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AFLAC Agreement
11/15r'2621 14:42 5416644225 CENTRAL FDIFIT HR PAGE 02/20 contract Ieemuwauon Ices Rsq I t REIMBURSEMENT SERVICES AGREEMENT . This Agreement, effective upon execution Fnr the Plan Year as set forth herein, by and between CITY OF CENTRAL POINT (the "Employer') antl American Family Life Assurance Company ("Aflac'") WITNESSETH; WHEREAS, the Employer has adopted a Medical Care Expense Reimbursement ("URM") Plan arid/or a Dependent Care Expense Reimbursement ("DOC") Plan for its Employees in conjunction with its Flexible Benefits Plan (collectively referred to as She "Plan" antl attached hereto) to be adoptatl and administered in accordance with Sections 105, 125, and 129 of the Internal Revenue Code of 1966, as amended (tho "Code"), and WHEREAS, the Employer will serve es the Plan Administrator; and 1AIHEREAS, the F_mplvycr desires that Aflac, as its agent, furnish reimbursement services within a framework of policies, interpretations, rules, practices and procedures (the "relmbursement practices and procedures") matle and established by the Employer in: (i) receiving and processing requests for benefits under the Plan ("Requests") and (ii) disbursing benefit payments from Employer funds (as provided for in Section ILA. end Appendix D) for eligible expenses under the flexible spending account provisions of the Plen; (il Self-Pay Processlno Optien is selected in Appendix D, Aflac shall convey its initial benefit determinations to Employer so the Employer can disburse reimbursement payments for eligible expenses under the Flexible Spending Agreement provisions of the PIan1; and WHEREAS, the Employer Is to pay all plan benefits owed yr established under the Plan to its Participants, and Aflac is to provide the agreed upon services to the Plan without assuming any such liability;. NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, It is hereby agreed as follows: Section I. Enrollment antl Determination of Eligiblllty A. The Employer shall (1) he responsible for interpreting the Plan end its provisions, its teens, conditions and operation; and (2) notify Plan Partloipants of their ability to apply {or relmbursement benefits and supply them mhth Request forms (to be provided by Aflac) and Request filing instructions; and t3} provide Aflac with the names, addresses, Social Security Numbors, and electetl amounts of all Partidpants in the Plan (for annual enrollment, provide such information at least twenty (20) days prior fo the effective date of Plan parkicipatlon, unless the Plan participation .effective date falls within the month of January and then at least thirty (30) days prior to such effeotive data); and (4) upon the occurrence of events that would change a Participant's status under the Plan (e. g, termination, Change in Status, Change in Cost or Coverage for DDC, etc.) immediately provide Aflac with updates (via telefax or other means of written communication acceptable to Aflac) which identify eligible participants in each of the respective relmbursement Plans andlor the amount of relmbursement benefits for which they are eligible; and (5) immediately intone Aflac (via telefax or other means of written communication acceptable to Aflac) as to any new Pahicipants in either of the reimbursement Plans, any Change in Status affecting a Participant's olection, or any Qualified Beneficiary electing coverage under COBRA and the amount of such election (if COBRA applies to the Employer), or of any other change which will affoct Aflac's responsibflltles hereunder, B. In determining any person's right to benefits under the Plan, Apac shall rely on the eligibility information furnished by the Employer, and any signed statements by Pardclpants r©garding the eligibility of (heir Requests under the respective Plan. ft is mutually ~-uuierstootl that the effective performance of this Agreement by Aflac will require that It be advised on a timely basis by the Employer during tho continuance of this Agreement of the identity of individuals oligible for benefits antler each of the respective reimbursement Plans. Informatlvn regarding a Participant's enrollment under either reimbursement Plan shall Identify the effective date 'of enrollment and shall be provided to Aflac (via telefax or other means of written communication acceptable to Aflac) in accordance with the applicable timeframes set forth in Sections LA.(3) through LA.(5) above. Any delay shall restdt in a corresponding delay in Flflads ability to make benelii determinations, Aflac shall not be responsible for delays in paying Requests where the Employer has failed to Inform Afav (in a form and with such information as may reasonably ba required by Aflacl of a Participant's enrollment infvrmaton in a timely mannor. Similarly, information modifying a Participant's eligibility or status/election under either reimbursement Plan shall identify the effective date of ell^ibility and the termination dale of eligibility and shall be provided to Aflac (via telefax or other means of vnitien communication acceptable to Aflac) prior to the effective dale of such modification in order to be considered by Aflac in making benefit determinations hereunder. Aflac shall not be responsible for Requests pall in error where the Employer has failed to inform Aflac (in a form and with such information as may reasonably be required ny Aflac) of a Participenfs eligibility or status change prior to the release of the benefit payment. RSA•GPD 11319101664ABCD 11/15!2821 14:42 5416644225 CENTRALPDINT HR PAGE 03/20 Section 11. ~undinca and Payment of Reauests for the Plan Benefits A. F_mployer must choose and agree to one of fhe funding methods described In the Funding Option Schedule (attached hereto as Appendix D), which shall he part of and incorporated into this Agreement. Employer, subject to Aflac's consent, may subsequently request to switch to another funding method by submitting e properly completed Funding Option Change Perm. The effective date of such change shall be determined by Aflac. Employer shall be required to fulfill any remaining obligations pursuant to the funding option the: was in place prior to the change. Notwithstanding paragraph (5) in Section VII of this Agreemr='•nt, once the change has been approv^d by Aflac and implemented by the parties, the Funding Option Change Form shall be deemed to de incorporated into this Agreement by reference, and the new funding opti^n shall replace the prior funding option in effect under this Agreement. All indemnification and liability provisions of any funding option chosen by the Employer shall continuo to bo in full force and effect after such funding option has been changed, and shall suivlve terminatior~ of this Agreement An execufed Funding Ootlon Change Form shall be valid and in force only It the Contract Identlflcatlon I<ey on the Funding Option Change Form matches the Contract Identification Key on this Agreement. B. Aflac, as aaent `or the Employer, shall provide those services described In Appendix A (attached hereto). Upon written request submitted to Aflac's Benefit ServiceslFlex One Department, Aflac may provide limited assistance with certain of the nondiscrimination tests, The terms and Conditions {including applicable fees) under which such services are provided are se: forth in Appendix B "Nondiscrimination Testing Services". In providing services, Aflac shall assume that FRISA and C09RA apply tc the Employer's Plan unless the Employer gives Aflac written direction otherwise. C. Aflac shall not be obligated or responsible for any duty with regard to the administration of the Plan (imposed by the Plan or othervvise) except~as specifically provided above or in the attached appendices. iNithout limiting Employers responsibilities described therein, d shall ho the Employer's sole responsibility (as Plan Adminlstratorj and duty to: ensure compllenee with COBRA; perform required nondiscrimination testing, emend the Plan as necessary to ensure ongoing compliance with .applicable IaN{ file any required tax or governmental rehirns (including Fnrm 5500 returns to meet ERISA requirements) relating to the Plan; determine If end when a valid election change has cccurred; handle Participant claim appeals; allow ,Aflac, by and through independent associates, a reasonable opportunity to discuss Aflac, URM, and DDC benefRs; execute and retain required Plan and claims d^cumentationl and take all other steps necessary to maintain and operate the Plan in +compliance with applicable provisions of the Plan, ERISF~ fhe Code and other applicable federal and state laws. D. In the event the<, A`lac overpays any person entitled t^ benefits under the Plan or pays benefits to any person who is not entitled to them, Aflac shall fake all reasonable steps to recover the overpayment, except that Aflac shall not be required to Initiate court proceedlncs to recover an overpayment. Aflac shall promptly notify the Employer if it is unsuccessful in recovering any overpaymer.±. E, Aflac will optically scan and maintain electronic copies of all URV: Plan and/or DDC Plan reimbursement Requests and supporting documentation for a period of seven (7) years aRer the claim is processed. Copies of URM and DDC claim documents can be reproduc?d upon wrlffen.request at Aflac's currently prevailing rate. Section III. I_iabihtV and Indemnity A, In pertormin5 its obligations under this Agreement, Aflac neither assumes nor undervvrltes any liability of the Employer under the ?Ian, but with respect to the Employer, acts only as provider of those services specifically described in Section ILB. of .this Agreement and wish respect to Plan Participants, acts only as the agent of the Employer. The services to 6e performed ~Uy Aflac shall be ministerial In nature and shall be performed within fhe framework of policies, 'interpretations, rules, 'practices, and procedures made or established by the Employer, Aflac shall have no discretionary authority or discretionary control over any assets of the Employer, the Plan, or Plan Participants. f3. Aflar, shall have no duty or obligation to detend any legal action or proceeding brought io recover a Request for Plan benefits. Aflac shall, however, make available to the Employer and ds counsel, such avid once relevant to such action or proceadina as Aflac rrtay have as a result of its processing of the contested benefit determination. G Ercept as olhenaise explicitly provided in this Agreement, the Employer shall retain the liability for all Plan benefit Requests and all expenses Incident to the Plan and for any end all violations of the Consolidated Omnibus Budget Reconciliation AM of 1g85 ("C06RA"), if applicable, and agrees to indemnify Aflac for and hold ii, its directors, officers, and employees, harmless from all amounts and expenses (including reasonable attorneys' fees and court costsl for which Aflac may become liable, This indemnity shat: suroivo the termination of this Agreement. D. Aflac shall use ordinary and reasonable care in the performance of its duties, but shall not be liable to the Employer for mistakes of judo moot ^r other actions taken in good faith unless such error results directly from an intentionally wrongful or grossly negligent act of Aflac, its bftioers or employees. E, Aflac shall have no duty or obligation with respect to Requests Incurred prior to the Effective Date of this Agreement or pertaining to a plan Year prior to the Initial Plan Yeer (hereafter "Prior Reimbursement Requests") and/or Plen Administrator (or other) services arising prior to the Effective Date of this Agreement ^r pertaining to a plan year prior to the Initial Plan 11319_101665ABCD RSA-GPD 11/15/2021 14:42 541664422E CENTRAL F'DINT HR PAGE 04/20 Cnntrat'f Irlpnlirir_afinn Key PSAT1 Year (hereafter "Prior Administrati^n"). 7ho Employer specifically aoknowletlge(s) and agree(s) that: (i) Aflac has no respgnsibility or obligation with respect to Prior Reimbursement Requests and/or Prior Adminlstration; (ii) the Employer will be responsible for processing Prior Reimbursement Requests (including any Run-Off Requests yr grace period Requests submitted after the Effective Date of this Agreement) and maintaining legally required records of all Prior Reimbursement Requests and Prior Atlministratlon sufficient to comply with applicable legal (e. g., IRS substantlativn) requirements and (Ili) the Employer agrees to indemnity and hold Aflac harmless for any liability relating to Prior Reimbursement Requests and/or Prior Atlmir.lstration. Except as otherwise provided in the IiIPAA Business Associate Agreement (Exhibit A), the Employer agrees that Aflac may communicate confidential, orotecletl, privileged or otherwise sensitive Information to Employer through the Named Contact (as designated on the applicable plan document request form or as subsequently updated by the Employer and maintained on file by Aflac) and specifically agrees to indemnify Aflac and hold it harmless, (i) for any such communications directed to the Employer through the Named Conlect attempted via telefax, mail, telephone, e-mail or any other media, acknowledging the possibility that such communications may be inadvertently misrouted or intercepted, and (ii) from any. claim for the improper use or disclosure of any health information by Aflac where such information is used or disclosed In a manner consistent with its duties and responsibilities under this Agreement, Section IV. Reimbursement Request. Processing$ervice Fee A. The Employer shall pay Aflac a fee for services performed under this Agreement (the "Service Fee") anda one time fee to initiate the reimbursement arrangement under the URN and/or DDC (the "Set-Up Fee"). Service fees are based on a marnber of Factors and are set forth on the Fee Schedule, attached hereto as Appendix C,. which shall be part of and incorporated into this Agryement, The Set-Up Fee is set forth In Appendix C. The Service Fee amount shall be due by the tenth (10th) of each month (or portion thereof) for which this Agreement is in effect. The Service Fee and Set-Up Fee are in addition to and separate from the Employer's obligation to make available sufficient funds to satisfy its obligations under the Plan and to make benefit disbursement in accordance with Seetlon ILA. above and Appendix D. The Employer is responsible for paying the Service Fee to Aflaa Except as othenvlse agreed to by the parties, ARac is not authorized to withdraw the Service Fee from the Account. Failure to pay any applicable monthly Service Fee by the next monthly Request processing cycle shall result In a cessation of Request processing services until such fees are received by Atlee. If Request processing services are pcndad for an entire monthly processing cycle, Aflac may terminate this Agreament in accordance with Section VI. B. Aflac may revise the Service Fee For services performed under this Agreement effective on each Anniversary Date (as defined in Section V) of this Agreement by giving the Employer written notice of the revised rate at Iyast thirty (30) days prior to the applicable Anniversary Dale. C. NoN/ithstanding any other agreement behveen the parties (and/or their agents), Rflac may revise the Service Fee set forth above at any time if revision is deemed necessary py Aflac by reason oF. (i) modification or amendment of the Plan by the Employer; or !;il) a slgnifi^_ant suspension, limitation, modification or revocation of the beneFlls made available to Participants under the reimbursement Plan or the Flexibly Benefit Plan Aflac shall advise the Employer vi the revised Service Fae at least thirty (30) days prior to its Implementation. If the Employer does not terminate this Agreement (by written notification pursuant to Section `11.A.(3)) within thirty (30) days after the receipt of a notice of such revision, the Employer shall be deemed to have agreed to such revision far the remainder of the Tarm of the Agreement. Thereafter, the Service Fee on and after the implementation date shall he made on the balls of such revised Service Fee. D. Aflac may revise the Service Fee set forth above at any time if any change in law or regulations imposes on Aflac greater duties or obliaslions than contemplated by the Agreement in forty ai the time of such change. Section V. Term of Agreement The initial term of this Agreement shall commence on the later of the (i) Effective Dale or (il) the first day of the Initial Plen Year and shall end on the last day of the Initial Plan Year (the "Initial Tenri'); thereafter, this Agreement will automatically renew for successive periods of tveelve (12) months (each, a "Terre" from the ilrst day of the Initial Plan Year (the "Anniversary Date") unless, at least thirty (30) days prior to the end of the than current Term (the "Renewal Date"j, the Employer or Aflac gives written notice t^ the other of its Intention not to renew the Agreement. In the event of a short PIanYear (other than the first Indial Plan Year) this Agreemen! shall automatically renew fw an additional hvelve (12) months unless the Employer yr Aflac gives written notice to the other of its intention not to renew the Agreement within thirty (30) days after the Employer notifies Aflac of the short Plan Year, Section VI. Termination of Agreement A. This Agreement shall terminate upon 4he earliest of the following dates. (i) The end of a Term (Including the Initial Term) of the Agreement following the delivery of written notloe of terrninaiion pursuant to Section V. - RSA - GPD 11319 101666A8CD 11/15/2021 14:4^_ 541E644225 CELITRAL POINT HR PAGE 05/20 wooed wa nmceuun nay: ttJH I'1 (2) At the option of Aflac, the date upon which the Employer fails to transfer sufficient, funds to A9ac (upon request by A'lacl; (i1 to pay all valid Requests pending under iho Plan as provided in Section ILA. and Appendix D; or (ii) to pay the Service Feo (as provided In See:ion iV.A. and.Appendix C). Ailae shall promptly communicate its election of this option t^ the ~In ployCr. (3) Upon the implementation date for a proposed Sen'ice Fee increase deemed to be unacceptable by the Employer (after delivery of written notice of termination by the Employer) pursuant to Section IV.C. (4) At the option of Aflaq upon slgnlfieant suspension, Ilmltation, modification or revocation of the benafts made available to Pa,licif%anis under '.he reimbursement Plan or the Flexible Benefit P)an (as de: ermined by Aflac in itssole discretion), Aflaa shell Immediately communicate Its election of this option to the Employer. (5) Any other date mu',ually aereeeble to the Employer and Aflac. 3. Upon fermination ct this Agreement, Aflac shall cease the processing of all Requests than in its possession, return any ~.mdistributed funds to the 'Gmployar, antl make all records relating to Requests in process Feasonably available to the Employe:. If the termination occurs pursuant to VI,A(1,) (above), Aflac shall process all Rue-08 Requests provided any Service Foe(s) is current Thereafter, the Employer and/or Flan Atlministrator shall be responsl6le for all aspects of reimbursement Request orocessing and Plan adminlsiratieo, 5eclion VII. Wliscellaneous (5) Notices, qny notice required to be given hereunder to Aflac shall ba sufficient if in writing and delivered personally, or by telcfa>: to a number specified by Aflac upon the Employers request, or by prepaid first class mail to Aflac Benefit ServicesrPlex Ona, Attn-. Service Contracts, 1932 VVynnfon Road, Columbus, GA 31999-9950, or If to the Employer, at the address of the Employer denoted on the signature page attached hereto, or as subseyucntly updated by Employer and maintained on file Cy Aflac. (2) Anollcable I_aw. This Agreement shall be governed by, and shalt be construed in accordance with the laws of the State of Nebraska, to the eXent they are not preempted by ERISA, the Codo, or env other federal law. (3) .Legal and Tas Sta'us. The Employer acknowledges that neither Aflac nor Its agents is providing legal or tax advice, and that neither Aflac nor its agpr.ts serves as the Plan Administrator or a fiduciary under the Plan. The Employer shall ha the sole party responsible 'or determining the legal and tar. status of the Plan under applicable law. Aflac shall have no power or authority to v/a iva after, breach, or modify any terms or conditions of the Plan. (4) Assign mint. Tl;is Agreement may no asslgnetl by Aflac to any other party, including any successor to the business o(AflaC by merger, consolidafion, purchase of assets, or otherwise, without ffie prior consent of the Employer. This Agreement shall be binding upon any corporation into which the Employer may be merged or vdith which it may be consolidated, or any corporation succeeding to all or substantially atl of the business of the Employer, (G) Entire Contr~f. This Agreement consiitutas the entire oontract between the parties and no modification or amendment hereto shall ba valid unless in writing and signed by an officer of the Employer and an Officer or duly authorized represeniativo of Aflac, (,) Tax P,eooding and \Nlthholtlinas. The Employer has ultimate control aver the payment of Plan benafts and shall be the sole party responsible for income and employment tax reporting and withholding obligations imposed as a result of the inoludabilhy of such payments in the gross income of recipients. Aflac Is a mere agent of the Employer for the processing of benefit Pequests, (7) Confldenlial Information Tha term "Confldentiel Information" as used in this Agreement means contidentlal or proprietary information a any party that is not generally known to the public, including, but not limited to compilations, lists of actual or potential customers or suppliers, hardvdare systems, software, or other documentation of any type, whether In printed or machine readahlb form, computer databases, forms and form letters, conG'acts, information regarding specific transactions, and marketing and business plans. For the purposes of this subsection, Confidential Information shall not include the personally Identifiable Information relating to any of Employer's employees, The te;,m "Trade Secrets" as used in this Agreement shall mean Confidential Information that: (1) derives economic value, actual or potential, Pram pat being aenerally known to, and not being readily escertalnabla by proper means by, other persons 'a:he can oh`.,aln economic value from its disclosure or use; and (2j is the subject of efforts that are reasonable under the circumstances to maintain its secrecy. The terms "Confidential Information" and "Tratle Secrets" do not Include infonmaticn that (o) is known to the receiving party prior to its disclosure by the disclosing party, evidenced by the receiving party's v+ri8en records, (b) is developed by the receiving party independently of env of the Confidential Information or Trede Secrets rer.eived In confidence from disclosing party, evidenced by the receiving party's written records; (c) is rightfully recei•ded by the receiving party from a thirtl party without restriction and without breach of any obligation of confitlentlallty ruhning to the disclosing party. 4 RSA-GPD 11319101661ABCD 11/15/'L021 14:42 5016644225 CEhITRAL POIFIT HR PAGE 06/20 Contract Identlflcabon KeV: NeATI Each party agrees that it shall not disclose to others or use for any purpose other than performance of the Agreement any of the ocher party's Confidential Information or Trade Secrets any time tluring or after the term of this Agreement. Each party further agrees that it will disclose Confidential Information or Trade Secrets to its employees only as necessary for the performance of the Adreement, and only to employees with a need to Im ow. Each party to this Agreement agrees that all Confidential Information and Trade Secrets are the property of the party disclosing it, and each agrees to promptly return to the disclosinp patty, upon demand, any Gonfidentiai Information or Trade Secrets furnished under this Agreement which is either received in or reduced to material form, and all copies thereof. The Employer agrees that Aflac may make lawtul references to Employer in its madceting activities. (8) Individual Information. Each party acknowledges that performance of Lhe Agreement may involve the use and disclosure of personal information relating [o the Employer's employees (including but not limited to names, addresses, benefit elections, claims and health information). Ailac agrees that it will not use any such Information disclosed to It by Employer except as authorized by the individual to whom the information relates or as otherwise pennitteU by applicable state or federal law or regulation. Employer agreesthat i1 vein not use any such Information disclosed to It by Aflac except for the purpose for which it received the inPormation and will not further disclose such information without the written authorization of the Individual to whom the information relates. This provision is not intended to create any third party beneficiary rights (in favor of Employer's employees or any other party). (g) Caoltallzed Terms shall have the same meaning as In the Plan documents unless otherwise defnetl herein IN WITNESS INMEREOF, the padies hereto have caused this Agreement to be executed and signed by an Officer of the Employer and an Officer or duly authorized U+orldwide Headquarters Employee of Ajl~agto do so, eff five a of the ~ day ("F_ffective pate') for the Flan Year beginning the ~`'"_ day of ~~ , (tha'Inltlal Plan Year"). oated atAt3ac this, 21 day of November 201 1 ~ ~~ Jason A. Goodro? ~' Second Vice President Aflac Benefit Services/Flex One f ~ ~~ } ( ~w Dated at +~~.~^-"~'S~%~"^ ~ ! ~ er r~a-~' this ~~iday of ~CL,IC~'aor+~'~,~.,f`^ ~~! Street Adtlress. Q ~/ 6~ .~, 6 •„~°;h I s RSA-GPD 11319101668ABCD 11/15/2921 14:42 5416644225 CEhlTRAL PUIhlT HR PAGE 08/20 Contract Identification Key: RSA71 Appendix A Schedule of Services to Be Provided By Aflac In accordance with attached Reimbursement Services Agreement Aflac shall provide the following services for the Employer General Plan Services: provide the Employer with a sample cafeteria plan document, Induding a medical care expense reimbursement ("URM") Plan and a dependent care expense reimbursement ("DDC"j Plan to be reviewed by the F_mployer and its legal counsel; and - provide the Employer with a sample flexible benefits summary plan description for distribution to each Plan Participant end employees and where may be requiretl by a Change in Status; and upon receiving instructions from the Employer on a Change in Status, Aflac will make the change requested by the Employer, Additional Services if DDC or URM Benefits Are Offered: - assist the Cmployer in explaining the URM andlvr DDC features o; the cafeteria plan to employees; and • process the Employee-exearted Salary Redirection Agreements as they relate to the URM anU DDC components of the Employer's flexible spending account; and prepare an enrollment conflrmatlbn letter and send It to the Cmployer to verity URM and DDC elections; and - provide each URM antllor DDC Participant with an Explanation of benefits and account balance statement with each ,= reimbu ,ement Request, and, unless the annual election is exhausted, at the end of each quarter (based on Plan Year) if no reimbursement Requests arc received; and - provide the Employer with monthly written reports summarizing the previous period's URM and/or DDC and Account activities; and - receive Requests for URM andlor DDC benefits, and expeditiously review such Requests in anon-discretionary manner under reimbursement guidelines established under the requirements of Section 1'<5 of the Internal Revenue Code ('Code'), to dctennine what amount, if any,' is due and payable with respect thereto; and tlisburse the benefit payments it determines to he due (provided the Employer transfers sufficient funds to Aflac or has sufficient funds yin the Account) or if Self-Pay is elected under Section ILA. and Appendix D, notify the Employer of the benefit tletenninetion in accordance evith the provisions of the Plan and the following procedures: - valid reimbursement for VRM and/or DDC ben efils shall he paid by Aflac.on the date funds are received from the Employer (with respect to such Requests) by mailing a check to the participants at their addresses l,unless otherwise requested by the [mployer as allowed by the terms of the Plan) err by initiating a direct deposit transfer directly to the Participants in their respective bank accounts in the appropriate amount(s), and - if the amount of the (otherwise) reimbursable DDC Request exceeds the amount the Participant had withheld for DDC benefits, the excess shall be carried forv~ard (within the same Plan Year) and Veated as an Eligible Employment-Related Expense ferthat month, and if the amount of UP. P.4 Requests exceeds the amount the Pa rticipani has had withheld from URM benefits, the entire amount shall be processed to the extent of the participant's annual e!ea[idn reduced by previous reimbursements made for expenses tluring the Plan Year (ptovideU the Employer makes available sufficient funds for Aflac to satisfy the Request); and Requests of less than S15.00 may be carried forward antl aggregated-with future Requests until the reimbursable amount is greater than 515.00, provided ho~a=ever, that the emir?amount of the reimbursable Requests shall be paid after the close of the Plan Year (antl any appllcabie grace period) without regard to the $15.00 threshold; and - unless otherwise specified In writing by the Employer, Requests for URM benefits following a Change in Status impacting the URf:4 election shall be processed using a "blended approach" (i.e„ the maximum URM benefit for a period of coverage following a Change in Status will be limited to the lesser cC (a) the annual URM maximum set forth In the Plan document less any benefit payments made prior to the Change in Status; and (b) the sum oT the Participants URM account balance immediately before the Change in Status and any additional contributions made during the remaining period of coverage); antl r RSA • GPD 11319107670ABCD 11/15/2621 14:42 5416544225 CEtdTRAt_ POINT HR PAGE 09/20 ..,.~,~~a~•,ucuun..a~,~u r.r7, nor+i i - notify claimants as to any Requests which are denied because of roadequafe RequoSt substantiation or improper Request form sebmisson~ and give affected claimantsthd opportunity to resubmit their Requests; and provide to the clalmantvrithinihlrty (30) days following reoeipt of e Request, written notlfioalion: (a) as to thv disposition of :he Recuest, or (b) of an anticipatetl delay beyond thirty (30) days, not to exceed 15 days from the end of the 3o-day period, with respect to the disposition of the Request 1ogethor with an explanation of the dolay, and - Claim Appeals, Although Aflac will process Requests in anon-discretionary manner imdar reimbursement guidoline5 established under the requirements of Section 125 of the Gode, and m~ilf further conduct Request review and appeal procedures in anon-discretionary manner, the Emoloyer shall have the ultimate right and responsibility to review contested Request appeals. Am; departure speclflcally rea,uested by the Employer in writing mall be implemented by Af1ac, but if Aflac ot;lecls to the departure as inconsistent avith the requirements of the Code and Aflae standard guidelines, implementation will he et the expense and risk of the Employer. F_xoep` as otherwise provided in Section IILE AFlac will perform grace period administrative services with regards to Requests for URM and/or DDC nenefits in accordance with the follo~.ving term s, The grace period has beer, exlentled for; ~ X ] Niedlcal Care Reimbursement Plan (URM) and/or ~ X j Dopondent Care Relmbw~sament Plan (DDC) The grece period applies to the URM andlor ODC Plan (a. noted above; - The grata period will begin on the first day of the Plan Year fallowing the Plan fear to which it relates and vAll end exactly h+'o (2) months from the Plan Year end dato !to the deg) and fl fieen (15) days later. For example, if the Plan Year ends Oecem ben 91st, the grace period begins January tst and ends March 96th; similarly, if the Plan Year ends June 30th, the grace period begins July ist, and ends September 94th. - Roqucsts for URM and/or DDC benefits relatod to expenses incurrod during the grace period (as noted above) and approved for reimbursement will be paid first Prom available amounts that were remaining at the end of tho Plan Year to which the grace period relates and then from any amounts that are available to reimburse expenses incurred during the current Plen Year, - Eligible Requests will be paid in the order in vahich they aro received Previous Requests v^+ill not be reprocessed or recharacterized s^ as to change the order in v:hich t!tey Nr@re received. - Raquess for URM andlor DDC benefits relatod to expenses incurrod during the grace ponod (as noted above) must be submCted before the end of the Fun-off Pericd. This is the same Run-off Period for expenses Incurred during the Plan Year to which the grace oeriod relates, Thu Empoyer will not amendlohange the Plan's Run-off period without first notifying Aflac at Nast one (1) month prior to the end of the existing Run-oti Period. In accordant- with Section IV. C., an amendment to the Plan's existing Runoff Period may result in additional service fees. Aflaa will continue to assume that the Plan's current Run-off Periotl still applies unless notified otherwise prior to tho end of the Run-off Period. If the Plan's current P,un-oft Period does not mend past the grace period, Aflac will assume that there is no Run-off Period for grace periotl expenses, Failure to limey notify Aflac of any changes An the Run-cif Period may result in an increase in the service lees as set forth in Seoticn IV and Appendix C of this p,greemert. - Ar,y amounts that are not used to reimburse eligible expenses incurred either during the Plan Year to which the grace period (as noted above) relates or during the grace period v/ill be forfeited by the Participant'to the Plan if not subm(tted for re!;nburseinent before the end of the applicable Plan Year's Run-off perioq. RSr~ - GPD 1131910i611ABCD 11/15/2021 14:42- 5015644225 Nondiscrimination Testing: CENTRAL POINT HR AppendixB Nondlserim(nation Testing Services [Provided Upon Annual Requcslj PAGE 10/20 wncracr iuenuncauen neY'. K5H I 1 The F_mployer, upon submission of an annual Employee Census Data Sheet, authorizes Aflac to compile nontliscrimination testing percentages based upon the employee census data provided. As consideration for this service, the Plan SponsnrlAdministrator agrees to release and hold A.flac, its subsidiaries, affiliates, officers, directors, owners, shareholders, attorneys, successors and assigns harmless from any liability arising as a result of the provision of, or reliance upon such testing percentages. In addition, the Emplovcr understands and agrees that: - Aflac is not in the business of provitliny legal or tar advice, and the Employer, as the plan sponsorladministrator, will not construe the testing percentages provided by Aflac to be legal or tar advice, Accordingly, the Employer will seek the advice of Its evro tax or legal advisor to interpret and verify the testing percentages provltled, and unsure compliance with applicable nondiscrimination requirements. The Employer bears sole responsibility for nondiscrimination testing and the continued qualified status of Its cafeteria plan under all applicable provisions of the Internal Revenue Code. The testing percentages provided by Aflac are merely an Indicator of compliance with three of the applicable nondiscrimination tests -the Cafeteria Plan 25^/° I<ey Employee Concentration Tesl, the Dependent Care 5% Shareholder Test, and the Dependent Care G5% Average Benefits Test. The F_rnployer must also ensure compliance with the Eligibility Test end Contributions and Benefits Test applicable to the Ca(oterla Plan, the UP,M, and the DDC Plan, as well as other tests that may apply to the benefits offered th rough the Cafeteria Plan, To ensure corpliance with aoplioable provisions of the Internal Revenue Code, additional nondiscrimination testing and result verification must be undertaken by the Employer with the assistance of its tax or legal counsel. Discrimination testing should be conducted at least 180 days prior. to the end of the Plan Year to which the data relates to ensure adequate time to make any required corrections. Testing should also be pertcrmed as of the last day of the Plan Year. Aflac will assist with discriminatlontesting no less frequentlythan once per year and no more frequently than once every thirty (30) days. 9 RSA-GPI 11319101612ABCD 11/15/2021 14:42 5416644225 CEhITRAL PDIhIT HR PAGE 12/20 Appendix C Fee Schedule In accortlance with the attached Reimbursement Services Agreement, the services provided pursuant to this Agreement are subject to the Scrvicc Fee and Set•Up Fee described in the Fee Schedule. To the extent 4hls Appendix conflicts with the Agreement, She Agreement shall control, 1. Service Fee. A. The Ser\~ice Fee shall be basaG on: f1) The Employee Count (datinetl below); (2) The number of Participants per Plan benefit (DDC or URM;. per month for the reimbursement Plans (URM and/or DDC) for which services are re-ndered (subjoef to a per Participant maximum); (3) The Funding option chosen by the Employer pursuant to Section II,A. and Appendix i]. B. Emplpyee Count. (1) The member of eligible employees (the "Employee Count") is one of the factors t,hal determines the Employer's monthly tee rate per Participant in +ho Plan (the "Fee Pate`1 under this Aareemant. For purposes of this Appendix C, the teen "eligible employees" includes all the Employer's employees who may Participate in the benefits offeretl under the Employer; Flexible Beneft Plan (Including VP,M or DDC Plan benefit;). (2) The Employee Count on record for the Employer for the Initial Term of this Agreement is 81. By executing this Agreeineni, the Employer certifies that the Employee Count listed above either (I) reflects the actual number of Employer's eligible employees, or (ii) falls within the same Employee Count range (see the Rate Table in Section 2 for the ranges) in which the actual number of Employer's eligible employees falls, If no Employee Count is on record for the Employer, Aflac will assume the Employer's Employee Count falls within the range of 1-50. Upon each Renewal Date of this Agreement, the Employer agrees to verify and update the Employee Count accordingly. I=ailuro to do so will result In Aflac assuming the Employee Count range of 1-50 applies and will use the applicable Fee Rate to calculate the monthly Service Fee for the renewal Plan year, Atlac will adjust the assessed Fee Rate for changes In the Employee Count only upon each subsequent plan year for which this Agreement is renewed, unless otherwise mutually agreed upon by both Aflac and the Employer. C. The calculation of ;he Service Fee will be subject to a per Participant maximum as vaell as a total monthly minimum. To the extent that there Is a change to factors (2) or (3) listed in subsection f.A, above, A',lac will make a corresponding adiushnent to the monthly Service Fee. Such change in the Service Fee, if any, shall take effect for the same month in which such change became effective. Adjustments to the Service Fee for changes to the Employee Count shall be acvernetl In accordance ~^+ith subsection 1.8. above. D. The Service Fee Is oalcuiatarl ss follows Using the Rete Table that corresponds to the Employer's funding option, multiply the Employer s applicable monthly Fee Rate per Participant by the number of Participants for a given month. 7hc calculation above shall be the-Service Fee far the month unless the Minimum Monthly Fee applicable to the Employer's F_mploVr'e Count Is greater, in which case the Minimum Monthly Fee amount shall apply. E, Sot-Up Pee. The Set-Up Fee shall be as set forth in the Rate table that corresponds to the Employer's funding option and the Employer's Employee Count. 2. Rate Table, The following rate table will apply if the Employer has chosen one of the follovuing Tier 1 (premier) funding options under Appendix D of this Agreement: Self-Pay Daily 4ocal Zero Balance Account ACH Debit Zero Balance Account Tier q (Premier) Fee Schedule Employee Count Account Establishment/ Set-Up Fee Monthly Fee Rate Per -Participant Minimum Monthly Fee 1 to 50 $300 $G.00/$G.00 max. ;50 51 Yo 200 8350 $5.00!.55.00 max. $50 201 to 300 $400 $q,00/Sq.00 max. S50 t 301 or more 5q 50 53.OO/S3.00 max. $50 I- 'i1 RSA-GPD 113191W674A8CD 11/15/2021 14:42 5416644225 CEhITRAL POINT HR PFGE 14/20 Appendix ~ Funding Option Schedule in accordance pvltlt 4he attached Reimbursement Sen~ices Agreement, Employer must designate a funding option. To the extent this Appendix conflicts with the Agreement (with the exception of Secton IhC. antl Section III; Liability and Indemnity section of the Agreement), antl to the extent the Contract Identification Key on this Appendix matches the Contract Identification Key on the Agreement, this Appendix (or the Funding Option Change Form In effect) shall control For purposes of the foregoiny, an executed Funding pptlon Change Form shall be valid and in force only if agreetl to by Aflac, and only if the Contract ldentlfication Key on the Funding Option Change Form matches the Contract Identification Key on this Agreement. 1, Employer must select one below: A. Self-Pay Processing Option. (1) Options: [ )Self-Pay (Tier 1 Option (Premier)) Benefits under the Employer's Plan will be remlited by the Employer from its ganeral assets. (2) Employer Obligatlons~, For any fundlny option chosen under the Self-Pay Processing Option, the Employer shall: (i) make sufficient funds available from Its general assets for amounts allocable to eligible reimbursemenl benefits under its Plan: and (ii) review Hflac's initial reimbursement determinations and issue reimbursement checks from its general assets {the "Account") within seven days of the receipt thereof for those Requests which are reimbursable pursuant to the terms of its Plan; and (iii) upon request, provide Aflac witl: proof timely benefit check disbursements in a form and manner deemed acceptable by Ailac (e. g., bank issued account statements or chock register). B. Daily Local Bank Option. (1) Options, [, ]Daily Local 7_ero balance Account [Tier 1 Option lPremler)] Benefits under the Employer's Plan vdlli be paid from en Employer-owned and named account (the "Account') in a financial Institution selected by the Employer and agreed upon by Aflac, The Account v,~ill Include a zero balance feature and benefits wilt be remitted from the Account without prior funds confirmation. Aflac shall not he responsible For anv delay in remitting such funds for benefits to the e#ent that such delay Is the result of Employer's delay In making sufficient funds available in the Account. (2) Employer OBligations: For any Funding option chosen under the Daily local Bank Account Option, the Employer shall: (i) make sufficient funds available from its general assets for amounts allocable to eligible reimbursement benefts under its Plan by tlepositing a 'Maintenance Deposit" (in amounts specified by Aflac from time to time) in the account. (Note; the Account should not be opened in the Plan's or Aflac's name,); and (ii) grant Aflac withdrawal authority over the Account sufficient to enable it to pay benefits under the Employer's Plans; and (iii) deposit additional funds (at the request of Aflac) in order to reestablish the Maintenance Deposit at the end of each Request processing cycle (or such earlier time specified by Aflac); and (iv) upon request by Aflao, tclefar. copies of all deposit verification receipts, Account statements, and other correspondence from the financial institution, and 13 P.SA - GPD 11319101616A8CD 11/15/2621 14:4^_ 541 b644225 CEhITRAL PRINT HR PAGE 15/20 (v) bear sole responsibility for any fees imposed with respect to the Account by the financial Institution, including but not limited to: Account maintenance fees, insufficient funds fees, fees with respect to voided and stopped checks, etc.; and ~ - toil authorize Aflac to access the Account by authorizing Aflac to: a) draw benefit checks directly on the ACCOd nI; b) electronically transfer benefit payments from the Account; c) -electronically access Account Information) and d) execute the financial institution's standard DeposiVAccount Agreement on the Employer's behalf (subJect to the terms and conditions set forth herein and as Aflac may otherwise establish). Employer shall provide Aflac with the name, address anU contact person at the financial ~lnstitution associated with the Account, and provide timely notice to Aflac if such information changes. (vii) ensure that any filters, debit blocks, or similar financial restrictions on the Account are removed or modified in such a way as to ensure the successful remittance of eligible reimbursement benefits under the Employer's Plan to Pian Participants whether by check draft or elactronic transfer (,such as direct deposit). C. Standard Bank Account Processing Option. (1) Options (~ ACH Debi[ Zero Balance [Tier 1 Option (Premier)] Amounts allocable to eligible reimbursements under the Employer's Plan will be electronically transferred Tram an Employer-owned and designated account (the "Account") automatically via an AGH transfer inHlated by Aflac to facilitate timely processing of Requests payable under the Plan. To this purpose, the Employer hereby authorizes Aflac to electronically transfer such amounts from the Account and will provide Aflac with all banking information related to the Account required to facilitate such transfers, to include but not limited to, [he ^.ccount's bank account number and transit number. Furthermore, any filters or debit blocks shall be removed or modified In such a way as to facilitate the automatic withdrawal. of funds Uy Aflac for the sale purpose of remitting benefits under the Employer's Plan. (2) Employer Obligations For any funtllno option chosen under the Standard Bank Account Processing Option, the Employer shall. (I) make sufficient funds available from Its general assets onfv (i. e., no funds that constitute or may constitute plan assets, including assets from a trust or a VE2A trust or fund derived from participant contributions or salary reductions) for amounts allocable to eligible reimbursement benefits under its Plan; and (ii) bear sole responsibility for any fees imposed with respect to the Account by the financial institution, including but not IimRed to. Account maintenance fens, insufficient funds fees, fees with respect to fund transfers, stopped and voided checks, etc,; and (iii) arovitle an amount equal~to the aggregate of all Requests payable under the Employer's Plan and facllltate funds transfer to Aflac via the option selected above, 2. The following provision Is applicable for any and all funding options: If, at any time, the amount of reimbursement benefits payable under the applicable Plan provisions exceeds the amount deposited by the F-mployer in the Account, the Employer shall transfer an amount necessary to the Account (as defined in the applicable funding option) to fulfill its obligations under the applicable Plan bolero any further reimbursement benefit payment is made. Aflac is~under no oUliyation to advance funds on behalf of the Employer. 3. The following orovision is applicable to all Standard Bank Account Processing Options; Aflao will not 6e responsible for paying claims to the ertenl sufficient funds are not providad to Aflac within fourteen (14) days of the receipt of [he request for such funds from Aflac. FurtPicrrnore, Aflac v~ill immediately Cease to provide the services outlined within this Agreement until such time as an amount equal to the aggregate of all Requests payable under the Cmployer`s Plan are received by Aflac from the Employer. The Employer agrees to Indemnify Aflac for all amounts and 14 RSA-GPD 11319101611ABCD 11/15/2021 14:42 5416644225 CEbITR.^,L POINT HR P::aE 16/20 expenses resuifing from the Employer's `allure to provide sufficient funds and shall bald Aflac, its officers and directors, harmless for any liability For which the Employer or the Plen may become liable. t5 RSA-GPD 11319101618ABCD 11/15/2021 14:42 5416644225 CENTRAL POINT HR - PAGE 18/20 Exhibit A HIPAA F3 JSINESS ASSOCIATE AGREEMENT THIS APPENnIX, effective upon the execution of the Reimbursement Services Agreement attached hereto, by and between American Femity Life Assurance Cmnpany of Columbus (Aflac) and tho CITY OF CENTRAL POINT MEDICAL CARE REI0.4BURSEMENT PLAN (the'URM Plan") Is adopted by She CITY 0= CENTRAL POINT (the "Employer') on bohalf of the URM Plan and is incorporated in;o and made a part of the Reimbursement Services Agreement ("Agreement") beriveen Aflac and the Employer. This Exhibit A Is intended to comply with the business associate agreement provisions set forth in 45 CFR §§ 184.314 and 164,504(el, and any other applicable provisions of 45 CFR parts 160 and 164, issued pursuant to the Health Insurance Portability and Accountablllty Act of 1996, Pu'olic Law 104-191 as amended, Including by the Health Information Technology for Economic & Clinical riealth Act of the American Recovery and Reinvestment Act of 2009 ("ARRA"), (collectively "HIPAA'). Aflac recognizes that in the performance of services for the URM Plan under the Agreement it will have access to, create, and/or receive from the URM Plan or on its behalf Protected Health Infonnatlon ("PHI"). For purposes herein, PHI shall have the meaning given fo such term in 45 CFR § 1640.103, limited to the information created or received from She URM Plan or on its behalf by Aflac. Whenever used in this Exhibit A other capitalized terms shall have the respective meaning set forth below, unless a different meaning shall be clearly required by the content. In addition, other capitalized terms used in this Exhibit A but not defined herein, shall have the same meaninc as those terms are Defined under HIPAA, SECTIDN 1. AFLAC RESPONSIBILITIES 1.1 Aflac may use or disclose PHI, provided that surh use or Disclosure o` PHI would not violate HIPAA, as follomrs: (d) as permitted or required in this Exhlblt A and in the Agreement; (h) as Required by Law in accordance with 45 GFR § 164.592; (c) for the proper management and administration of Aflao; (tl) to fulfill any present or future legal responsibilities; (e) far Dala Aggregation services to the URM Plan (as defined In 45 CFR § 164.501)', or (p any use and disclosure of PHI that has been de-identified ~a~ilhin the meaning of q5 GFR § 164.514. 1.2 Aflac agrees m implement commercially reasonable and appropria;.e safeguards to proven, the use or disclosure of PHI other than as provided for by this Erh lhlt A. 1,3 A`lac agrees to Implement commercially reasonable administrative, plrysical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, of transmits on bohalf of the URM Plan. 1.4 Aflac agrees to report to tho URPJ! Plan any successful Security Incident that is material or any use or disclosure et PHI of which it hocomes aware that is not provided fcr by this Exhibit A or in the Agreement, 1,5 Aflac agrees to ensure that any agent, including a subcontractor, to whom Il provides PHI agrees to similar restrictions and conditions that apply through this Exhibit A?o Aflac with respec? to such information. 1.6 Al the request of the URM Plan, and in a mutually agreeable time end manner, Atlac agrees to provide accas> to PHI it holds In a Designated Record Sct (as defined in q5 CFR § 164.501), to the URM Plan, or as directed by the URM plan, tv an Individual Iri order to meet the requirements under 45 CFR § 164.52;. Aflac shall have the right to charge the Individual a reasonable cost-based fee, as permitted t;y 45 CFR § 164.574. Aflac ass~ames no obilgation to coordinate the provision of PHI maintained by other business associates of the URM Plan. 1.7 AC the request of the LIRM Plan, and In a mutually agreeable limo and manner, Aflac agrees to make any amendment(s) to PHI It holds in a Designated Record Set that the UP,M plan directs or agrees to pursuant to 45 CFR § 164526 at the request of tho URM Plan or an Individual. 1,8 .4t the request of the URM Plan, and In a mutually agreeable Jme end manner, Aflac agrees to make its internal practices, books and records relating to theuse and disclosure of PHI received from, or craatod or received by A`lac on behalf of the URM Plan available to the Secretary (as defined in 45 GFR § 160.103), for purposes of the Secretary determining the URM Plan's compliance with the Privacy and Securrty Rules. 1.9 Aflac agrees to document such disclosures of PHI and information related to such disclosures as would be rr_qulred for the LIRM plan to respond to a request by an lndlvld ual for an 2ecounting of disclosures ai PHI in accordance vrlth 45 CFR § 164,528. L10 Aflac agrees to provide to URM Plan or an Individual, in the lime and manner designated by URM Plan, i~;formation Collected in accordance with 1.09 to permit the URM Plan to respond to a request by an Individual fof an accounting of disclosures of PHI 'm accordance with 45 CFR § 164.528. 1.11 Except as provided for herein, or as required by la~,v, upon termination of the Agreement, Aflac agrees to returr, to the URN, Plan or destroy PHI and retain no copies in any form, if feasible. In the event that Aflac determines that returning - or destroying the PHI is infeasible, Aflac agrees to eytend the prctectlons, limilallons and restrictions of this Exhlblt A i0 1 ~ RSA - GPI 11319107680ABCD 11/15/2021 14:42 5416644225 ~ CENTR.^,L POINT HR PA~_E 19/20 l,.On11 Jl:l 1UCI111111:tlll Vll n=y. n.~nll such PHI antl to limit any further uses and/or disclosures of such PHI retained to the purposes that make the return or destruction of the PHI infeasible, for as long as Aflac maintains such PHI. Bath parties agree that this Section 1,11 shall survive the expiration ^r termination of the Agreement and remain in full force and effect thereafter for so long as Aflac or any of Aflac's employees, subcontractors, or agents remain in possession of any PHI, and shall expire thereafter, SECTION 2. PLAN AND EMP! DYER RESPONSIBILITIES 2.1 Employer acting as the Plan Sponsor agrees to comply with the administrativo requirements set forth in 95 CFR §§ 1©4530 and 104.504(f)~ including but not limited to amending the URM Plan to restrict uses antl disclosures of PHI. 22 The Employer acknowledges and agrees that Aflac shall only disclose PHt in Its possession to the Named Ccntact as designated (and through the modes specified) in Section IILF of the Agreement The employees who. are Iderdi`ied on the applicable plan document request form (and in the Plan documents) shall bo the Designated Persons in acrordance with 45 CFR § 169.504(f), and disclosures to such persons by Aflac are solely for purposes of carryinc cut plan administration functions that the Employer performs for the URM Plan. 2,3 Employer shall timely notify Aflac in writing of any changes to the names or pos'dlons of employees listed in F~.Ibsection 2.2 as Designated Persons. Aflac shall have no duly to inquire vdhelher the list of Designated Persons Is accurate. 2A F_mpbyer acknowledges and agrees that under the HIPAA~Privacy Rules Designated Persons may only request the minimum amount of PHI necessary to accomplish the purpose of the request, use or disclosure. Aflac shall have no duty to ensure that the amount of PFII requested by the Designated Persons is the minimum amount necessary. 7_.5 Aflac shall have no liability for uses or disclosures contemplated in the Agreement, Employer shall indemnify and hold harmless Aflac (and its employees) for any and all liability Aflac may incur as a result of any improper use or des d;osure of PHI by the URM Plan, Employer or a Designated Person(s). 2.8 URM Plan shall not request Aflac to use or disclose PHI in any manner that would not be permissible under th>_ Frivacy and Security Rules if done dy the URM Plan, except that Aflac may use or disclose PHI as provided In Sectiv:i ',. ~. 2.7 VRM Plan shall provido URM Plan participants and beneficiaries with adequate notice of the uses and disclosures of PHI that may be m2de by the URM Plan, and of the Individual's rights antl the URM Plan's responslblllties wih~, rasped to PHI as requirad in 45 CFR § 164.520. The URPA Plan further agrees to forv~ard a rnpy of such notice to P.flac, as well as any chances to :uch nbllces. 2.8 URM Plan shall provide Aflac with any changes to, or revocation of, permission by a Participant or 6enaficia ry ;:? use or disclose PHI, if such changes effect Aflac's permitted yr required uses or disclosures. 2,9 URM Plen shall not agree to any special privacy restrictions requested by an Individual without Aflac's written aparvval, including those provided for 45 CFR § 184.522. 2.10 Notwithstanding any other provision of this Agreement, Aflac recognizes that the URM Plan may have other business associates and Its sharing of PHI with such other business associates of the URM Plan will be re a5onable antl necessary to facilitate URM Plan administration. Aflac agrees to disclose PHI in its possession to such other cn';;!=_s as Directed 6y the URM Plan, provided that such other business associates agree to dimply with the Privacy onC Security Rules with respect to the use and disclosure of such PHI. UP,M Plan shall be solely responsible far ensuring ;rat it has entered Into appropriate business associate agreements with its other business assocates in accordance with ~~~ .. F, R. SECTION 3. MISCELLANEOUS 3.1 Both parties agree that nothing express or impliod in this Exhibit A is intended to confer, nor shall anytL:rg herein confer, upon any person other than Atlac, the URM Plan, the employer, antl their respective successors, or assigns, any rights, remedies, obllgatlons, or liabilities whatsoever. 3.2 This Exhibit A shall Ue interpreted as broadly as necessary to implement and comply with HIPAA and the Pri~:=.ry and Security Rules, and any ambiguity in this Gxhibii A shall be resolved in favor of a meaning that compiles and is consistent with HIPAA and the Privacy and Security Rules. Both parties agree that the provisions of this E>:hibi: ~; shall prcva'4 aver any provisions In the Agreement that may conflict or appear'mconslstenl v,~lth any provisions of :".~s °_xhibit A, 3.3 Both parties acknowledge that future changes to the requirements of FIIPAA, the Privacy antl Security Rubaa. ~ 1 other applicable laws relating to the security or confidentiality of PHI may require amendment of this Exhibit l>. '. on tho written request of either party, the other party agrees to promptly enter into negotiations concerning the le. n~s of an amendment to this Exhibit A. If either party disagrees v^9th 2ny such amendment, it shall se notify the chc: party In 18 _ '~. ~ GPD 11319101661A8CD 11/15/2021 14:42 541 E644225 CENTRAL FOINT HR PAGE ^0/20 writing within 30 days of notice. If the parties are unable to ayroe on en amendment within 30 days thereafter, than any of the parties may tennlnate the Agreement in accordance with the termination section of the Agreement. 3.4 N•omrilhstanding Section 3,3 above and without limiting the rights of the parties under the Agreement, upon written notice of the existence of an alleged material breach of the terms of this F_xhlbit A, the URM Plan shall afford Aflac an opportunity to cure said breach upon mutually agreeable terms. Failure to curd wlYhin 30 days shall be imm,ediete ^rounds for termination of the Agreement. 3.5 Section 1.11 shall survive the termination or expiration o,' the Ayreement for the reasons statod therein. The other provisions of this Exhibit A shall survive the termination of the Agreement and remain in full force and effect the=after for so long as Aflac or any of its employees, agents or subcontractors remains in possession of PWI in accordance with Section 1.11 of this Exhibit A and shall expire therea ftar. >1 s a w u_ m 0 0 O T O Z Q V_ H V 19 RSA-GPI °11319101682ABCD 11/21/2011 Dear Ylan Administrator: Please find the enclosed: ® Executed copy of the Reimbursement Services Agreement (RSA) to retain for your records. ^ Documentation submitted to our office for your self-administered Aflac Wingspan Benefit Services account. Aflac Wingspan Benefit Services does not require this information and should be retained for your records. ^ Documentation submitted to our office for your premium only plan. Aflac Wingspan Benefit Sen~ices dots not require this information. Please retain for your records. ^ Documentation for your canceled Flexible Spending Account (FSA) plan. (These documents should be retained for your files). ^ Salary Redirection Agreements submitted in error. These documents should be retained for the: ^ Employer ^ Employee ^ Associate [f there are any questions or concerns about the enclosed information, please contact us toll-free at 1-800- 323-5391. Thank you, Atlac Wingspan Benefit Services