Page 27 - PWH 2018 Plan Documents

SECTION 125 CAFETERIA PLAN

General

If elected in the Adoption Agreement, the Benefit Programs shall include a Cafeteria Plan Arrangement
which shall permit Employees to choose between cash (or other taxable benefits) and the Benefit
Programs on a non-taxable basis, subject to the requirements of Code § 125 and the regulations
thereunder.

Eligibility

Notwithstanding anything to the contrary contained in the Governing Documents, participation in the
Cafeteria Plan Arrangement shall be restricted to Employees, which may include former Employees if
permitted in the Governing Documents.

Irrevocable Elections

An Employee’s election under the Cafeteria Plan Arrangement shall be effective for the Program Year, and
shall be irrevocable, except to the extent permitted under the Governing Documents and Treasury
Regulation § 1.125-4.

Additional Required Terms

Additional terms required under Code § 125 shall be set forth in the Governing Documents for the
Cafeteria Plan Arrangement.

HEALTH BENEFIT PROGRAMS

Health Benefit Programs

The Plan shall include the Health Benefit Programs identified on the Adoption Agreement. Such Health
Benefit Programs are designated as the health care component of the Plan within the meaning of the
Standards for Privacy of Individually Identifiable Health Information (45 CFR Part 164, the “Privacy
Standards”) and the Security Standards for the Protection of Electronic Protected Health Information (45
CFR Part 164.300 et. seq., the “Security Standards”). Each reference to the “Plan” in Section 2 below
shall mean the health care component of the Plan.

HIPAA Privacy and Security Standards

General. If a Health Benefit Program is not exempted from the requirements of the Privacy
Standards and the Security Standards, then this Section shall apply.

Privacy and Security Standards.

The Plan shall not disclose Protected Health Information to any member of an Employer’s
workforce unless each of the conditions set out in this Section are met. “Protected Health Information”
shall have the same definition as set forth in the Privacy Standards but generally shall mean individually
identifiable information about the past, present or future physical or mental health or condition of an
individual, including information about treatment or payment for treatment. “Electronic Protected Health
Information” shall have the same definition as set out in the Security Standards, but generally shall mean