Summary Plan Description

Eligibility For Payments From Account

Eligibility of Retiree

You are eligible to use your account on the first day of the calendar month in which you satisfy the following requirements:

  • You have accrued $500 in your account; and
  • You become eligible for Retiree Coverage, or you commence COBRA Coverage following dollar bank eligibility in lieu of Retiree Coverage.

You must be both retired and eligible for Retiree Coverage to use your account.

Eligibility of Dependent

Your dependent becomes eligible for payment of eligible expenses from your account on the date you become eligible, or if later, on the date your dependent becomes a dependent. Your dependent is also eligible for payment of eligible expenses from your account following your death, provided you have $500 or more in your account at the time of your death and your dependent is otherwise eligible for medical benefits under Retiree Coverage or for post-retirement COBRA Coverage following dollar bank eligibility.

Payment of Benefits/Eligible Expenses

If you are eligible, you are entitled to use the balance in your account to pay a portion of your monthly contribution needed to maintain Retiree Coverage. You may also use your account to help purchase COBRA Coverage. No other expenses qualify as eligible expenses.

Forfeiture of Account and Termination of Participant or Retiree Eligibility

Your account is forfeited and eligibility (if established) terminates on the earliest of:

  • The last day of the plan year after you have no account activity for a period of 120 consecutive months regardless of the size of your account balance; or
  • The last day of the first plan year in which you have had no account activity for 12 months, if the account balance is less than $500; or
  • The date of termination of eligibility for Retiree Coverage; or
  • The date there is a zero balance in your account; or
  • Upon your death, unless you are survived by eligible dependents, in which case your account will be forfeited upon termination of eligibility of all dependents; or
  • The date of termination of the Retiree Health Reimbursement Accounts by the Trustees.

For purposes of this section, "account activity" means there have been no employer contributions to the account and no payments from the account. Although allocation of new employer contributions is not currently allowed, in the event the Trustees approve a future allocation, a determination of whether there has been account activity during a plan year will be made after allocation of employer contributions to accounts for the plan year.

Periods of qualified military service for which you retain reemployment rights under the Uniform Services Employment and Reemployment Rights Act are deemed to be activity in the account for purposes of determining whether there has been "account activity."

Termination of Dependent Eligibility

If a dependent has established eligibility before forfeiture of your account, then dependent eligibility terminates on the earliest of:

  • The date of termination of the participant's or retiree's eligibility, except by death; or
  • The day the dependent ceases to meet the definition of dependent; or
  • In the case of the participant's or retiree's death, the last day of the plan year that is 60 months after the last account activity, regardless of the size of the account balance; or
  • In the case of the participant's or retiree's death, the last day of the first plan year in which the participant or retiree has had no account activity for 12 months, if the account balance is less than $500; or
  • The date there is a zero balance remaining in the participant's or retiree's account; or
  • The date of termination of the Retiree Health Reimbursement Accounts by the Trustees.

Forfeiture

A participant's or retiree's account is forfeited upon termination of eligibility, unless termination is due to the death of the participant or retiree who is survived by eligible dependents in which case the participant's or retiree's account is forfeited upon termination of eligibility of all dependents.

Death

If you die, your eligible dependents may use your account balance for payment of eligible expenses until termination of dependent eligibility. The account will then be forfeited upon termination of eligibility of all dependents.