person claiming any interest or benefit in 
this Plan through a Participant with the maximum protection against alienation, encumbrance and

22 
any legal and equitable process, including, but not limited to, attachment, garnishment, levy, 
seizure or other lien, afforded his interest in the plan (and the benefits provided thereunder) by law 
and any applicable regulations. 
 
 
8.7 
Unknown Whereabouts.  It shall be the affirmative duty of each Participant to 
inform the Plan Administrator, and to keep on file with the Plan Administrator, his current mailing 
address.  If a Participant fails to inform the Plan Administrator of his current mailing address, 
neither the Plan Administrator, the Board of Trustees, the Board or the County shall be responsible 
for any late payment of or loss of benefits. 
 
 
8.8 
Construction.  The Plan shall be construed, enforced and administered according to 
the laws of the State of Arizona.  In case any provision of the Plan is held to be illegal or invalid 
for any reason, it shall not affect the remaining provisions of the Plan, but the Plan shall be 
construed and enforced as if such illegal or invalid provision had not been included therein.

23 
ARTICLE IX 
 
PRIVACY ACT AMENDMENT 
 
 
9.1 
Use and Disclosure of Protected Health Information. 
 
 
 
(a) 
The Plan will use protected health information (“PHI”) to the extent of and 
in accordance with the uses and disclosures permitted by the Privacy provisions of the Health 
Insurance Portability and Accountability Act of 1996, codified at 42 U.S.C. § 1320d et seq., and 
the Health Information Technology for Economic and Clinical Health Act, codified at 42 U.S.C. 
§ 17921, and any current and future regulations promulgated under either Act, including but not 
limited to 45 C.F.R. Parts 160 and 164 (collectively, “HIPAA”).  The term “PHI” shall include 
electronic protected health information (“ePHI”) and both PHI and ePHI shall have the same 
meanings given to the terms under HIPAA.  The Plan will use and disclose PHI for purposes 
related to health care treatment, payment for health care and health care operations and as 
otherwise permitted or required by law.  The provisions of this Article IX shall apply to all Benefit 
Plans maintained under this Plan to the extent such Benefit Plans are subject to the Privacy 
provisions contained in HIPAA. 
 
 
 
(b) 
The term “payment” includes activities undertaken by the Plan to obtain 
premiums or determine or fulfill its responsibility for coverage and provision of Plan benefits that 
relate to an individual to whom health care is provided.  These activities include, but are not limited 
to, the following: 
 
 
 
 
(i) 
determination of eligibility, coverage and cost sharing amounts (for 
example, cost of a benefit, Plan maximums and co-payments as determined for an individual’s 
claim); 
 
 
 
 
(ii) 
coordination of benefits; 
 
 
 
 
(iii) 
adjudication of health benefit claims (including appeals and other 
payment disputes); 
 
 
 
 
(iv) 
subrogation of health benefit claims; 
 
 
 
 
(v) 
establishing employee contributions; 
 
(vi) 
billing, collection activities and related health care data processing; 
 
 
 
 
(vii) 
claims management and related health care data processing, 
including auditing payments, investigating and resolving payment disputes and responding to 
participant inquiries about payments; 
 
 
 
 
(viii) obtaining payment under a contract for reinsurance (including stop-
loss and excess of loss insurance);

24 
 
 
 
(ix) 
medical necessity reviews or reviews of appropriateness of care or 
justification of charges; 
 
 
 
 
(x) 
utilization review, including precertification, preauthorization, 
concurrent review and retrospective review; 
 
 
 
 
(xi) 
disclosure to consumer reporting agencies related to the collection 
of premiums or reimbursement as required by law and limited to the following PHI: name and 
address, date of birth, Social Security number, payment history, account number and name and 
address of the provider and/or health Plan; and 
 
 
 
 
(xii) 
reimbursement to the Plan. 
 
 
 
(c) 
The term “health care operations” includes, but is not limited to, the 
following activities: 
 
 
 
 
(i) 
population-based activities relating to improving health or reducing 
health care costs, protocol development, case management and care coordination, disease 
management, contacting health care providers and patients with information about treatment 
alternatives and related functions; 
 
 
 
 
(ii) 
rating provider and Plan performance, including accreditation, 
certification, licensing or credentialing activities; 
 
 
 
 
(iii) 
underwriting, premium rating and other activities relating to the 
creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, 
securing or placing a contract for reinsurance of risk relating to health care claims (including stop-
loss insurance and excess of loss insurance); 
 
 
 
 
(iv) 
conducting or arranging for medical review, legal services and 
auditing functions, including fraud and abuse detection and compliance programs; 
 
 
 
 
(v) 
business planning and development, such as conducting cost-
management and planning-related analyses related to managing and operating the Plan, including 
formulary development and administration, development or improvement of payment methods or 
coverage policies; 
 
 
 
 
(vi) 
business management and general administrative activities of the 
Plan, including, but not limited to: 
 
 
 
 
 
(A) 
management activities relating to the implementation of and 
compliance with HIPAA’s administrative simplification requirements, or 
 
 
 
 
 
(B) 
customer service, including the provision of data analyses 
for policyholders or other customers; 
 
 
 
 
(vii) 
resolution of internal grievances; and

25 
 
 
 
 
(viii) due diligence in connection with the sale or transfer of assets to a 
potential successor in interest, if the potential successor in interest is a “covered entity” under 
HIPAA or, following completion of the sale or transfer, will become a covered entity. 
 
 
 
(d) 
The Plan will make PHI available to an individual in accordance with 
HIPAA’s access requirements, and the Plan will make PHI available for amendment and 
incorporate any amendments to PHI in accordance with HIPAA. 
 
 
9.2 
The Plan Will Use and Disclose PHI as Required by Law and as Permitted by 
Authorization of the Participant or Beneficiary.  In addition to the disclosures authorized in Section 
9.1, with a written authorization, the Plan will disclose PHI to the County’s other medical, 
disability and workers’ compensation plans for purposes related to administration of these plans, 
as well as to others as permitted by the authorization. 
 
 
9.3 
Disclosures to the County as Plan Sponsor.  The Plan will disclose or allow 
disclosure of PHI to the County as plan sponsor of the Plan (the “Plan Sponsor”), upon receipt of 
a certification by the Plan Sponsor that the Plan Sponsor agrees to: 
 
 
 
(a) 
not use or further disclose PHI other than as permitted or required by the 
Plan document or as required by law; 
 
 
 
(b) 
ensure that any agents, including a subcontractor, to whom the Plan Sponsor 
provides PHI received from the Plan agree to the same restrictions and conditions that apply to the 
Plan Sponsor with respect to such PHI; 
 
 
 
(c) 
not use or disclose PHI for employment-related actions and decisions unless 
authorized in writing by the affected Employee; 
 
 
 
(d) 
not use or disclose PHI in connection with any other benefit or employee 
benefit plan of the County unless authorized by the subject individual or otherwise permitted by 
law; 
 
 
 
(e) 
report to the Plan any PHI use or disclosure that is inconsistent with the uses 
or disclosures provided for of which it becomes aware; 
 
 
 
(f) 
make internal practices, books and records relating to the use and disclosure 
of PHI received from the Plan available to the Secretary of Health and Human Services for the 
purposes of determining the Plan’s compliance with HIPAA; and 
 
 
 
(g) 
if feasible, return or destroy all PHI received from the Plan that the Plan 
Sponsor still maintains in any form, and retain no copies of such PHI when no longer needed for 
the purpose for which disclosure was made (or if return or destruction is not feasible, limit further 
uses and disclosures to those purposes that make the return or destruction infeasible).

26 
 
9.4 
Adequate Separation Between the Plan and the Plan Sponsor Must Be Maintained.  
In accordance with HIPAA, only the following employees or classes of employees of the Plan 
Sponsor may be given access to PHI: 
 
 
 
(a) 
the Benefits Manager; and 
 
 
 
(b) 
staff of the Plan Sponsor designated by the Benefits Manager, who have a 
need to know the PHI for authorized purposes in connection with benefits administration. 
 
 
9.5 
Limitations of PHI Access and Disclosure.  The persons described in section 9.4 
may only have access to and use and disclose PHI for Plan administration functions, which include 
payment for health care and health care operations that the Plan Sponsor performs for the Plan. 
 
 
9.6 
Noncompliance Issues.  If the persons described in section 9.4 do not comply with 
this Plan document, the Plan Sponsor shall provide a mechanism for resolving issues of 
noncompliance, including disciplinary sanctions.

27 
ARTICLE X 
 
SECURITY ACT AMENDMENT 
 
10.1Security Standards. 
 
(a) 
The Plan shall: 
 
 
 
 
(i) 
Use appropriate safeguards, and comply with Subpart C of 45 C.F.R. 
Part 164 with respect to ePHI, to ensure the confidentiality, integrity, and availability of all PHI 
the Plan creates, receives, maintains or transmits; 
 
 
 
 
(ii) 
Protect against any reasonably anticipated threats or hazards to the 
security or integrity of such PHI; and 
 
 
 
 
(iii) 
Protect against any reasonably anticipated uses or disclosures of PHI 
that are not permitted or required under HIPAA.  
 
(b) 
In implementing the foregoing security standards, the Plan shall comply 
with the standards and implementation specifications and shall be entitled to use the flexibility 
approach set forth in 45 Code of Federal Regulations (“CFR”) Section 164.306. 
 
(c) 
The provisions of this Article X shall apply to all Benefit Plans maintained 
under this Plan to the extent such Benefit Plans are subject to the PHI security provisions contained 
in HIPAA. 
 
 
10.2 
Business Associate Agreements.  The Plan will enter into written agreements with 
its business associates in accordance with 45 C.F.R. §164.314, which shall include, at a minimum, 
assurances from the business associate that it will appropriately safeguard any ePHI that the 
business associate creates, receives, maintains or transmits on behalf of the Plan. 
 
 
10.3 
County Requirements.  As Plan Sponsor, the County must:  
 
 
 
(a) 
Reasonably and appropriately safeguard ePHI, created, received, 
maintained, or transmitted to or by the County on behalf of the Plan; 
 
 
 
(b) 
Implement administrative, physical and technical safeguards that 
reasonably and appropriately protect the confidentiality, integrity, and availability of ePHI that the 
County creates, receives, maintains, or transmits on behalf of the Plan; 
 
 
 
(c) 
Ensure that the adequate separation required by 45 CFR Section 
164.504(f)(2)(iii) and described in Section 9.4 is supported by reasonable and appropriate security 
measures; 
 
 
 
(d) 
Ensure that any agent, including a subcontractor, to whom the County 
provides ePHI agrees to implement reasonable and appropriate security measures to protect the 
information; and

28 
 
 
 
(e) 
Report to the Plan and the County’s HIPAA Privacy Officer any HIPAA 
security incident relating to the Plan of which the County becomes aware. 
 
 
 
 
 
 
 
 
DATED this ____ day of ______________, 
20182020. 
 
 
 
 
 
 
 
 
 
MARICOPA COUNTY, ARIZONA 
 
 
 
 
 
 
 
 
 
 
 
By 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chairman, Board of Supervisors 
 
ATTEST: 
 
 
 
____________________________________ 
Clerk of the Board 
 
APPROVED AS TO FORM: 
 
 
 
____________________________________ 
Deputy County Attorney