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EXECUTIVE MEDICAL REIMBURSEMENT PLAN



This Executive Medical Reimbursement Plan (the "EMRP") is effective [DATE].


ELIGIBILITY

To be eligible for EMRP, an employee must be an officer of the [YOUR COMPANY NAME] (the "Company"). The employee must elect coverage for himself/herself and any eligible dependents under the Company's [GROUP HEALTH PLAN NAME] Group Health Plan.


ENROLLMENT

Upon becoming eligible for the EMRP, an employee will automatically be enrolled in the plan provided he/she is currently enrolled in the [GROUP HEALTH PLAN NAME] Group Health Plan.


COVERAGE

Coverage will be extended by the plan for any medical expense which would be a deductible medical expense under [FEDERAL/STATE/PROVINCIAL] Income Tax regulations. This can include expenses not reimbursed by the [GROUP HEALTH PLAN NAME] Group Health Plan due to deductibles, co-insurance, plan exclusions, eyeglasses, orthodontics, medically necessary additions and alterations to a home, or [SPECIFY]. These and other expenses would be covered by the EMRP if they qualify under applicable [IRS or YOUR COUNTRY REVENUE AGENCY] regulations.


BENEFITS

The EMRP does not require satisfaction of a deductible. Eligible medical expenses will be reimbursed at 100%.


CLAIM FILING

Bills for medical expenses should be submitted to [CLAIMS ADMINISTRATOR] in the special MRP (Medical Reimbursement Plan) envelopes provided. The administrator will first pay benefits under the [GROUP HEALTH PLAN NAME] Group Health Plan. Reimbursement for expenses not fully covered (or not covered at all) by the [GROUP HEALTH PLAN NAME] Group Health Plan will then be paid for the EMRP.


MAXIMUM ANNUAL BENEFIT

The maximum EMRP benefits payable during a calendar year for a covered employee and family is $[AMOUNT].






TAXES

Unlike benefits received from the Group Health Plan (which are not taxable income) payments under the EMRP are regular income. They are subject to both Federal and [STATE/PROVINCE] income tax, and [FICA or YOUR COUNTRY INSURANCE CONTRIBUTION ACT] if the employee's pay falls below the [FICA or YOUR COUNTRY INSURANCE CONTRIBUTION ACT] salary limit.


ADDITIONAL REIMBURSEMENT

In March of each year while the EMRP remains in effect, the Company will make an additional payment to each employee who received benefits under the plan during the previous year. The amount paid will be a percentage of the EMRP benefits, calculated to cover the taxes generated by such benefit payments. That percentage may be changed from time to time in order to reflect changes in applicable tax rates. The additional reimbursement is also taxable income, and will be included in the employee's [W-2 or YOUR COUNTRY WAGE AND TAX STATEMENT] for the year in which the additional reimbursement was paid.


TERMINATION OF COVERAGE

Coverage will terminate on the earliest of the following dates:

An employee terminates employment with [YOUR COMPANY NAME].

Coverage under the Company's Group Health Plan terminates, either due to voluntary action on the part of the employee, or because the Company has cancelled the Group Health Plan.

At the end of an approved leave of absence, unless the employee returns to full-time employment with the Company.

The employee is no longer an officer of the Company.

The Company elects to discontinue the Executive Medical Reimbursement Plan.


The EMRP is a cash bonus plan, not insurance. It is not funded, nor does it come under provisions of the [FEDERAL EMPLOYEE RETIREMENT INCOME SECURITY ACT or YOUR COUNTRY EQUIVALENT].

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