HomeMy WebLinkAboutAmendment Number 3 to The HRA Plan for 12-01AMENDMENT NUMBER THREE TO THE
HRA PLAN
FOR
CITY OF REXBURG
WITNESSETH:
WHEREAS, City of Rexburg has previously adopted a HRA Plan and;
WHEREAS, certain changes are now desirable;
NOW, THEREFORE, the City of Rexburg HRA Plan is hereby amended in the following particulars only;
and
FURTHER, the effective date of this amendment is January 1, 2012. App rvV / r
ARTICLE III BENEFITS is amended to read as follows:
SECTION 3.1 (c) ESTABLISHMENT OF PLAN
(c) The Employer shall make available to each Participant an Employer Contribution for the
reimbursement of Qualifying Medical Expenses. A wellness exam (physical) each Plan
Year by the Participant and spouse (if applicable) is required. A physical is not required
for children. If the Participant has two deductibles, but no spouse, only the Participant is
required to receive the physical in order to receive the HRA contribution. The physicals
must be completed in the previous HRA Plan Year to receive the HRA contribution in the
current year.
The Employer shall contribute an amount as set forth by motion or resolution of the City
Council.
These contribution amounts will be pro -rated based on the Participant's entry date or
termination of participation in the Plan. However, if a Participant incurs expenses more
than the pro -rated amount during the period of participation, the full expense will be
reimbursed up to the maximum amount available for a full Coverage Period.
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IN WITNESS WHEREOF, this Amendment THREE has been executed this day of
City of Rexburg �(
BY ,-z_ r2G l
Title: 114i&L
CERTIFICATE OF CORPORATE RESOLUTION
The undersigned Principal of City of Rexburg (the Corporation) hereby certifies that the
follo ing resolutions were duly adopted by the board of directors of the Corporation on
W% to Z C I and that such resolutions have not been modified or rescinded as of the date
hereof:
RESOLVED, that Amendment Number THREE to the Health Reimbursement Account
Plan (HRA) effective January 1, 2012, presented to this meeting is hereby approved and adopted and that
the proper officers of the Corporation are hereby authorized and directed to execute and deliver to the
Administrator of the Plan one or more counterparts of the amendment.
RESOLVED, that the proper officers of the Corporation shall act as soon as possible to
notify the employees of the Corporation of the adoption of this Amendment Number THREE to the HRA
Plan by delivering to each employee a copy of the summary description of the changes to the Plan in the
form of the Summary Plan Description and/or Material Modification presented to this meeting, which
form is hereby approved.
The undersigned further certifies that attached hereto as Exhibits A and B respectively,
are true copies of Amendment Number THREE to City of Rexburg HRA Plan and Summary Plan
Description - Material Modifications approved and adopted in the foregoing resolutions.
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