in coverage offered under an existing benefit plan. You may cancel your election and receive coverage under the new or improved benefit option. No election change may be made as to the Health Care FSA Program on account of a significant improvement in coverage. (vi) elimination or "significant" cutback in coverage provided by an insurance company or other third party. You may cancel your election and receive coverage under a similar plan, provided both plans agree to make the change. No election change may be made as to the Health Care FSA Program on account of a significant cutback in coverage. (vii) your failure to make the required premium payment. Your election will be canceled but you will not be able to make a new election for the rest of the Plan Year. (viii) your separation from service. If you terminate employment, you may cancel your election for any remaining period of coverage. (ix) your loss of group health coverage sponsored by a governmental or educational institution. No election change may be made as to the Health Care FSA Program and the Dependent Care FSA Program loss of such coverage. (x) your spouse or dependent makes an election change under a plan maintained by his or her employer that has a different period of coverage than this Plan. No election change may be made as to the Health Care FSA Program for this reason. (xi) your enrollment and/or or a related individuals' enrollment in Marketplace coverage. If you and/or a related individual enroll or intend to enroll in Marketplace coverage during the Marketplace's annual open enrollment period or during a special enrollment period, the Administrator may permit you to cancel your election for any remaining period of coverage, provided that you and/or the related individual or related individuals who cease coverage due to the revocation enroll in a Marketplace plan effective immediately following the revocation. If only a related individual or related individuals enroll or intend to enroll in Marketplace coverage, you will be transitioned to self-only coverage (or family coverage including one or more already-covered related individuals) under the Employer's health benefits. Coverage may only be terminated for those covered individuals who are enrolling or intend to enroll in Marketplace coverage during open enrollment or pursuant to a Marketplace special enrollment period. No change is permitted with regard to non-health benefits including the Health Care Flexible Spending Account Program and Dependent Care Flexible Spending Account Program available under the Plan. (xii) your permanent reduction of hours. If you were reasonably expected to average 30 hours of service or more per week and experience an employment status change such that you are no longer reasonably expected to average 30 hours of service or more per week, the Administrator may permit you to cancel your election for any remaining period of coverage, provided that you (and any related individuals who cease coverage due to the revocation) enroll or intend to enroll in another plan no later than the first day of the second full month following the revocation. No change is permitted with regard to non-health benefits including the Health Care Flexible Spending Account Program and Dependent Care Flexible Spending Account Program available under the Plan. If you have a status change and you want to cancel or modify your election for a Plan Year, you must file a written application with the Plan Administrator within 30 days of the event, or within 60 days in the case of a special enrollment right due to the loss of eligibility for Medicaid or state children's health insurance program coverage, or eligibility for a state premium assistance subsidy from a Medicaid plan or through a state children's health insurance program with respect to coverage under the group health plan. Keep in mind that any change to your election must be consistent with your status change. The Plan Administrator will consider your application and inform you of the decision. Elections made under this Plan automatically terminate on the date on which you cease to be a participant in the Plan, although coverage or benefits under the Medical Plans and/or the Health Care Flexible Spending Account Program may continue if and to the extent provided by such plan or as required by law. In the event you become a participant again within 30 days of the date you stopped being a participant and before the end of the same Plan Year, the elections you previously had in effect shall automatically be reinstated for the balance of the Plan Year. If you become a participant 30 days or more after the date you stopped being a participant and before the end of the Same Plan year, you may make new elections; however your elections for the Health Care Flexible Spending Account and Dependent Care Flexible Spending Account may not exceed the maximum annual contributions as set forth Sections 5.1 and 6.1 herein and applicable law. Page 7
Summary Plan Description for Achieva Section 125 and FSA Plan Page 6 Page 8