§ 5.41.060. Procedures.

A.

Enrollment and Election Procedures. Eligible Employees may enroll, specify the amount of his Employee Contributions and designate the corresponding Annual Contribution Credits for a Plan Year only by completing the enrollment procedure in accordance with Section 5.41.030. Upon initial eligibility and during Annual Enrollment, the Plan Administrator will provide all Eligible Employees with information about permissible benefit elections under the Plan and procedures for enrollment and benefit elections.

B.

Dependent Care Accounts. The Plan Administrator shall establish a Dependent Care Account for each Covered Employee. Each Covered Employee's Dependent Care Account will be credited with Employee Contributions and/or Employer Contributions in accordance with Section 5.41.040, and will be debited by the amount of any Qualifying Dependent Care Expenses paid or incurred on behalf of the Covered Employee under the Plan for the Plan Year. The amount of Qualifying Dependent Care Expenses payable from the Plan at any time shall be limited pursuant to Section 5.41.050E of the Plan. Any unused balance in a Covered Employee's Dependent Care Account after the claims period described in Section 5.41.060C has expired for any Plan Year shall be forfeited.

C.

Claim Procedures. Any Covered Employee (or duly authorized representative) seeking Plan benefits shall assert a claim under the procedures of this Section regardless of the basis asserted for the claim or when the act or omission occurred on which the claim was based. The Plan Administrator or Claims Administrator will provide, upon request, forms required for filing a claim for Plan benefits and instructions on the information that must be submitted for the claim to be processed. The Plan Administrator shall determine the information that must be included in any claim submission. Such information may include, but is not limited to:

1.

itemized bills or receipts,

2.

the amount, date, and nature of the expense,

3.

the name, address, social security number or tax identification number and signature of the provider,

4.

the name of the person for whom the expense was incurred and the person's relationship to the Covered Employee,

5.

the amount, if any, that has been reimbursed or is reimbursable from any other source, and

6.

any other information required by the Plan Administrator. Claimants must complete and file the appropriate forms with the Claims Administrator by June 30th following the close of the Plan Year to which the claim relates.

D.

Claim Determination. The Plan Administrator or Claims Administrator shall determine all matters pertaining to claims for Plan benefits. If the Plan Administrator or Claims Administrator denies a Covered Employee's claim for benefits, the entity reviewing such claim shall notify the Covered Employee in writing of such denial within a reasonable period of time.

E.

Claim Review Procedures.

1.

Appeal Process. A Covered Employee may appeal an adverse benefit determination under the Plan to the Plan Administrator by filing an appeal to the Plan Administrator within 180 days of receiving notice of the adverse benefit determination. If the Plan Administrator upholds the adverse benefit determination on appeal, it shall provide written notification to the Covered Employee of such determination as soon as reasonably possible.

2.

Determination Final. The Plan Administrator's decision on appeal shall be final and binding on all persons.

(Ord. 2008-0014 § 20 (part), 2008.)