R-83-05 Amendment Section 125 Cafeteria Plan Code Section 105 Code Section 129 (DCSA) Extending The Grace Period For An Additional 2 1/2 MonthsAttes •
RESOLUTION —R
RESOLUTION APPROVING AMENDMENT TO
SECTION 125 CAFETERIA PLAN (FSA),
CODE SECTION 105 (HCSA), AND CODE SECTION 129 (DCSA)
EXTENDING THE GRACE PERIOD FOR AN ADDITIONAL 2 % MONTHS
WHEREAS, the Village of Lemont previously adopted a Flexible Spending Account Plan
( "Plan"), a Code Section 125 Cafeteria Plan, so that its eligible employees who elected to participate could
pay their share of certain qualified benefits identified in the Plan with pre -tax salary reductions; and
WHEREAS, the Village of Lemont previously adopted a Health Care Savings Account (HCSA),
a Code Section 105 health care reimbursement plan, and a Dependent Care Savings Account ( "DCSA "),
a Code Section 129 dependent care reimbursement plan by Resolution R- 03 -02, so that eligible employees
who elected to participate could receive tax free reimbursement for certain eligible expenses; and
WHEREAS, the Village of Lemont desires to amend the HCSA and the DCSA to reflect certain
changes in the applicable rules and regulations.
NOW, THEREFORE, BE IT RESOLVED that the attached Amendment and Summary of
Material Modifications, effective as of the dates set forth in the attached amendments is hereby approved;
BE IT FURTHER RESOLVED that the Village Administrator is hereby authorized and directed
to take any and all action as may be necessary to effectuate the attached Amendment and Summary of
Material Modifications.
PASSED AND APPROVED BY THE PRESIDENT AND BOARD OF TRUSTEES OF THE
VILLAGE OF LEMONT, COUNTIES OF COOK, WILL, AND DU PAGE, ILLINOIS, on this 12'"
day of December , 2005.
Debby Blatzer
Peter Coules
Clifford Miklos
Brian Reaves
Ronald Stapleton
Jeanette Virgilio
AYES NAYS PASSED ABSENT
v
v
U
V
v
ENE SMOLLEN, Village Clerk
CERTIFICATE OF RESOLUTION
The undersigned authorized individual, Officer, Board of Directors, or Committee of the
Employer named below, ( "Employer"), hereby adopts the following resolutions by unanimous
consent and directs that this Consent Resolution be entered in the minute books of the
Employer.
WHEREAS, the Employer previously adopted a Flexible Spending Account Plan
( "Plan "), a Code Section 125 Cafeteria Plan, so that its eligible employees who elected to
participate could pay their share of certain qualified benefits identified in the Plan with pre -tax
salary reductions; and
WHEREAS, the Employer previously adopted either a Health Care Savings Account
( "HCSA "), a Code Section 105 health care reimbursement plan, or a Dependent Care Savings
Account ( "DCSA "), a Code Section 129 dependent care reimbursement plan, so that its eligible
employees who elected to participate could receive tax -free reimbursement for certain eligible
expenses; and
WHEREAS, the Employer desires to amend the HCSA and the DCSA to reflect certain
changes in the applicable rules and regulations; and
NOW, THEREFORE, BE IT RESOLVED that the authorized individual, Officer, Board of
Directors, or Committee of the Employer hereby approves the attached Amendment and
Summary of Material Modifications, effective as of the dates set forth in the attached
amendments;
BE IT FURTHER RESOLVED that the authorized individual, Officers, Board of
Directors, or Committee of the Employer are authorized and directed to take any and all action
as may be necessary to effectuate the attached Amendment and Summary of Material
Modifications.
EMPLOYER (please print): Village of Lemont, 418 Main Street, Lemont IL 60439
By tze Date December 12, 2005
Gary C. lmes, Village Administrator
By Date
By Date
Amendment to Plan Document
Regarding the Grace Period
The Flexible Spending Account Plan (Plan) has adopted the concept of "Grace Period" as
described in Revenue Notice 2005 -42 commencing with the end of the current Plan Year. The
Grace Period for this Plan is the 2 -1/2 month period following the end of each Plan Year.
The Plan Year to which a Grace Period relates is called the "Prior Plan Year." During the Grace
Period, a Participant may incur eligible expenses to be paid from the respective accounts a
Participant had in the Prior Plan Year.
If the Participant is also participating in a Plan Year that overlaps with the Grace Period (the
"New Plan Year"), the ordering rules are:
• Pay Me Back (Reimbursement). Eligible expenses incurred during a Grace Period and
approved for reimbursement will be charged first against the Prior Plan Year's balance, and
then against any amounts available in the New Plan Year's account. Once paid, a claim is
considered final and no request for adjustments in either Plan Year's account will be
processed.
• Debit Card Transactions. Eligible health care expenses incurred during the Grace Period
and paid using the Health Care Card will be paid from the New Plan Year's account, not the
Prior Plan Year's account.
• Pay My Provider (Bill Pay). Eligible expenses incurred during a Grace Period and approved
for reimbursement will be charged first against the Prior Plan Year's balance, and then
against any amounts available in the New Plan Year's account. Once paid, a claim is
considered final and no request for adjustments in either Plan Year's account will be
processed.
Effect on Run -Out Period
The amount of time a Participant may submit a claim for reimbursement ( "Run -Out Period ")
shall be extended to the end of the fifth (5th) month following the end of the Prior Plan Year.
IN WITNESS WHEREOF, the Employer has adopted this Amendment to the Health Care FSA
and /or the Dependent Care FSA Plan (as applicable) on the date shown below.
Print Name of Employer: village of Lemont
By (Print Name):
Signature:
Title:
Date:
Gary C. Hol
Village Administrator
]2/12/05
Amendment to Summary Plan Description (SPD) /
Summary of Material Modifications
Regarding the Grace Period
Effective on the first day of the current Plan Year, your Employer's Flexible Spending Account
(FSA) plan(s) has been amended to allow amounts remaining in your Health Care FSA or
Dependent Care FSA (as applicable) at the end of a Plan Year to be used to reimburse eligible
expenses that are incurred during a 2 -1/2 month Grace Period that follows the end of each Plan
Year.
Example: If you are covered on the last day of the Plan Year, your coverage will automatically
be extended for an additional 2 -1/2 months. Any eligible expenses you incur during that 2 -1/2
month Grace Period are eligible to be reimbursed from your Prior Plan Year's account. If you
re- enroll for the next Plan Year, the expenses incurred during the 2 -1/2 month Grace Period are
also eligible to be paid from your New Plan Year's account.
If you are also participating in a New Plan Year, the following are the ordering rules:
• Pay Me Back (Reimbursement). Eligible expenses incurred during a Grace Period and
approved for reimbursement will be paid first against the Prior Plan Year's balance and then
against any amounts available in the New Plan Year's account. Claims will be paid in the
order in which they are processed, and will not be reprocessed to enable payment
from a different Plan Year's account.
• Debit Card Transactions. Eligible health care expenses incurred during the Grace Period
and paid using the Health Care Card will be paid from the New (or current) Plan Year's
account and not the Prior Plan Year's account. Card transactions will not be
reprocessed to enable payment from the Prior Plan Year's account.
• Pay My Provider (Bill Pay). Eligible expenses incurred during a Grace Period and
approved for reimbursement will be paid first against the Prior Plan Year's balance and then
against any amounts available in the New Plan Year's account. Claims will be paid in the
order in which they are processed, and will not be reprocessed to enable payment
from a different Plan Year's account.
To submit a claim for reimbursement, it must be received by the end of the fifth (5th) month
following the end of the Prior Plan Year.