Corona City Council
August 19, 2026

RESOLUTION NO. 2026-091

RESOLUTION OF THE CITY COUNCIL OF THE CITY OF

CORONA, CALIFORNIA, ADOPTING THE CITY OF
CORONA RESTATED SECTION 125 CAFETERIA PLAN
AND REPEALING RESOLUTION NO. 2009-123
WHEREAS, the City of Corona (“City”) sponsors an eligible cafeteria plan to provide certain benefits on a pre-tax basis in accordance with Section 125 of the Internal Revenue Code with the City’s service provider, Nationwide; and
WHEREAS, on December 16, 2009, the City Council adopted Resolution No. 2009-123 to amend and adopt the City’s Section 125 Cafeteria Plan (“Plan”); and WHEREAS, pursuant to Section 14.2 of the Plan, the Plan may be amended by the City at any time and from time to time, by a written resolution adopted by a majority of the City Council; and
WHEREAS, the City desires to adopt the City of Corona Restated Section 125 Cafeteria Plan (“Restated Plan”) for administration by Nationwide effective for plan years beginning on or after January 1, 2027; and
WHEREAS, the Restated Plan incorporates Schedule “A” (Schedule of Benefits), currently identifying benefits which will periodically change as labor agreements are negotiated and the master list of benefits for unrepresented employees is updated by resolution, and, as such, it is necessary that the Administrator of the Restated Plan as designated herein, have the authority to automatically update or revise Schedule “A” as necessary upon City Council approval of changes to such benefits; and
WHEREAS, the City desires to repeal Resolution No. 2009-123.

NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF CORONA, CALIFORNIA, AS FOLLOWS:

SECTION 1. Incorporation of Recitals. The foregoing recitals are true and correct and are incorporated herein and made an operative part of this Resolution.

SECTION 2. Section 125 Cafeteria Plan. The City Council hereby adopts the City of Corona Restated Section 125 Cafeteria Plan attached hereto as Exhibit “A” and incorporated herein by reference and repeals the City of Corona Section 125 Cafeteria Plan adopted pursuant to Resolution No. 2009-123.

SECTION 3. Updates to Schedule “A”. The City Council hereby authorizes the City Manager, or his or her designee, to automatically update Schedule “A” (Schedule of Benefits) of the Restated Plan as changes to the benefits referenced therein are approved by the City Council.

SECTION 4. Designation. The City Council hereby designates the City Manager, or his or her designee, as Administrator for the Plan.

SECTION 5. Authorization. The City Council hereby authorizes the City Manager, or his or her designee, to execute the Plan document on behalf of the City, along with any future amendments that contain only non-substantive and/or administrative changes to the Plan document, and any other documents necessary for the effective implementation of the Plan.

SECTION 6. Repeal of Resolution No. 2009-123. Resolution No. 2009-123 is hereby repealed and of no further force or effect.

PASSED, APPROVED AND ADOPTED this 19th day of August 2026.

Mayor of the City of Corona, California
ATTEST:

City Clerk of the City of Corona, California

CERTIFICATION
I, Sylvia Edwards, City Clerk of the City of Corona, California, do hereby certify that the foregoing Resolution was regularly passed and adopted by the City Council of the City of Corona, California, at a regular meeting thereof held on the 19th day of August 2026 by the following vote:

AYES:

NOES:

ABSENT:

ABSTAINED:

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the official seal of the City of Corona, California, this 19th day of August 2026.

City Clerk of the City of Corona, California
[SEAL]
EXHIBIT "A"
CITY OF CORONA SECTION 125 CAFETERIA PLAN.
[SEE ATTACHED FIFTY-TWO (52) PAGES]

CITY OF CORONA
RESTATED SECTION 125 CAFETERIA PLAN
The CITY OF CORONA (the “Employer”) established the CITY OF CORONA RESTATED CAFETERIA PLAN (the “Plan”) for the benefit of its employees and their dependents effective November 1, 1998. The Employer hereby amends and restates the Plan, effective August 19, 2026

ARTICLE I

TITLE AND PURPOSE
This Cafeteria Plan shall be known as the CITY OF CORONA SECTION 125 CAFETERIA PLAN (the "“Plan"”). The purpose of the Plan is to furnish to eligible employees choices among certain Benefits provided by the Employer, so that employees may receive Benefits that best meet their individual needs. The Plan is intended to provide benefits in accordance with Sections 125, 105 and 129 of the Internal Revenue Code, as amended, and the Regulations issued thereunder, so that the Benefits that an Employee elects to receive under the Plan are eligible for exclusion from the Employee’s income for federal income tax purposes. The Employer shall offer at least one permitted taxable benefit and at least one nontaxable qualified benefit.

The Plan is also intended to qualify under Sections 105(b) and 129(d) of the Internal Revenue Code with regard to the written documentation requirements for self-funded health care reimbursement and dependent care assistance plans.

ARTICLE II

COMPONENT PLANS
The Benefits offered under this Plan are provided through separate Component Plans which are set forth in separate plan documents, group insurance policies or administrative service contracts and are incorporated herein and identified in Schedule “A” attached hereto. Schedule “A” shall be updated administratively by the Administrator, or his or her designee, consistent with any changes to the Benefits or Employer Allowance approved by the City Council, or as required by federal or state law. Notwithstanding, the provisions of the separate Health Care Flexible Spending Account and Dependent Care Flexible Spending Account Component Plans are set forth in this Plan document.

ARTICLE III

DEFINITIONS
The following words and phrases, when used herein, shall have the following meanings, unless a different meaning is clearly required by the context:

3.1 Administrator. “Administrator” means the Employer or any person or entity appointed by the Employer to administer this Plan on its behalf, as provided in Article IV.

3.2 Benefit. “Benefit” means any of the qualified benefits and permitted taxable benefits which may be purchased under this Plan. “Benefits” shall also mean any amounts paid to a Participant in the Plan as reimbursement under the Health Care Flexible Spending Account (see Article X) or the Dependent Care Flexible Spending Account (see Article IX).

3.3 CalPERS. “CalPERS” shall refer to the Public Employees’ Retirement System created under the authority of the Public Employees’ Retirement Law as provided under Section 20000 et. seq. of the California Government Code and as administered by the CalPERS Board of Administration. ·

3.4 Code. “Code” means the Internal Revenue Code of 1986, as amended and regulations issued thereunder. References to any section of the Code include references to any comparable or succeeding provision of any legislation which amends, supplements or replaces such section.

3.5 Compensation. "Compensation" means all earnings of a Participant reportable on Form W-2 for the Plan Year but does not include any amounts received from a dependent care assistance plan, any pension or annuity, or as unemployment or worker's compensation in accordance with Section 129(e)(2) of the Code.

3.6 Component Plan. “Component Plan” means any plan offering Benefits available under this Plan; as set forth in the separate plan documents, except for the Health Care Flexible Spending Account (see Article X) and the Dependent Care Flexible Spending Account (see Article IX).

3.7 Core Coverage. “Core Coverage” means the Benefit option consisting of at least employeeonly health coverage under the plans offered by the Employer which a Participant, other than a Retiree, is required to elect under the terms described in Section 6.3.

3.8 Dependent. “Dependent” means (a) an individual who qualifies as the Participant's dependent under Code § 105(b); (b) any child of the Participant (within the meaning of Code § 152(f)(1)) who has not attained age 26, to the extent required by applicable federal law for purposes of the Employer's group health plans; and (c) solely for purposes of the Dependent Care Flexible Spending Account, a Qualifying Individual as defined in Code §§ 21(b)(1) and 129. The term "Dependent" shall be interpreted and administered in accordance with applicable provisions of the Code, the Affordable Care Act, and other applicable federal law. To the extent the eligibility requirements for a particular Benefit option differ under applicable law, the requirements applicable to that Benefit option shall control.

Notwithstanding the preceding, if a Component Plan permits a Participant to cover an individual other than the Participant’s Spouse or Dependent (including a Participant’s registered domestic partner as recognized by the State of California), the term Dependent as used throughout the Plan document shall also include such individual provided the benefit is treated as a taxable benefit in accordance with Section 8.7.

3.9 Effective Date. “Effective Date” means the effective date of this restatement which is August 19, 2026. The date this Plan was first adopted was November 1, 1998.

3.10 Employee. “Employee”” shall include any active employee of the Employer that is entitled to receive an Employer Allowance under a memorandum of understanding between the Employer and a bargaining unit of Employees. “Employee” shall also mean all other regular full time employees of the Employer and, to the extent necessary, former employees who are entitled to receive Benefits under this Plan.

3.11 Employer. “Employer” means the City of Corona.

3.12 Employer Allowance. “Employer Allowance” means the amount specified in Schedule “A” for the applicable employee group and contributed by the Employer on behalf of each Participant, other than a Retiree, toward the purchase of coverage under a Health Benefit Plan.

3.13 Entry Date. “Entry Date” means, for all newly hired Employees, the first day of the month following date of hire unless otherwise provided under the terms of the applicable memorandum of understanding. In all other cases, the “Entry Date” shall mean the first day of each Plan Year.

3.14 ERISA. “ERISA” means the Employee Retirement Income Security Act of 1974.

3.15 FMLA. “FMLA” means the Family Medical Leave Act of 1993, as amended and including all regulations issued thereunder.

3.16 Grace Period. “Grace Period” means the period commencing on the date immediately following the end of the Plan Year and ending no later than then fifteenth day of the third month following the end of the Plan Year.

3.17 Health Benefit Plan. “Health Benefit Plan” means any medical, dental, vision, or other group health benefit plan sponsored or maintained by the Employer and offered to eligible Employees or Retirees, including any health benefit plan made available through CalPERS, as designated by the Employer from time to time.

3.18 Leave of Absence. “Protected Leave of Absence” means any absence of an Employee which is authorized by the Employer and is state or federally protected under Family Medical Leave Act, California Family Rights Act, Pregnancy Disability Act, Workers’ Compensation Leave, Military Leave, or Kin Care Leave. “Unprotected Leave of Absence” means any absence of an Employee that may be authorized by the Employer but does not fall under any of the above listed state or federal protections.

3.19 Medical Insurance Opt-Out. “Medical Insurance Opt-Out ” means the amount available to a Participant, other than a Retiree, in the event that such Participant satisfies the requirements for waiving the Core Coverage option pursuant to Section 6.3. Such amount shall be as set forth in the Schedule of Benefits for each Employee group as set forth in Schedule “A”.

3.20 Open Enrollment Period. “Open Enrollment Period" means the period before the beginning of the next Plan as determined by the Administrator. For a new Employee, “Open Enrollment Period” shall mean the period between the Employee’s date of hire and the first day which an Employee may become a Participant.

3.21 Participant. “Participant” means an Employee, and a Retiree with respect to the Employer Allowance only, who becomes enrolled in the Plan pursuant to Article V. “Participant” shall also mean a former Employee who elects to continue health coverage under the Plan.

3.22 Period of Coverage. “Period of Coverage” generally means the Plan Year beginning on January 1 and ending on December 31. A Participant’s Period of Coverage may be less than 12 months if a new Participant enters the Plan during the year or a Participant completes a permitted election change in accordance with Article VI. A Participant’s Period of Coverage shall also include continuation coverage elected by a terminated Participant or Qualified Beneficiary. A Participant’s Period of Coverage under the Health Care Flexible Spending Account or Dependent Care Flexible Spending Account shall not be less than twelve (12) months unless the Plan Year is a Short Plan Year.

3.23 Plan. “Plan” means the CITY OF CORONA RESTATED SECTION 125 CAFETERIA PLAN, set forth herein, including all subsequent amendments and modifications hereto.

3.24 Plan Year. “Plan Year” means the twelve (12) consecutive month period commencing January 1 and ending on December 31.

3.25 Retired Elected Officials. “Retired Elected Officials” shall refer to the following: (i) former members of the Employer’s legislative body elected prior to January 1, 1999 and who retired from the City of Corona under the CalPERS system on or prior to February 18, 2009; and (ii) any individual elected to serve as the treasurer of the City of Corona prior to· January l, 1999 and who retired from the City of Corona under the CalPERS system on or prior to February 18, 2009.

3.26 Retired M/C Personnel. “Retired M/C Personnel” shall mean employees of the Employer subject to the terms of the master list of Benefits for the Management, Confidential and Executive Employees established by resolution of the City Council , as amended from time to time, hired by the Employer prior to January 1, 1999 that are receiving retirement benefits under the Employer’s retirement plans.

3.27 Retiree. “Retiree” shall mean Retired Elected Officials or Retired M/C Personnel.

3.28 Salary Reduction. “Salary Reduction” means the amounts paid into the Plan pursuant to elections made by the Participant, to reduce his or her Compensation for the purchase of Benefits elected by the Participant.

3.29 Spouse. “Spouse” means the person to whom the Participant is legally married but shall not include an individual legally separated from a Participant under a decree of legal separation unless it is court ordered. Notwithstanding, a Participant’s registered domestic partner shall be entitled to and receive the same rights and coverage attributable to medical and health benefits offered under the Plan pursuant to the California Domestic Partner Rights and Responsibilities Act of 2003.

3.30 Student. “Student” means an individual who during each of the five calendar months during a Plan Year is enrolled as a full-time student at an “educational institution.” For this purpose, “educational institution” means any institution which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of pupils or students in attendance at the place where its educational activities are regularly carried on.

3.28 Uniformed Services. “Uniformed Services” means the Armed Forces, the Armed National Guard, and the Air National Guard when engaged in active duty for training, inactive duty training, or full-time National Guard duty, the commissioned corps of the Public Health Service, and any other category of persons designated by the President of the United States in time of war or emergency.

ARTICLE IV

ADMINISTRATION

4.1 Allocation of Responsibility for Administration.
(a) Designated Representatives. The Employer may appoint an individual or an administrative committee to serve at its discretion as Administrator. The Administrator shall have only those powers, duties, responsibilities and obligations as are specifically given to the Administrator under the Plan.
(b) Employer Responsibilities. The Employer shall have the sole responsibility for making the contributions provided for under Article VII and shall have the sole authority to amend or terminate, in whole or in part, the Plan at any time. (c) Administrator’s Responsibilities. The Administrator shall have the sole responsibility for the administration of the Plan, as set forth herein. The Administrator warrants that any directions given, information furnished, or action taken by it shall be in accordance with the provisions of the Plan authorizing or providing for such direction, information or action. The Administrator shall be responsible for the proper exercise of its own powers, duties, responsibilities and obligations under this Plan and shall not be responsible for any act or failure to act of another Employee. Neither the Administrator, nor the Employer makes any guarantee to any Participant in any manner for any loss or other event because of the Participant’s participation in the Plan.
(d) Transfer of Duties. The Employer may, at any time, assign all or any portion of the Administrator’s duties to a contracting third party.

4.2 Powers and Duties of Administrator.
(a) Powers and Duties Delegated to Administrator. The Administrator shall supervise the administration of the Plan. The Administrator shall be responsible for ensuring that the terms and conditions of the Plan are carried out for the exclusive benefit of persons entitled to participate in the Plan without discrimination. The Administrator shall have full power to administer the Plan, subject to the applicable requirements of the law and any agreement executed by and between the Employer and the Administrator. For this purpose, the Administrator’s powers shall include the following:
(1) to construe and interpret the Plan, decide all questions of eligibility and determine the amount, manner and time of payment of any Benefits hereunder; (2) to prescribe the procedures for the Participants to follow in filing applications for Benefits and to prepare forms to be used by the Participants; (3) to prepare and distribute, in such manner as the Administrator determines appropriate, information explaining the Plan;
(4) to receive from the Employer, Participants, Participant’s Spouses and Dependents, and other persons such information as shall be necessary for the proper administration of the Plan;
(5) to furnish to the Employer and the Participants, upon request, annual reports detailing the administration of the Plan;
(6) to receive, review and keep on file records pertaining to the Plan, as the Administrator deems convenient and proper;
(7) to allocate its administrative responsibilities;
(8) to appoint or employ individuals and any other Agents the Administrator deems advisable, including legal and actuarial counsel, to assist in the administration of the Plan (9) to adopt such rules as the Administrator deems necessary, desirable or appropriate, subject to applicable law. All rules and decisions of the Administrator shall be uniformly and consistently applied to all Participants in similar circumstances; and (10) to take all other steps necessary to properly administer the Plan in accordance with its terms and conditions and the requirements of the applicable law. (b) Powers and Duties Not Delegated to Administrator. The Administrator shall have no power to add to, subtract from or modify any of the terms of the Plan, or to change or add to any Benefits provided by the Plan, or to waive or fail to apply any requirements of eligibility for a Benefit under the Plan, except as may be expressly provided herein. Interpretations of the provisions of the Plan shall not be deemed to be additions, subtractions, or modifications of the Plan.

4.3 Nondiscriminatory Exercise of Authority. Whenever in the administration of the Plan any discretionary action by the Administrator is required, the Administrator shall exercise its authority in a nondiscriminatory manner so that all persons similarly situated shall receive substantially the same treatment.

4.4 Payments to Authorized Representatives. If a Participant or other person entitled to receive a payment under the Plan is deceased, legally incapacitated, or otherwise legally unable to receive the payment, the Administrator may make the payment to the Participant’s personal representative, conservator, guardian, attorney-in-fact acting under a valid power of attorney, or other person authorized under applicable law or a court order. The Administrator may rely in good faith on documentation reasonably establishing such authority, and any payment made in good-faith reliance on such documentation shall fully discharge the Employer, the Plan, and the Administrator with respect to the amount paid.

4.5 Indemnification of Administrator. The Employer agrees to indemnify any Employee serving as Administrator (including any Employee or former Employee who formerly served as Administrator), against any and all liabilities, damages, costs and expenses (including attorneys'’ fees and amounts paid in settlement of any claims approved by the Employer) occasioned by any act or omission to act in connection with the Plan, if such act or omission is made in good faith pursuant to the provisions of the Plan and not as a result of the Administrator’s gross negligence or willful misconduct.

4.6 Use of Electronic Communications and Elections. To the extent permitted by applicable law, the Administrator may furnish any notice, disclosure, election form, reimbursement request, certification, consent, or other communication required or permitted under the Plan by electronic means, including electronic mail, an Internet or intranet website, or another electronic enrollment or benefits administration system designated by the Employer, provided the intended recipient has the effective ability to access the electronic medium used.

The Administrator may establish reasonable procedures governing the use of electronic communications and electronic signatures, including procedures for authentication of Participants, confirmation of elections, correction of errors, maintenance of records, and requests for paper copies of Plan communications. To the extent required by applicable law, a Participant shall be advised of the right to request a paper copy of any electronically furnished communication at no charge.

An election, consent, or other document submitted through an authorized electronic system in accordance with such procedures shall be deemed to satisfy any requirement under the Plan that the communication be in writing or signed.

ARTICLE V

ELIGIBILITY AND PARTICIPATION

5.1 Eligibility. Each Employee and Retiree shall be eligible to participate in the Plan as of his or her Entry Date.

5.2 Participation and Elections. An Employee or Retiree may become a Participant by completing and submitting an enrollment form and any other forms or information required by the Administrator. A current Employee who elects to participate in any Benefit option through a Salary Reduction shall also complete and submit a Salary Reduction agreement in accordance with Section 6.2. A Retiree shall participate in accordance with the applicable enrollment procedures and payment requirements established by the Administrator.

A Participant’s election shall be effective for the applicable Plan Year. Unless otherwise provided by the Plan, the Administrator, or applicable law, an election of an insured Benefit option, including medical, dental, or vision coverage, shall automatically continue for the following Plan Year unless the Participant makes a timely election to change or revoke such election during the Open Enrollment Period.

Notwithstanding the foregoing, the Administrator may require an affirmative annual election, certification, or other documentation for any Benefit option for which annual elections are required or appropriate under applicable law or administrative procedures, including but not limited to Health Care Flexible Spending Account elections, Dependent Care Flexible Spending Account elections, and any Medical Insurance Opt-Out benefit.

The Administrator shall establish reasonable procedures for enrollment, elections, certifications, and administration of the Plan, including procedures applicable to Employees, Retirees, and Participants.

5.3 Recommencement of Participation. A former active Participant may recommence participation in the Plan on his or her date of reemployment as an eligible Employee. If a former active Participant is rehired by the Employer within 30 days of his or her date of termination, such Participant shall not be permitted to submit a new election and his or her prior election shall be reinstated for the remainder of the Plan Year. However, a reemployed former active Participant may not make a new election to participate in a Health Care Flexible Spending Account and/or dependent care flexible spending account which is effective during the same Plan Year in which he or she separated from service with the Employer.

Any employee who returns to active employment within ninety (90) days of completing a Protected Leave of Absence for duty in the Uniformed Services shall reenter the Plan upon reemployment. A Participant whose health coverage under the Plan is terminated on account of his or her being in “uniformed service”, and is later reinstated, shall not be subject to a new exclusion or waiting period requirement imposed by such Group Health Plan and/or Health Care Flexible Spending Account, provided that such requirements would not have been imposed if coverage had not been terminated as a result of the “uniformed service.”

5.4 Leave of Absence. A Participant shall not be disqualified from participating in the Plan with respect to Core Coverage, dental and/or vision insurance or the Health Care Flexible Spending Account (“Health Benefits”) during the period in which the Participant is on an Protected Leave of Absence; provided that Participant continues to have an employment relationship with the Employer and arranges to continue to pay his or her required costs, if any, for coverage for the Health Benefits elected for the Plan Year.

The Employer shall continue to provide the Employer Allowance during the Participant’s Protected Leave of Absence irrespective of whether such leave is paid or unpaid.

However, a Participant who takes an unpaid Unprotected Leave of Absence, the Employer will not continue to provide the Employer Allowance during the Participant’s Unprotected Leave of Absence and the Participant shall be required to pay his or her required costs of coverage, if any, in the form provided in Section 8.2. Notwithstanding the preceding, the Participant may revoke his or her election to participate under any health Benefit offered under this Plan, for the remainder of the Plan Year in which such Unprotected Leave of Absence commences. Such revocation shall take effect in accordance with such procedures as prescribed by the Administrator.

If the Participant makes such an election, the Employer’s provision of the Employer Allowance shall also cease. Upon returning from an Unprotected Leave of Absence, a Participant may resume participation in the Plan on the same terms that applied immediately before the leave, as modified by any election changes validly made during the leave, and shall have such additional rights to make or change elections as are otherwise provided under the Plan.

Notwithstanding the foregoing, a Participant on either Protected or Unprotected Leave of Absence shall have no greater rights to Benefits for the remainder of the Plan Year in which the Leave of Absence commences as other Participants.

5.5 Cessation of Participation. An Employee shall cease to be a Participant under this Plan and therefore, under each Component Plan, as of the earliest of:
(a) the date on which the Participant separates from employment with the Employer; or
(b) the date on which the Administrator, on a consistent and uniform basis, deems the Participant has failed to make the required premium payments, if any, for the elected Benefits, as provided in Section 5.6; or
(c) the date on which the Participant is not eligible to participate in any of the Component Plans for which he or she wishes to make an election; or (d) the date on which the Participant dies; or
(e) the date on which the Plan terminates.

5.6 Cessation of Required Contributions. A Participant’s election to participate in the Plan may be terminated in accordance with Subsection 5.5(b) if the Participant fails to make the required premium payments with respect to a Benefit. In such case, that Participant may not make a new benefit election for the remaining portion of the Plan Year. In the event a Participant returns from a Protected or Unprotected Leave of Absence, the Participant may then elect to be immediately reinstated in the Plan on the same terms that applied to the Participant prior to the Leave of Absence.

5.7 Eligibility Under Component Plans. The eligibility of a Participant under a Component Plan shall be the same as set forth in this Article, unless otherwise specified in the Component Plan under which a Participant has elected to receive Benefits. Each Component Plan may provide more rigorous eligibility requirements which may cause a Participant to be ineligible to participate in a particular Component Plan but continue to be eligible to participate in this Plan.

ARTICLE VI

ELECTIONS AND PROCEDURES

6.1 Election of Benefits. Prior to the annual Entry Date (or the first Entry Date for newly hired Employees), there shall be an Open Enrollment Period during which the Employee may elect to participate in this Plan. During the Open Enrollment Period, the Administrator shall provide each Employee and Retiree with an enrollment form and for current or active employees a Salary Reduction Agreement. The Participant shall specify on his or her enrollment form the amount of Salary Reduction, if any, and Employer Allowance which are to be applied to provide the Benefits selected, subject to the limitations on use as set forth in this Plan.

6.2 Salary Reduction Agreement. Prior to participation and prior to each Plan Year, the Employee shall complete a Salary Reduction Agreement which shall include, at a minimum, the following information:
(a) that the enrollment form must be completed and returned to the Administrator during the Open Enrollment Period; and
(b) that the election shall be irrevocable and effective for the entire Plan Year for which the election is made, unless the Participant is entitled to change his or her election as provided in this Article VI; and
(c) that the Participant’s Salary Reduction shall be considered Employer contributions used to pay for Benefits under the Plan.

Salary Reductions shall be contributed to the Plan by the Employer, on behalf of a Participant on a level and pro rata basis for each payroll period. The Administrator, may, in its discretion, establish a limit on the amount of Salary Reductions which a Participant may elect for the Plan Year or adjust any Salary Reduction election made under the Plan, to ensure that the Plan complies with the nondiscrimination provisions of Article XII.

6.3 Core Coverage - Mandatory Health Coverage. Each Employee shall be permitted to select among the Benefits made available under the Plan; however, each Employee shall be required to select Core Coverage under the Plan unless the Employee and his or her eligible Dependents, if any, are enrolled in another group health plan for the following Plan Year. An Employee shall only be exempt from electing a Core Coverage option upon completion of the following:
(a) The Employee shall provide the Administrator with satisfactory evidence substantiating that the Employee and his or her eligible Dependents, if any, are enrolled in a group health plan through another source for the following Plan Year and that the Core Coverage option would duplicate the other coverage.
(b) The Employee declines coverage under the Employer’s Health Benefit Plan and agrees in writing to hold the Employer harmless for any consequences resulting in the waiver of such coverage.
(c) The Employee acknowledges in writing that the Employee and his or her eligible Dependents, if any, shall not be permitted to enroll in health coverage under the Plan until the next Open Enrollment Period, subject to the terms and restrictions of the insurance provider. (d) The Employee completes and submits to the Administrator CalPERS HBD-12 form to decline health coverage through CalPERS.

In the event an Employee satisfies the requirements for waiving the Core Coverage option pursuant to this Section 6.3, Employee shall receive the Medical Insurance Opt-Out in lieu of the Employer Allowance. The Employee may apply the Medical Insurance Opt-Out toward other Benefit options made available under this Plan, including the cash option described in Section

7.1(c). The amount of the Medical Insurance Opt-Out made available to the Employee shall be based upon the opt-out provisions for the respective employee group, as set forth on Schedule “A”.

6.4 Failure to Make Initial Election. If an Employee who first becomes eligible fails to return a completed enrollment form before the end of the Open Enrollment Period and does not affirmatively opt out of Core Coverage in accordance with Section 6.3, the Employee shall be automatically enrolled in employee-only Core Coverage under the Health Benefit Plan designated by the Employer or Administrator if permitted by the CalPERS health program. Any optional employee-paid benefits available under this Plan shall be deemed declined unless affirmatively elected by the Employee.

6.5 Elections for Subsequent Plan Years.
(a) Open Enrollment Period. An Open Enrollment Period shall occur prior to the beginning of each Plan Year. During the Open Enrollment Period, a Participant who wishes to change his or her existing elections shall have the opportunity to elect new or different coverage under the Plan effective for the subsequent Plan Year subject to the terms and conditions of the Component Plans.
(b) Failure to Reelect. If a Participant fails to designate on the election form how he or she wishes to allocate the Employer Allowance but remains eligible to participate, the Participant shall be deemed to have elected to allocate the Employer Allowance towards the premium for Core Coverage, as determined by the Administrator on a uniform and nondiscriminatory basis. (c) Flexible Spending Accounts. Elections to contribute to the flexible spending accounts must be affirmatively elected each year by the Participant and a failure to reelect shall result in nonparticipation under the flexible spending accounts. (d) Continuation Coverage. During an Open Enrollment Period, any Participant, or a Qualified Beneficiary thereof, that has elected continuation of health coverage under the Plan, shall have the opportunity to elect new or different coverage under the Plan effective for the subsequent Plan Year. However, any such election shall be limited to health care options available under the Plan.

6.6 Special Enrollment Period. In accordance with the Code Section 9801(f) and the regulations issued by the Department of Health and Human Services, an eligible Employee or Dependent, who either incurs a loss of health coverage or becomes otherwise eligible for health coverage under this Plan shall be permitted to enroll for health coverage under the Plan in accordance with one of the special enrollment periods described in paragraphs (a) and (b) below. (a) Loss of Health Coverage. An Employee who is otherwise eligible to enroll in the Plan but has not enrolled, or an eligible Dependent who is not enrolled under the Plan, shall be permitted to enroll in the Plan if:
(1) The Employee or Dependent was covered under another group health plan or had alternate health insurance coverage (“Prior Health Coverage”) at the time coverage under this Plan was previously offered to the Employee.
(2) The Employee stated in writing at such time that Prior Health Coverage was the reason for declining enrollment.
(3) The Employee’s or Dependent’s Prior Health Coverage was either:
(i) under a continuation coverage provision and the coverage period was exhausted; or
(ii) was terminated as a result of loss of eligibility (including a result from a change in family status) or employer contributions toward such coverage were terminated. (4) The Employee requests enrollment under the Plan not later than thirty (30) days after the loss of the other coverage or employer contribution. (b) Dependent Special Enrollment Period. Any Employee, regardless of whether said Employee is currently enrolled for health coverage under the Plan, who experiences an increase in the number of Dependents whether through marriage, birth, adoption or placement for adoption, shall be permitted to enroll for health coverage under the Plan. In such event, Employee shall have the opportunity to enroll all other Dependents who are otherwise eligible for coverage, including the Employee if not enrolled, provided the Employee elects enrollment within thirty (30) days after the date of the marriage, birth, adoption, or placement for adoption. (c) Health Care Flexible Spending Account. Notwithstanding the foregoing, the special enrollment rights conveyed under this Section shall not extend to include an election to contribute to a Health Care Flexible Spending Account offered under the Plan.

6.7 Revocability of Elections. Except as otherwise provided in this Plan, a Participant's election for a Plan Year is irrevocable. Notwithstanding the foregoing, the Administrator may permit a Participant to revoke an election and make a new election during a Plan Year to the extent permitted under Section 125 of the Code, Treasury Regulation § 1.125-4 (or any successor regulation), and the terms of this Plan, including the following:
(a) a change in family status, as described in Section 6.9; (b) a significant change in the cost of coverage of the Benefits, as described in Sections

6.10 and 6.11;
(c) a qualified medical child support order, as described in Section 6.12; (d) eligibility for continuation coverage under Article XI, as described therein; (e) special enrollment rights under HIPAA;
(f) entitlement to or loss of entitlement to Medicare or Medicaid; (g) a change in employment status affecting eligibility for coverage; (h) a change in residence affecting eligibility for coverage; (i) Any other event for which a mid-year election change is permitted under Section 125 of the Code, applicable Treasury Regulations, or other applicable IRS guidance, as determined by the Administrator.

6.8 Participant Makes Incorrect Election. If a Participant does not elect the correct amount under his or her Salary Reduction to pay for coverage of the Benefits selected under the Plan, the Administrator is authorized to increase or decrease a Participant’s Salary Reduction by the amount necessary to provide the Participant’s elected coverage under the Plan.

6.9 Change in Family Status. A Participant may make a change in coverage during a Plan Year due to a change in family status, as set forth in this Section. A Participant must notify the Administrator and must complete a new election form to change coverage. The Participant’s election shall only be deemed valid if the requested change in coverage is necessitated by and corresponds with the change in family status and is consistent with the terms and conditions of the affected Component Plan. A Participant must notify the Administrator and submit a completed election form requesting the change no later than thirty (30) days after the applicable change in family status (or such longer period as required by applicable law). This election shall be effective as of the first day of the month following the date the Participant provides the Administrator with a new election form reflecting the change in coverage due to a change in family status.

A change in family status shall include the following:
(a) a change in the Participant’s marital status, including marriage, death of Spouse, divorce, legal separation, or annulment;
(b) a change in the number of Dependents of a Participant, including a birth of a child, adoption, placement for adoption, or death of a Dependent; (c) any change in the employment status of the Participant, Spouse or Dependent which results in that individual becoming or ceasing to be eligible under this Plan or other employee benefit plan maintained by the employer of the Participant, Spouse or Dependent, including a termination or commencement of employment; a strike or lockout; a commencement or return from an unpaid leave of absence (including leave taken under FMLA); a change in work site; or a reduction or increase in hours of employment (including a switch between part-time and full-time); (d) a Dependent satisfies or ceases to satisfy the eligibility requirements for coverage due to attainment of age, Student status, or any similar circumstances as provided under the Component Plan under which the employee receives coverage; (e) a change in the place of residence of the Participant, Spouse, or Dependent; and (f) a Participant, Spouse, or Dependent becoming or ceasing to be entitled to coverage under Medicare or Medicaid.

To the extent the Code, and regulations issued thereunder, alters this definition of change in family status, this Section 6.9 is intended to be interpreted in accordance with any revised definition or interpretation.

6.10 Change in Cost of Benefit.
(a) Insignificant Change. If the cost of any Benefit offered under the Component Plans (except a Component Plan which provides for the reimbursement of health or dependent care expenses) increases or decreases during the Plan Year, the Administrator may, on a reasonable and consistent basis, automatically increase or decrease a Participant’s Salary Reduction by a corresponding amount to ensure that the Participant continues to receive the elected coverage under the Component Plans; provided, however, that if the increase or decrease is a significant change in cost, that the Participant shall be given the option to elect to change his or her Benefits, as further explained in (b) below.
(b) Significant Increase in Cost of Benefit. If the cost of a Benefit option (other than a Component Plan which provides for the reimbursement of health or dependent care expenses) significantly increases during a Plan Year, all affected Participants may make a corresponding change in their Benefit election under the Plan. Changes that may be made include the following:
(1) In the case of a Benefit option which has experienced a significant decrease in cost, a Participant may make a prospective change to an election to commence participation in that Benefit option.
(2) In the case of a Benefit option what has experienced a significant increase in cost, a Participant may change an election to terminate such coverage and either, elect prospective coverage under another Benefit option providing similar coverage or drop coverage if no other Benefit option providing similar coverage is available.

For purposes of this Section 6.10(b), a “cost of increase or decrease” refers to an increase or decrease in the amount of the Salary Reductions contributed by a Participant under the Plan, whether that increase or decrease results from an action taken by the Employee (such as switching between full-time and part-time status) or from an action taken by the Employer (such as reducing the amount of Employer contributions for a class of Employees). (c) Dependent Care Flexible Spending Account. In the case of a Participant’s election to contribute under the Dependent Care Flexible Spending Account, a Participant’s prior election may be changed only if the cost change is imposed by a Dependent Care Provider who is not a relative of the employee.

6.11 Significant Change in Coverage of Component Plan Benefit. (a) Significant Curtailment Without Loss of Coverage, If a Participant or a Participant’s Spouse or Dependent experiences a “significant curtailment of coverage” under a Benefit option that is not a loss of coverage, including a significant increase in the deductible, copayment, or the out-of-pocket cost sharing limit under a Group Health Plan; the Participant may revoke his or her election for such coverage and prospectively elect to receive coverage under another Benefit option providing similar coverage. For purposes of this Section, “significant curtailment of coverage” under a Component Plan occurs only if there is an overall reduction in coverage provided under the Component Plan so as to constitute reduced coverage generally. In this regard, the loss of one particular physician in a health care provider network in most cases will not qualify for a significant curtailment of coverage under this Section. (b) Significant Curtailment With Loss of Coverage. If a Participant or a Participant’s Spouse or Dependent experiences a significant curtailment of coverage that is a “loss of coverage” under a Benefit option, the Participant may revoke his or her election for such coverage and elect either to receive coverage under another Benefit option providing similar coverage or to drop coverage if no other Benefit option providing similar coverage is available under the Plan. For this purpose, a “loss of coverage” means a complete loss of coverage under a Benefit option, including the elimination of a Benefit option, an HMO ceasing to be available in the area where the individual resides, or the individual losing all coverage under the Benefit option by reason of an overall lifetime or annual limitation under a Group Health Plan. In this regard, each of the following is considered to be a “loss of coverage” under this Section:
(1) a substantial decrease in the medical care providers available under the Benefit option (such as a major hospital ceasing to be a member of a preferred provider network or a substantial decrease in the physicians participating in a preferred provider network or an HMO;
(2) a reduction in the Benefits for a specific type of medical condition or treatment with respect to which a Participant or the Participant’s Spouse or Dependent is currently in a course of treatment; or
(3) any other similar fundamental loss of coverage.
(c) Addition or Improvement of Benefit Option. If during the Plan Year, a Component Plan adds a new Benefit package option or other coverage option, or if coverage under an existing Benefit option is significantly improved, any Participant or Employee, who is otherwise eligible to participate in the Plan, may revoke their election under the Plan for the Plan Year and make an election on a prospective basis for coverage under the new or improved Benefit option. (d) Change In Coverage Under Another Employer Plan. A Participant, or an Employee who is otherwise eligible to participate in the Plan but has elected not to participate, may make a prospective election change that is on account of and consistent with a change made under another Group Health Plan (including a plan of the Employer or another employer) by the Employee or the Employee’s Spouse or Dependent, provided the other employer plan allows participants to make an election change that would be permitted under the rules of IRS Reg. §1.125-4(c) and as provided in this Plan.

6.12 Qualified Medical Child Support Order. A Participant may make a change in coverage during a Plan Year to provide health coverage under the Plan for Participant’s Dependent pursuant to the terms of a judgement, decree, or order resulting from a family law proceeding, including a “qualified child support order” as defined under ERISA Section 609, requiring Participant to provide health coverage for the Dependent. The Participant may also make a change which cancels health coverage for the Participant’s Dependent provided the order requires the Spouse, former Spouse, or other individual to provide health coverage for the Dependent.

ARTICLE VII

EMPLOYER ALLOWANCE

7.1 Employer Allowance. The Employer shall contribute on behalf of each Participant an Employer Allowance in an amount to be determined each Plan Year by the Employer for each employee group in accordance with the provisions set forth in Schedule “A”. Schedule “A” shall be updated or revised as required after such time the City Council has approved the Employer Allowance authorized by the labor contracts or the memorandum of understanding with the identified labor associations, the Benefits for the Management, Confidential, Executive Employees, and Retirees established by resolution of the City Council. The Employer Allowance shall be credited to each Participant as of the first day of each month in each Plan Year during which he or she is a Participant under the Plan and can only be used to purchase Core Coverage, unless the provisions of Section 7.1(b) apply. The Employer shall inform the Participant of the amount of the Employer Allowance available for each Plan Year during the Open Enrollment Period. Notwithstanding the preceding, a Participant that satisfies the requirements for waiving the Core Coverage option pursuant to Section 6.3 shall receive the Medical Insurance Opt-Out set forth in Schedule “A” in lieu of the Employer Allowance. (a) Designated Employer Contribution. Unless the Participant satisfies the requirements for waiving the Core Coverage option pursuant to Section 6.3, a portion of the Employer Allowance shall be designated as the Employer’s contribution towards health coverage under the Public Employees’ Medical and Hospital Care Act. The amount shall be determined pursuant to Section 22892 of the California Government Code in accordance with the Employer’s resolution filed with the California Public Employees’ Retirement System. (b) Unused Employer Allowance. If a Participant elects Core Coverage having aggregate costs less than the Participant’s Employer Allowance, the remaining amount may be used to offset the cost of coverage under the City’s dental and/or vision plans elected by the Participant. No Participant shall be entitled to the cash value of any unused Employer Allowance. (c) Special Rule Regarding Medical Insurance Opt-Out. In the event a Participant elects to waive coverage under the Employer’s Health Benefit Plan in accordance with Section

6.3, he or she shall receive the Medical Insurance Opt-Out determined on the basis of such Participant’s employee bargaining group, as set forth on Schedule “A” and the enrollment form and Salary Reduction Agreement. The Participant shall receive the Medical Insurance Opt-Out as taxable cash. The Medical Insurance Opt-Out shall be paid by the Employer in twenty-four (24) equal installments payable during the first two payroll dates of each month during the Plan Year.

7.2 Nature of Employer Allowance. No money shall actually be allocated to any account(s) on behalf of Participants. The Employer Allowance credited to a Participant shall be of a memorandum nature, the amount of which is maintained by the Administrator for accounting purposes and shall not be representative of any identifiable trust assets.

ARTICLE VIII

FUNDING AND AVAILABLE BENEFITS

8.1 Funding. The Benefits provided herein shall be paid by the Employer; provided, however, that the Employer’s payments under the Plan shall be limited to such amounts of Compensation as a Participant elects to forego pursuant to his or her Salary Reduction Agreement and the Employer Allowance, or if the Participant satisfies the requirements for waiving the Core Coverage option pursuant to Section 6.3, the Medical Insurance Opt-Out.

8.2 Payment of Contributions While on an Unpaid Leave of Absence. If a Participant takes an unpaid Leave of Absence, whether protected or unprotected, continuation of coverage under any health Benefit elected by the Participant shall be subject to the terms and conditions of the applicable Health Benefit Plan, the Participant’s continued eligibility for coverage, the rules of the CalPERS Health Benefits Program under the Public Employees’ Medical and Hospital Care Act (“PEMHCA”), if applicable, and applicable federal, state, and local law.

To the extent a Participant remains eligible for coverage during an unpaid Leave of Absence, the Participant may be required to make payments directly to the applicable Health Benefit plan or carrier in accordance with the procedures established by the Administrator, CalPERS, or the applicable Health Benefit plan. For Participants enrolled in a PEMHCA plan, such payments may include the full applicable monthly premium under the CalPERS Direct Payment process, rather than only the Participant’s normal employee contribution, as provided under the applicable CalPERS rules and the Employer’s applicable policies.

Any employee contribution that is required to be made through this Plan on an after-tax basis during an unpaid Leave of Absence shall be administered in accordance with applicable federal tax law. No pre-tax salary reduction shall be made under this Plan from compensation that is not otherwise available to the Participant.

If coverage is not continued through the CalPERS Direct Payment process or other applicable continuation arrangement, or if the Participant otherwise experiences a loss of coverage that gives rise to a right to continuation coverage under COBRA or other applicable law, continuation coverage shall be offered and administered in accordance with the applicable COBRA requirements, the applicable CalPERS procedures, and the terms of the applicable Health Benefit plan. COBRA continuation coverage shall be subject to the applicable COBRA premium, election, payment, notice, and termination requirements.

Failure to make any required payment for continued coverage may result in termination of coverage in accordance with the terms of the applicable Health Benefit plan, CalPERS procedures, COBRA requirements, and other applicable law, including any applicable notice and grace-period requirements. The Administrator shall not terminate coverage solely by reason of a missed payment except in accordance with those applicable requirements.

Nothing in this provision shall be construed to require the Employer to continue making an employer contribution toward a Participant’s Health Benefits during an unpaid Leave of Absence unless such contribution is required by applicable law, the applicable CalPERS contract or resolution, the applicable Health Benefit plan, collective bargaining agreement, personnel policy, or other governing Employer policy.

Nothing in this provision shall limit any rights or obligations applicable to a Participant on FMLA, CFRA, pregnancy disability leave, military leave, or any other legally protected leave.

8.3 Uniformed Service Under USERRA. In accordance with the Uniformed Services Employment and Reemployment Rights Act of 1991(“USERR.A”), a Participant who is absent from employment with the Employer on account of being in the Uniformed Services as defined in Section 3.28, may elect to continue participation in the Plan. The coverage period shall extend for the lesser of eighteen (18) months or until the Participant fails to apply for reinstatement or to return to employment with the Employer. The Participant shall be responsible for making the required contributions to pay for Benefits elected during the period during which he or she is in Uniformed Service. The manner in which such payments are made shall be determined by the Administrator, in a manner similar to the payment of contributions with respect to a Leave of Absence.

8.4 Provision of Benefits. The Employer shall provide those Benefits elected by a Participant on his or her election form for any Period of Coverage in accordance with such election. The Benefits shall be provided pursuant to the terms and conditions of the Component Plans, where applicable, as shall be set forth from time to time in the individual Component Plan documents; provided, however, that the terms and conditions of the Component Plans are not inconsistent with the terms and-conditions of this Plan. No Benefit under the Plan shall be paid in any manner that defers the receipt of Compensation beyond the last day of the Plan Year except as specifically provided in Sections 9.8 with respect to the Grace Period for reimbursement of Eligible Dependent Care Expenses and Section 10.8 with respect to the carryover provisions for the reimbursement of Eligible Medical Care Expenses.

8.5 Cash Payments. Any cash to be paid to a Participant resulting from the Medical Insurance Opt-Out shall be added to his or her taxable Compensation and shall be paid in twenty-four (24) equal installments payable during the first two payroll dates of each month during the Plan Year, subject to any applicable wage withholding or similar taxes. No Benefit under the Plan shall be paid in any manner that defers the receipt of Compensation beyond the last day of the Plan Year.·

8.6 Flexible Spending Accounts. The amounts designated by the Participant to be applied for health care reimbursement or dependent care assistance shall be credited to a separate ledger account in the Participant’s name. Any amounts credited to a Participant’s Health Care Flexible Spending Account for any Plan Year shall be used only toward the payment of or reimbursement for Participant’s Eligible Medical Care Expenses, as that term is defined in Section 10.2(a) below, incurred for such Plan Year, as determined under Article X. Likewise any amounts credited to a Participant’s dependent care flexible spending account for any Plan Year shall be used only toward the payment of or reimbursement for Participant’s Eligible Dependent Care Expenses, as that term is defined in Section 9.2(d) below, incurred for such Plan Year, as determined under Article IX.

8.7 Taxable Benefits. If offered by the Employer, Employees shall be permitted to elect to receive certain permitted taxable benefits. An Employee receiving such benefits shall be treated as having received, at the time that the Benefit is received, cash compensation equal to the full value of the Benefits and then subsequently purchasing the Benefits with after-tax Employee contributions. For example, the Employer may allow Participants to elect health coverage under the Employer’s Health Benefit Plan for an individual who is not the Spouse or Dependent of the Participant; provided, however, that the fair market value of such health coverage is included in the Participant’s W-2 taxable income.

ARTICLE IX

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT

9.1 Component Plan. This Article IX sets forth the provisions of the CITY OF CORONA DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT PLAN (“Dependent Care Flexible Spending Account” or “Dependent Care FSA”). Benefits under the Dependent Care FSA shall be provided through reimbursement of Eligible Dependent Care Expenses incurred by a Participant during the Participant’s Period of Coverage, subject to the requirements and limitations of Code Sections 125 and 129 and the regulations and guidance thereunder. A Participant shall be entitled to reimbursement only for Eligible Dependent Care Expenses incurred during the period in which the Participant is covered under the Dependent Care FSA, including any applicable Grace Period.

9.2 Definitions. For purposes of this Article IX, the following definitions shall supplement the definitions contained elsewhere in the Plan. To the extent of any conflict, the definitions in this IX shall control with respect to the Dependent Care FSA; provided, however, that applicable provisions of the Code and Treasury Regulations shall control to the extent required by law. (a) Qualifying Day Care Center. “Qualifying Day Care Center” means facility that satisfies the requirements of Code Section 21(b)(2)(D), including a facility that provides care for more than six individuals (other than individuals who reside at the facility) on a regular basis during the taxable year and that complies with applicable laws and regulations of the state or local jurisdiction in which it is located and receives a fee, payment or grant for providing such care, whether or not operated for profit).
(b) Qualifying Individual. “Qualifying Individual’ means an individual who satisfies the requirements of Code Sections 21(b)(1) and 129, as applicable, including:
(1) a Qualifying Child who is under age 13 when the Eligible Dependent Care Expense is incurred; or
(2) a Spouse or other individual who is physically or mentally incapable of caring for himself or herself and who satisfies the applicable residence and dependency requirements under Code Section 21(b)(1).

For purposes of determining whether an individual is a Qualifying Individual, the applicable requirements of the Code and Treasury Regulations shall apply. (c) Qualifying Dependent Care Services. “Qualifying Dependent Care Services” means employment-related dependent care services described in Code Sections 21(b)(2) and 129, including services performed in or outside the Participant’s home, that are incurred for the purpose of enabling the Participant and, if married, the Participant’s Spouse to be gainfully employed or to actively seek employment, subject to the requirements of applicable law.

An expense shall not be an Eligible Dependent Care Expense if the expense is paid to:
(1) the Participant’s Spouse;
(2) a person whom the Participant is entitled to claim as a dependent for federal income tax purposes;
(3) the Participant’s child who is under age 19 as of the close of the taxable year; or
(4) the parent of the Participant’s Qualifying Child if the Qualifying Child is under age 13.
(d) Eligible Dependent Care Expense. “Eligible Dependent Care Expense” means an expense for Qualifying Dependent Care Services that satisfies the requirements of Code Sections 21 and 129 and the applicable Treasury Regulations and that is incurred during the Participant’s Period of Coverage or applicable Grace Period. An expense is incurred when the Qualifying Dependent Care Services giving rise to the expense are provided, regardless of when the Participant is billed for or pays the expense.

Expenses for nonrefundable registration, enrollment, or similar fees shall be eligible only to the extent permitted under applicable law and the fees are allocable to Eligible Dependent Care Expenses. No expense shall be eligible to the extent it is attributable to education, meals, transportation, lodging, entertainment, or other services that do not constitute employment-related dependent care under applicable law.

9.3 Annual Election. For each Plan Year an eligible Employee who elects to participate in the Dependent Care FSA shall affirmatively elect the amount of Compensation to be contributed through a Salary Reduction for that Plan Year, subject to the applicable annual limit established by the Plan and the limitations by Code Section 129.

The maximum amount that may be elected for a Plan Year shall not exceed the lesser of:
(a) the annual amount permitted under Code Section 129(a)(2), as amended from time to time, subject to any lower maximum established by the Plan; (b) the Participant’s earned income for the taxable year, if Participant is unmarried at the close of the taxable year; or
(c) the lesser of the Participant’s earned income or the Partcipant’s Spouse’s earned income for the taxable year, if the Participant is married at the close of the taxable year.

The applicable earned-income limitation shall be determined in accordance with Code Section 129 and the applicable Treasury Regulations. If the Participant’s Spouse is a full-time student or is physically or mentally incapable of caring for himself or herself, the Spouse’s earned income shall be determined in accordance with the special rule provided under Code Sections 21(d) and 129.

The maximum amount available under this Section shall be reduced, as required by Code Section 129, by dependent care assistance provided to the Participant or the Participant’s Spouse under any other dependent care assistance program or arrangement that is required to be taken into account for purposes of Code Section 129

9.4 Dependent Care Flexible Spending Account. The Dependent Care FSA shall be maintained as an unfunded bookkeeping account established for each Participant in accordance with the Participant’s annual election. The account shall be credited with amounts contributed through Salary Reduction and debited for reimbursements of Eligible Dependent Care Expenses.

Because the uniform coverage rule applicable to health flexible spending arrangements does not apply to dependent care assistance programs, reimbursement of Eligible Dependent Care Expenses shall be limited to the Participant’s unused account balance attributable to contributions actually made and available for reimbursement at the time the claim is approved, subject to the applicable Grace Period and other provisions of this Article IX

9.5 Reimbursement of Eligible Expenses. A Participant shall be entitled to reimbursement only for Eligible Dependent Care Expenses that have been incurred and properly substantiated in accordance with the Plan’s claims procedures. An Eligible Dependent Care Expense shall be considered incurred when the Qualifying Dependent Care Services giving rise to the expense are provided regardless of when the Participant is billed for or pays the expense. Reimbursement may be made after a Participant’s cessation of participation to the extent the expense was incurred while the Participant was covered under the Dependent Care FSA and the claim is otherwise timely and properly submitted under the Plan.

9.6 Limitations on Reimbursement and Forfeiture. The total amount reimbursed to a Participant for any Plan Year and appliable Grace Period shall not exceed the amount of Eligible Dependent Care Expenses incurred during the applicable period and the amount available in the Participant’s Dependent Care FSA for reimbursement.

Amounts elected but not used for Eligible Dependent Care Expenses within the applicable Plan Year and Grace Period shall be forfeited, subject to any rights expressly provided under applicable law or the Plan’s claims and forfeiture provisions.

No reimbursement shall be made unless the expense has been properly substantiated in accordance with the Plan’s claims procedures.

9.7 Claims for Benefits. A Participant seeking reimbursement under the Dependent Care FSA shall submit a claim to the Administrator or its designated claims administrator in the form and within the time prescribed by the Administrator. The Administrator may require such information and documentation as is reasonably necessary to determine whether an expense is an Eligible Dependent Care Expense and to satisfy the substantiation requirements of Code Section 125 and 129.

Such information or documentation may include, as applicable:
(a) the name and identifying information of the Qualifying Individual for whom the expense was incurred;
(b) the dates and nature the Qualifying Dependent Care Services; (c) the name, address, and taxpayer identification number of the care provider, except to the extent not required by appliable law for a tax-exempt provider; (d) the amount of the expense and evidence that the expense has been incurred; (e) the relationship, if any, between the Participant and the care provider; (f) information necessary to establish that the expense was incurred to enable the Participant and, if applicable, the Participant’s Spouse to be gainfully employed or to actively seek employment;
(g) information concerning the Participant’s and, if applicable, Participant’s Spouse’s earned income and any applicable Student or incapacity status; and. (h) information concerning dependent care assistance received under any other plan or arrangement, to the extent necessary to administer the Plan in accordance with Code Section 129.

The Administrator may rely upon information and documentation submitted by the Participant, subject to applicable substantiation requirements. The Administrator shall process properly submitted claims in accordance with the Plan’s claims procedures.

9.8 Time Limit; Grace Period. Claims for Eligible Dependent Care Expenses incurred during Plan year must be submitted within the run-out period established by the Administrator following the end of the Plan Year. During the Grace Period, amounts remaining from the immediately preceding Plan Year may be used to reimburse Eligible Dependent Care Expenses incurred during the Grace Period.
(a) Applicability. The Grace Period shall apply uniformly to Participants in accordance with applicable Treasury Regulations. A Participant who was covered by the Dependent Care FSA on the last day of the Plan Year shall be eligible to use any applicable prior Plan Year balance for Eligible Dependent Care Expenses incurring during the Grace Period, subject to the terms of the Plan.
(b) No Cash-Out or Conversion. Amounts remaining from a prior Plan Year may not be cashed out or converted to another taxable or nontaxable benefit and may be used only for reimbursement of Eligible Dependent Care Expenses. Dependent Care Flexible Spending Account amounts may not be used to reimburse Eligible Medical Care Expenses. (c) Order of Reimbursement. Eligible Dependent Care Expenses incurred during the Grace Period shall be reimbursed first from any available prior Plan Year balance and then, to the extent permitted by the Plan and applicable law, from amounts available for the current Plan Year.

The Administrator may establish reasonable administrative procedures governing the order and processing of claims.
(d) Forfeiture. Any amount remaining after the expiration of the applicable Grade Period and completion of the applicable run-out period shall be forfeited in accordance with the Plan and applicable law.

9.9 Forfeitures and Plan Administration. Forfeited amounts shall be treated and applied in accordance with the general forfeiture provisions of the Plan and applicable Treasury Regulations.

Nothing in this Article IX shall be construed to require forfeited amounts to be distributed to Participants or to prohibit the use of forfeited amounts for purposes permitted under applicable law.

9.10 Coordination with Applicable Law. The Dependent Care FSA shall be administered in accordance with Code Sections 125 and 129, the applicable Treasury Regulations, and applicable IRS guidance. If a provision of this Article IX is inconsistent with a mandatory requirement of applicable law, the provision shall be administered to the extent necessary to comply with such requirement, and the Plan shall be interpreted and, if necessary, amended accordingly Nothing in this Article IX shall be construed to permit reimbursement of any expense unless the expense constitutes an Eligible Dependent Care Expense under this Plan and satisfies the requirements of Code Sections 125 and 129 and the applicable Treasury Regulations. To the extent any provision of this Article IX is inconsistent with a mandatory requirement of applicable federal tax law, this Article IX shall be administered in a manner consistent with such requirement.

ARTICLE X

HEALTH CARE FLEXIBLE SPENDING ACCOUNT

10.1 Component Plan. This Article X sets forth the provisions for the CITY OF CORONA HEALTH CARE FLEXIBLE SPENDING ACCOUNT PLAN (the “Health Care Flexible Spending Account” or “Health Care FSA”). Benefits under the Health Care FSA shall be provided through reimbursement of Eligible Medical Care Expenses incurred by a Participant or an individual whose expenses are eligible for reimbursement under this Article X during the Participant’s Period of Coverage. A Participant shall be entitled to reimbursement only for Eligible Medical Care Expenses incurred during the Participant’s Period of Coverage, subject to the applicable provisions of this Article X.

10.2 Definitions. For purposes of this Article X, the following definitions shall supplement the definitions contained elsewhere in the Plan. To the extent of any conflict, the definitions in this Article X shall control with respect to the Health Care FSA; provided, however, that applicable provisions of the Internal Revenue Code and Treasury Regulations shall control to the extent required by law.
(a) Eligible Medical Care Expense. “Eligible Medical Care Expense means an expense incurred for medical care as defined in Code Section 213(d), as amended, and the applicable Treasury Regulations, that is eligible for reimbursement under a health flexible spending arrangement and is properly substantiated in accordance with the Plan and applicable law.

Eligible Medical Care Expenses may include, to the extent permitted under Code Section 213(d) and applicable guidance, expenses for medical, dental, and vision care, prescription drugs, over-the-counter medicines and drugs, and other eligible medical care expenses not otherwise reimbursed or reimbursable under insurance or another plan or arrangement. Eligible Medical Care Expenses shall not include premiums for accident or health insurance or premiums for qualified long-term care insurance, except to the extent otherwise permitted by applicable law.

An expense shall not constitute an Eligible Medical Care Expense to the extent that it is reimbursed or reimbursable under any other plan or arrangement, or to the extent the expense is otherwise ineligible under applicable law. (b) Dependent. “Dependent” means an individual who is a dependent as defined in Code Section 152, determined without regard to Code Section 152(b)(1), (b)(2), or (d)(1)(B), as required by Code Section 105(b) and applicable Treasury Regulations.

10.3 Annual Election. For each Plan Year, an eligible Employee who elects to participate in the Health Care FSA shall affirmatively elect the amount of Compensation to be contributed through Salary Reduction for that Plan Year.

The maximum amount that may be elected for a Plan Year shall not exceed the maximum salary reduction contribution permitted for a health flexible spending arrangement under Code Section 125(i), as amended from time to time, subject to any lower maximum established by the Plan or the Employer.

For Plan Years beginning in 2026, the maximum annual salary reduction election shall not exceed $3,400. Any amount permitted to be carried over from a prior Plan Year under Section 10.8 shall not count against the annual salary reduction election limit for the current Plan Year.

10.4 Health Care Flexible Spending Account; Uniform Availability of Benefits. The Health Care FSA shall be maintained as an unfunded bookkeeping account established for each Participant pursuant to the Participant’s annual election under Section 6.1.

The full amount of the Participant’s annual Health Care FSA election, reduced by amounts previously reimbursed for the applicable Period of Coverage, shall be available throughout the Participant’s Period of Coverage for reimbursement of Eligible Medical Care Expenses, without regard to the amount of Salary Reduction contributions actually made by the Participant at the time the expense is incurred.

Any amount carried over from a prior Plan Year pursuant to Section 10.8 shall be available in addition to the Participant’s annual election for the current Plan Year and shall be subject to the terms and limitations of the carryover provision.

10.5 Reimbursement of Eligible Expenses. A Participant shall be entitled to reimbursement of Eligible Medical Care Expenses incurred during the Participant’s Period of Coverage, subject to the terms of this Article X and the Plan’s applicable claims and substantiation procedures.

An Eligible Medical Care Expense shall be considered incurred when the medical care or service giving rise to the expense is provided, regardless of when is billed for or pays the expense.

Reimbursement shall not be made for an expense that has not been properly substantiated or that is not an Eligible Medical Care Expense. Reimbursement shall be made in accordance with the uniform coverage requirements applicable to health flexible spending arrangements.

A Participant may submit a claim for reimbursement after cessation of participation to the extent the expense was incurred during the Participant’s Period of Coverage and the claim is otherwise timely and properly submitted under the Plan.

10.6 Debit Card and Other Electronic Payment Procedures. (a) Use of Debit Card. The Administrator may make available to Participants a Health Care Flexible Spending Account debit card or other electronic payment method for the payment of Eligible Medical Care Expenses. Use of the debit card or other electronic payment method shall be subject to the terms and conditions established by the Administrator and its designated third-party administrator.
(b) Substantiation. The use of a debit card or other electronic payment method does not eliminate the requirement that each expense be substantiated in accordance with Code Section 125, applicable Treasury Regulations, and other applicable guidance. Transactions may be substantiated through an automated or electronic substantiation process when permitted by applicable law, including through merchant-level substantiation, electronic claims information, explanation-of-benefits information, or other documentation or data that satisfies applicable substantiation requirements.
(c) Additional Documentation. If a transaction cannot be automatically substantiated, the Participant may be required to provide additional documentation or information, including an itemized receipt, explanation of benefits, or other documentation sufficient to establish that the expense is an Eligible Medical Care Expense. (d) Improper or Unsubstantiated Transactions. If a debit card transaction is determined to be ineligible or remains unsubstantiated after reasonable efforts to obtain substantiation, the Administrator may take corrective action permitted under applicable law and the procedures of the third-party administrator, including requiring repayment of the improper payment, offsetting the amount against subsequently submitted Eligible Medical Care Expenses to the extent permitted by law, suspending the Participant’s use of the debit card, or taking other corrective action permitted under applicable law.
(e) Administrative Procedures. The Administrator may establish and periodically modify reasonable administrative procedures governing the use of debit cards, electronic payment methods, automated substantiation, claims submission, documentation, reimbursement, and correction of improper payments, provided that such procedures are consistent with the Plan and applicable law.

10.7 Claims and Substantiation Procedures.
(a) Reimbursement Claim. A Participant who pays an Eligible Medical Care Expense without using an approved debit card or other electronic payment method may submit a claim for reimbursement to the Administrator or its designated third-party administrator in the form and manner prescribed under the Plan or applicable administrative procedures of the designated third-party administrator.
(b) Substantiation. Claims and payment-card transactions shall be substantiated in accordance with Code Section 125, applicable Treasury Regulations, and applicable administrative guidance. The Administrator or its designated third-party administrator may require documentation reasonably necessary to establish the nature, date, and amount of the expense and that the expense constitutes an Eligible Medical Care Expense. No reimbursement shall be made unless the expense has been properly substantiated in accordance with applicable law.
(c) Claims Administration. The Administrator may engage or delegate to a qualified third-party administrator responsibility for receiving, reviewing, adjudicating, substantiating, and processing claims and payment-card transactions pursuant to an administrative services agreement or other arrangement. The Administrator and any designated third-party administrator shall administer claims in accordance with the terms of the Plan, applicable administrative procedures of the designated third-party administrator and applicable law. The retention of a third-party administrator shall not relieve the Employer or the Plan of any obligation imposed by applicable law.
(d) Notice and Appeals. The Administrator or its designated third-party administrator shall provide claimants with any notices concerning denied claims and applicable claim review and appeal rights to the extent required by applicable law. The applicable claims and appeals procedures may be set forth in separate administrative materials or procedures maintained by the Administrator or its designated third-party administrator and applied consistently with the Plan and applicable law.
(e) Approved Transactions. A Participant shall not be required to submit a separate claim for a transaction that has been properly paid through an approved debit card or other electronic payment method and has been properly substantiated through an automated or electronic substantiation process in accordance with applicable law. If additional substantiation is required, the Participant shall provide the requested substantiation within the time and in the manner prescribed by the Administrator or its designated third-party administrator.

10.8 Carryover; Run-Out Period; Forfeiture.
(a) Carryover. The Plan shall permit a Participant to carry over unused amounts remaining in the Participant’s Health Care FSA at the end of a Plan Year to the immediately following Plan Year, subject to the maximum amount permitted under applicable law.

For Plan Years beginning in 2026, the maximum amount that may be carried over from a Plan Year shall be $680, or such other amount as may be permitted under Code Section 125 and applicable guidance for the applicable Plan Year. The Employer may establish a lower carryover amount, provided that the limitation applies uniformly in accordance with applicable law. The maximum amount that may be carried over in subsequent Plan Years shall be specified in Schedule “A”.
(b) Determination of Carryover Amount. The amount eligible for carryover shall be determined after the end of the Plan Year and after giving effect to all Eligible Medical Care Expenses incurred during the Plan Year and properly submitted during the applicable run-out period. The amount eligible for carryover shall not exceed the applicable carryover limit. (c) Use of Carryover Amounts. Amounts carried over from a prior Plan Year may be used to reimburse Eligible Medical Care Expenses incurred during the entire subsequent Plan Year, subject to the terms of the Plan. Carryover amounts shall not be cashed out or converted to any other taxable or nontaxable benefit and may be used only to pay or reimburse Eligible Medical Care Expenses.
(d) Run-Out Period. The Plan shall provide a run-out period following the end of each Plan Year during which Participants may submit claims for Eligible Medical Care Expenses incurred during the immediately preceding Plan Year. The run-out period is solely a period for submitting and processing claims for expenses incurred during the preceding Plan Year and is not a Grace Period. Expenses incurred during the run-out period shall not be reimbursable from the prior Plan Year’s Health Care FSA merely because the claim is submitted during the run-out period. (e) Order of Reimbursement. The Administrator may establish reasonable administrative procedures governing the order in which current Plan Year amounts and carryover amounts are applied to Eligible Medical Care Expenses, provided that such procedures are consistent with applicable law. The Administrator may, for administrative convenience, apply reimbursements for current Plan Year expenses first against amounts credited for the current Plan Year and thereafter against applicable carryover amounts. (f) Forfeiture. Any unused amount in a Participant’s Healthcare FSA remaining from a Plan Year after completion of the applicable run-out period that exceeds the amount permitted to be carried over under this Section shall be forfeited in accordance with the Plan and applicable law.
(g) No Grace Period. The Health Care FSA shall not provide a Grace Period for any Plan Year. The carryover provision in this Section is intended to replace, and shall be administered in lieu of, any Grace Period provision.

10.9 Continuation Upon Cessation of Participation. Upon termination of participation in the Health Care FSA, reimbursement of Eligible Medical Care Expenses shall be subject to the terms of the Plan and applicable law. Nothing in this Article shall be construed to provide a posttermination reimbursement period or continuation of coverage except to the extent expressly provided under the Plan or required or permitted under applicable law, including applicable COBRA requirements.

To the extent a Participant or Qualified Beneficiary is entitled to COBRA continuation coverage with respect to the Health Care FSA, such continuation coverage shall be administered in accordance with applicable COBRA requirements and the procedures established by the Administrator or its designated third-party administrator.

10.10 Forfeitures and Plan Administration. Forfeited amounts under the Health Care FSA shall be treated and applied in accordance with the general forfeiture provisions of the Plan and applicable law. Such amounts may be used for purposes permitted under applicable law, including, to the extent permitted, defraying reasonable expenses of administering the Plan.

10.11 Compliance with Applicable Law. The Health Care FSA shall be administered in accordance with Code Sections 105, 125, and 213, the applicable Treasury Regulations, and applicable IRS guidance. If a provision of this Article X is inconsistent with a mandatory requirement of applicable federal tax law, the provision shall be administered in a manner consistent with such requirement, and the Plan shall be amended as necessary.

Nothing in this Article X shall be construed to permit reimbursement of an expense unless the expense constitutes an Eligible Medical Care Expense under this Plan and satisfies the requirements of applicable law.

ARTICLE XI

CONTINUATION COVERAGE

11.1 In General. To the extent required by applicable law, continuation coverage shall be available under the Plan with respect to Benefits providing medical, surgical, hospital, dental, vision, prescription drug, or other health care coverage that are subject to federal continuation coverage requirements. Such continuation coverage shall be provided in accordance with applicable federal law, including COBRA, the Public Health Service Act, applicable Treasury regulations, PEMHCA, requirements of the California Public Employees’ Retirement System (“CalPERS”), and the terms and procedures of the applicable health plan.

11.2 Qualified Beneficiaries and Qualifying Events. A “Qualified Beneficiary” and “Qualifying Event” shall have the meanings prescribed under applicable federal law and, to the extent applicable to coverage provided through CalPERS, PEMHCA and CalPERS requirements. Subject to applicable law, Qualifying Events generally include the death of a covered Employee; termination of employment or reduction in hours resulting in loss of coverage; divorce or legal separation; the covered Employee’s entitlement to Medicare; and a Dependent child ceasing to qualify as a Dependent under the applicable health plan. A registered domestic partner shall be treated in accordance with PEMHCA, CalPERS, and applicable law

11.3 Election and Type of Coverage. A Qualified Beneficiary who would otherwise lose coverage as a result of a Qualifying Event shall have the right to elect continuation coverage within the period prescribed by applicable law. Each Qualified Beneficiary shall have an independent right to elect continuation coverage to the extent required by applicable law. Continuation coverage shall be substantially identical to the coverage available to similarly situated active Participants, subject to applicable law and the terms of the applicable health plan.

11.4 Coverage Period. Continuation coverage shall be available for the period required by applicable law. Subject to applicable law, the maximum period generally shall be eighteen (18) months following a termination of employment or reduction in hours resulting in loss of coverage, with applicable extensions, including the disability extension and extension following a second Qualifying Event. For Qualifying Events other than termination of employment or reduction in hours, continuation coverage may be available for up to thirty-six (36) months. No provision of this Article shall be construed to limit any longer period of continuation coverage or other extension required under PEMHCA, CalPERS requirements, or applicable law.

11.5 Premiums. Continuation coverage shall be contributory. The Qualified Beneficiary shall be responsible for timely payment of the applicable premium, which shall not exceed the maximum amount permitted under applicable law. Premiums shall be paid to CalPERS, the applicable health plan, or another entity designated to administer continuation coverage, in accordance with applicable procedures and applicable law. The timing and manner of premium payments, including applicable rules concerning initial payments, grace periods, and insufficient or deficient payments, shall be administered in accordance with applicable law. Failure to make timely payment may result in termination of continuation coverage as permitted by applicable law.

11.6 Notice and Administration. Notices concerning continuation coverage, including notices of Qualifying Events, election notices, and notices concerning termination of continuation coverage, shall be provided in the manner and within the time periods required by applicable law.

The Administrator, CalPERS, the applicable health plan, or another designated administrator may establish and administer reasonable procedures for the administration of continuation coverage.

11.7 Health Care Flexible Spending Account.
(a) General Rule. Notwithstanding any other provision of this Article XI, continuation coverage under the Health Care FSA shall be subject to the special rules applicable to health care flexible spending arrangements under Code Section 4980B, the Treasury Regulations thereunder, and other applicable guidance. A Participant who experiences a Qualifying Event and who is otherwise a Qualified Beneficiary with respect to the Health Care Flexible Spending Account shall be offered continuation coverage to the extent required by applicable law. (b) Availability of Continuation Coverage. The Health Care FSA shall not be required to offer continuation coverage for the remainder of the Plan Year in which the Qualifying Event occurs if, as of the date of the Qualifying Event, the applicable conditions under Treasury Regulation § 54.4980B-2 are satisfied for the Health Care FSA to be excepted from the requirement to offer such continuation coverage. The Administrator shall determine the availability of continuation coverage in accordance with applicable law. (c) Amount of Coverage Available. If continuation coverage is available and elected, the Qualified Beneficiary shall be entitled to receive reimbursement for Eligible Medical Care Expenses incurred during the period of continuation coverage, subject to the terms and limitations of Article X and applicable law. The maximum amount of benefits available during the remainder of the Plan Year shall be determined in accordance with applicable law and shall take into account any unused amount carried over from the preceding Plan Year under Section 10.8, to the extent required by applicable law.
(d) Carryover Amounts. If the Plan permits a carryover of unused Health Care FSA amounts under Section 10.8, a Qualified Beneficiary who elects COBRA continuation coverage shall be permitted to use any carryover amount on the same terms and conditions applicable to similarly situated Participants, subject to applicable law. A carryover amount shall not be included in determining the applicable premium that may be charged for COBRA continuation coverage.
(e) COBRA Premium. The premium for continuation coverage under the Health Care FSA shall be determined in accordance with applicable law and shall not exceed the maximum amount permitted under Code Section 4980B and the Treasury Regulations thereunder.

In determining the applicable premium, unused amounts carried over from a prior Plan Year shall not be included.
(f) Duration. Continuation coverage under the Health Care FSA generally shall continue only through the end of the Plan Year in which the Qualifying Event occurs, except to the extent that applicable law requires or permits continued access to benefits, including through a permitted carryover of unused amounts or other applicable extension. Nothing in this Section shall require the Plan to permit a Qualified Beneficiary to make additional Salary Reduction contributions for a subsequent Plan Year or to receive the Employer Allowance for a subsequent Plan Year, except as otherwise required by applicable law. (g) Coordination with Article X. The Health Care FSA shall be administered in accordance with Article X, including the Plan’s provisions concerning the annual election, uniform availability of benefits, eligible expenses, substantiation, claims, run-out period, carryover, and forfeiture, except to the extent that a different rule is required for COBRA continuation coverage under applicable law.

11.8 Coordination with PEMHCA and State Law. Continuation coverage provided through CalPERS shall be administered in accordance with PEMHCA, CalPERS requirements, the applicable health plan documents, and applicable federal and state law. Any additional continuation coverage or extension of coverage required or made available under PEMHCA, CalPERS requirements, or applicable state law shall be provided in accordance with the applicable requirements and procedures.

11.9 Governing Requirements. If any provision of this Article is inconsistent with applicable federal law, PEMHCA, CalPERS requirements, or the terms of the applicable health plan, the applicable law, requirement, or plan provision shall control. The Administrator may implement procedures and make administrative adjustments necessary to comply with applicable law and the requirements of CalPERS and the applicable health plans without formal amendment of this Article, provided that such procedures and adjustments do not materially reduce a benefit otherwise provided under the Plan.

ARTICLE XII

DISCRIMINATION

12.1 Memorandum of Understanding. This Plan was adopted pursuant to the terms of one or more memorandum of understanding between the Employer and the Employees and hence, is exempt from the discrimination provisions set forth in Section 125 of the Code, as of the Effective Date.

12.2 Methods to Avoid Discrimination. Notwithstanding any other provisions of the Plan, the Administrator may limit the amounts reimbursed or paid with respect to any Highly Compensated Participant to the extent the Administrator deems such limitation advisable to assure compliance with any nondiscrimination provision of the Code. Such limitation may be imposed whether or not is results in a forfeiture.

12.3 Reimbursement Plans. The Plan is intended not to discriminate in favor of “highly compensated individuals” (as defined in Section 414(q) of the Code with respect to the Dependent Care Flexible Spending Account and as defined in Section 105(h) of the Code with respect to the Health Care Flexible Spending Account) as to eligibility to participate, contributions, and/or Benefits under the Health Care Flexible Spending Account and Dependent Care Flexible Spending Account (the “Reimbursement Plans”). If the Administrator determines the operation of either Reimbursement Plan in any Plan Year would result in such discrimination, then the Administrator shall select and exclude from coverage under the applicable Reimbursement Plan such Participants and/or reduce such contributions and/or Benefits to ensure compliance with the nondiscrimination requirements of Section 129 and 105 of the Code.

ARTICLE XIII

CLAIMS PROCEDURE

13.1. Claims for Benefits. Except as otherwise provided under Article IX with respect to Dependent Care FSA benefits and Article X with respect to Health Care FSA benefits, all claims for Benefits that are provided through insurance contracts, whether such contracts are between the insurer and the Employer or the insurer and the Participant, shall be made in accordance with the claims procedures established under the applicable insurance contract or Component Plan document. The Employer shall not be responsible for processing, reviewing, or paying claims for insured Benefits, except to the extent otherwise required by applicable law or the terms of the applicable Component Plan document. All disputes regarding such insured Benefits shall be resolved in accordance with the procedures established under the applicable Component Plan document or insurance contract.

13.2 Claims and Reimbursement Procedures for Flexible Spending Accounts. Claims for reimbursement under the Dependent Care FSA and Health Care FSA shall be administered in accordance with Articles IX and X, applicable law, and the procedures established by the Administrator or the third-party administrator designated by the Employer. The Employer may delegate to a third-party administrator responsibility for receiving claims, substantiating expenses, administering payment-card transactions, determining whether expenses qualify for reimbursement, processing reimbursements, communicating claim determinations, and administering applicable claims and appeals procedures; provided that the Plan shall remain administered in accordance with the requirements of Code Section 125 and other applicable law.

The use of a third-party administrator shall not relieve the Employer or the Plan of any obligation imposed by applicable law.

ARTICLE XIV
AMENDMENTS. TERMINATION AND ACTION BY EMPLOYER

14.l Action by Employer. Any action by the Employer under this Plan, including but not limited to, termination of this Plan, shall be by action of the Employer, or by any person or persons duly authorized by action of the Employer to act on its behalf.

14.2 Amendments. The Employer reserves the right to make, from time to time, any amendment or amendments to this Plan as it deems necessary or desirable, without retroactive effect, unless specifically permitted to comply with the law.

14.3 Right to Terminate. The Employer may terminate this Plan at any time. In the event of the dissolution, merger, consolidation or reorganization of the Employer, the Plan shall terminate unless the Plan is continued by a successor to the Employer in accordance with the Employer’s procedures.

14.4 Plan Termination. Upon the termination of the Plan, the Administrator may determine the best method to make payments to the effected Participants.

ARTICLE XV

HIPAA PRIVACY, SECURITY, AND BREACH NOTIFICATION

15.1 Purpose. This Article is intended to ensure that the Plan is administered in compliance with the privacy, security, and breach notification requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended by the Health Information Technology for Economic and Clinical Health Act (“HITECH Act”), and the regulations promulgated thereunder, including 45 C.F.R. Parts 160 and 164, as amended. Nothing in this Article shall be construed to alter the Benefits provided under the Plan or to affect eligibility for Benefits.

15.2 Definitions. Unless otherwise defined in the Plan, terms used in this Article shall have the meanings assigned to them under HIPAA and its implementing regulations, including, without limitation, “Protected Health Information” (“PHI”), “Electronic Protected Health Information” (“ePHI”), “Summary Health Information,” “Plan Administration Functions,” “Payment,” “Health Care Operations,” “Business Associate,” and “Privacy Rule.”

15.3 Employer as Plan Sponsor. The Employer serves as the Plan Sponsor for purposes of HIPAA. In performing Plan Administration Functions, the Plan Sponsor shall comply with this Article and all applicable federal privacy and security requirements. The Plan Sponsor shall designate one or more Privacy Officials and Security Officials responsible for administering the Plan’s HIPAA compliance program as it applies to Plan Sponsor. Such officials may delegate responsibilities as appropriate.

15.4 Certification by Plan Sponsor. The Plan may disclose PHI to the Plan Sponsor only after the Plan Sponsor has certified to the Plan that:
(a) the Plan has been amended to incorporate the provisions required by HIPAA; (b) the Plan Sponsor agrees to the restrictions and conditions on the use and disclosure of PHI required by HIPAA;
(c) the Plan Sponsor agrees to comply with this Article and the Plan’s HIPAA policies and procedures that apply to Plan Sponsor.

15.5 Permitted Uses and Disclosures. The Plan Sponsor may use or disclose PHI received from the Plan solely for Plan Administration Functions permitted under HIPAA. The Plan Sponsor shall not use or disclose PHI:
(a) for employment-related decisions or actions;
(b) in connection with any other employee benefit plan or program except as expressly permitted by HIPAA;
(c) for any purpose not permitted by HIPAA or this Plan; or (d) in any manner inconsistent with the Plan’s HIPAA policies and procedures appliable to Plan Sponsor.

Nothing in this Article shall prohibit disclosures expressly permitted or required by HIPAA.

15.6 Responsibilities of the Plan Sponsor. The Plan Sponsor shall:
(a) use appropriate administrative, physical, and technical safeguards to protect the privacy, security, and confidentiality of PHI and ePHI;; (b) comply with the HIPAA Security Rule with respect to ePHI; (c) comply with the HIPAA minimum necessary standard to the extent applicable; (d) require any Business Associate, agent, or subcontractor receiving PHI on its behalf to comply with applicable HIPAA requirements;
(e) promptly report to the Plan any use or disclosure of PHI that is inconsistent with this Article or applicable law of which the Plan Sponsor becomes aware.; (f) report breaches of unsecured PHI as required by HIPAA and cooperate with the Plan in satisfying applicable breach notification requirements; (g) make PHI available to individuals as required by HIPAA, including rights of access, amendment, and accounting of disclosures;
(h) make its books, records, policies, and practices relating to PHI available to the Secretary of the United States Department of Health and Human Services for purposes of determining HIPAA compliance; and
(i) when PHI is no longer needed for the purpose for which it was disclosed, return or securely destroy the PHI if feasible or, if return or destruction is not feasible, continue to protect the information and limit further uses and disclosures to those purposes that make return or destruction infeasible.

15.7 Persons Authorized to Receive Protected Health Information. Only those employees, officers, or other persons designated by the Plan Sponsor whose duties require access to PHI for Plan Administration Functions shall be permitted access to PHI. The Plan Sponsor shall maintain appropriate policies identifying the classes of workforce members authorized to receive PHI and shall ensure that such persons receive appropriate HIPAA training.

15.8 Summary Health Information and Enrollment Information. The Plan may disclose Summary Health Information to the Plan Sponsor for obtaining premium bids, modifying, amending, or terminating the Plan, or for other purposes permitted by HIPAA. The Plan may disclose enrollment, disenrollment, and participation information to the Plan Sponsor as permitted by HIPAA.

15.9 De-Identified Information. Information that has been de-identified in accordance with HIPAA shall not constitute PHI and may be used or disclosed as permitted by applicable law.

15.10 Separation Between the Plan and the Plan Sponsor. The Plan Sponsor shall establish and maintain adequate separation between the Plan and the Plan Sponsor, including administrative safeguards reasonably designed to ensure that PHI is accessed and used only by authorized workforce members for Plan Administration Functions.

15.11 Other Applicable Law. The Plan shall be administered in accordance with applicable federal and California laws governing the privacy and security of medical information to the extent not preempted by HIPAA.

15.12 Scope of Article. This Article applies only to those components of the Plan that constitute a group health plan or otherwise are subject to HIPAA. It does not apply to benefits or programs that are not subject to HIPAA.

ARTICLE XVI

GENERAL PROVISIONS

16.1 Written Plan. The Administrator shall, upon request, provide each Participant with a copy of the Plan(s) detailing the benefits available to the Participant.

16.2 No Trust Fund Required. The Employer shall have no obligation, but shall have the right, to insure any benefits under the Plan or to establish any fund or trust for the payment of Benefits under the Plan.

16.3 Insured Benefits. The Employer shall have no responsibility for the payment of any Benefits covered under the Component Plans provided by policies of insurance.

16.4 Rights to Employer’s Assets. No Employee or beneficiary shall have any right to, or interest in, any specific asset of the Employer by reason of participation in the Plan. Benefits shall be payable only in accordance with the terms of the Plan and applicable law. Nothing in the Plan shall be construed to create a trust or other separate ownership interest in any assets of the Employer, unless expressly provided otherwise by the Plan or required by applicable law.

16.5 Nonalienation of Benefits. Benefits payable under this Plan shall not be subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, charge, garnishment, execution, or levy of any kind, either voluntary or involuntary, including any such liability which is for alimony or other payments for the support of a spouse or former spouse, or for any other relative of the Employee, prior to actually being received by the person entitled to the benefit under the terms of the Plan; and any attempt to anticipate, alienate, sell, transfer, assign, pledge, encumber, charge or otherwise dispose of any right to benefits payable hereunder shall not be recognized, except to the extent required by law. The Employer shall not in any manner be liable for, or subject to, the debts, contracts, liabilities, engagements, or torts of any person entitled to benefits hereunder.

16.6 Divestment of Benefits. Subject only to the specific provisions of this Plan, nothing shall be deemed to divest a Participant of a right to the Benefit to which the Participant becomes entitled in accordance with the provision of this Plan.

16.7 Discontinuance of Contributions. In the event of a permanent discontinuance of contributions to the Plan, all Participants shall receive any and all Benefits to which they were entitled as of the date the discontinuance of contributions occurred.

16.8 Plan Interpretation. This Plan and the various Component Plans are intended to be read in conjunction with one another. However, to the extent of any conflict, the provisions of the Plan shall control, unless otherwise provided by Sections 125, 129 or 105(b) of the Code or the Regulations issued thereunder.

16.9 Governing Law. The Plan shall be administered in the State of California and its validity, construction, and all rights hereunder shall be governed by the laws of the State of California, unless superseded by the Code or other federal law.

16.8 Severability. If any provision of the Plan shall be held invalid or unenforceable, the remaining provisions shall continue to be fully effective.

16.9 Gender and Number. Words used in the masculine, feminine, or neuter gender shall each be deemed to refer to the other whenever the context so requires. Words used in the singular or plural number shall each be deemed to refer to the other whenever the context so requires.

16.10 Headings. Headings used in the Plan are intended solely for reference and are not intended to explain, modify or place any construction on any of the provisions of the Agreement. Any conflict between such headings and the text shall be resolved in favor of the text.

16.11 Successors and Assigns. The Plan shall inure to the benefit of and be binding upon the parties hereto, their successors and assigns. The right of a Participant to receive reimbursement under the Participant’s Health FSA or Dependent Care FSA shall not be assigned or subject to claims by creditors.

16.12 Discharge of Employee. The adoption and maintenance of the Plan shall not be deemed to be a contract between the Employer and the Employee. Nothing herein contained shall be deemed to give any Employee the right to be retained in the employ of the Employer or to interfere with the right of the Employer to discharge any Employee at any time.

16.15. Consolidation With Other Plan Documents. In the event the Plan merges or consolidates with, or transfers the assets and liabilities to, any other plan, no Participant herein shall, solely on account of such consolidation or transfer, be entitled to a Benefit on the day following such event which is less than the Benefit to which he or she was entitled on the day preceding such event. For the purpose of this Section, the benefit to which a Participant is entitled shall be calculated and based upon the assumption that a Plan termination and distribution of assets occurred on the day as of which the amount of the Participant’s entitlement is being determined.

16.16 Counterparts. The Plan may be executed in an original and any number of counterparts by the Employer, each of which shall be deemed an original of one and the same instrument.

IN WITNESS WHEREOF, the Employer has caused this Restated Section 125 Cafeteria Plan to be executed on [**INSERT DATE**].

EMPLOYER:

CITY OF CORONA
By:

Jacob Ellis
City Manager
ATTEST:

By: ___________________________
Sylvia Edwards
City Clerk
APPROVED AS TO FORM AND CONTENT:

By: ____________________________
Dean Derleth
City Attorney
SCHEDULE “A”

SCHEDULE OF BENEFITS
as of August 19, 2026
The following Schedule of Benefits, which may be amended from time to time by the Employer, specifies the Benefits and the Component Plans which set forth the terms, conditions and limitations of the Benefits offered to Participants. The periods of coverage for the Component Plans shall be the same as the Plan Year of the Plan, unless specified otherwise.

The following definitions shall apply for purposes of this Schedule of Benefits. Capitalized terms not otherwise defined in this Schedule of Benefits shall be as defined in Article III of the City of Corona Section 125 Cafeteria Plan.

1. “Base Contribution Rate” shall refer to the rate of contribution applicable to the Employer with respect to each Employee bargaining group as determined under the provisions of Section 22892 of the California Government Code in accordance with the Employer’s resolution filed with the California Public Employees'’ Retirement System.

2. “Confidential Personnel” shall mean Employees who are subject to the terms of the Compensation and Benefits for City of Corona Confidential Employees, as established by resolution of the City Council and as may be amended from time to time.

3. “Executive Personnel” shall mean Employees who are subject to the terms of the Compensation and Benefits for City of Corona Executive Employees, as established by resolution of the City Council and as may be amended from time to time.

4. “Fire Personnel” shall mean Employees who are members of the Corona Firefighters Association IAFF Local 3757 covered under the “Corona Firefighters Association IAFF Local #3757 Memorandum of Understanding” in effect from 2025 through 2027, as amended from time to time.

5. “General Personnel” shall mean Employees who are covered under the "“Corona Public Service Employees Association Memorandum of Understanding"” in effect from January 1, 2025 through December 31, 2027, as amended from time to time.

6. “Management Personnel” shall mean Employees who are subject to the terms of the Compensation and Benefits for City of Corona Management Employees, as established by resolution of the City Council and as may be amended from time to time.

7. “Memorandum of Understanding” shall refer to a memorandum of understanding between the Employer and a bargaining unit of Employees.

8. “PEMHCA” shall mean the CalPERS Health Program as governed by the Public Employees’ Medical & Hospital Care Act.

9. “Police Personnel” shall mean Employees covered under the: (i) “Corona Police Employees Association Memorandum of Understanding” in effect from January 1, 2025 through December 31, 2027, as amended from time to time; and (ii) “Corona Police Supervisors Association Memorandum of Understanding” in effect from January 1, 2025 through December 31, 2027, as amended from time to time.

10. “Retiree” shall mean Retired Elected Officials or Retired M/C Personnel.

11. “Supervisory Personnel” shall mean Employees covered under the “Corona Supervisors Association Memorandum of Understanding” in effect from January 1, 2025 through December 31, 2027, as amended from time to time.

12. “Utilities Personnel” shall mean Employees covered under the Corona Utilities Employee Association” in effect from July 1, 2026 through December 31, 2027, as amended from time to time.

JAMIER\09000.25600\10323005.2
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager

FIRE PERSONNEL
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health
Insurance
All Fire Personnel Plan Year $2,408.95
(Employee+2 or
more)
N/A

OTHER AVAILABLE BENEFITS
Dental
Insurance
All Fire Personnel Plan Year N/A N/A
Vision
Insurance
All Fire Personnel Plan Year N/A N/A
Dependent
Care Flexible
Spending
Account
All Fire Personnel Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care
Flexible
Spending
Account
All Fire Personnel Plan Year $3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical
Insurance OptOut
All Fire Personnel Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee opts-out
of Core Coverage pursuant to Section

6.3. JAMIER\09000.25600\10323005.2

GENERAL PERSONNEL
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health Insurance All General
Personnel
Plan Year $2,273
(Employee+2 or
more)
N/A

OTHER AVAILABLE BENEFITS
Dental Insurance All General
Personnel
Plan Year N/A N/A
Vision Insurance All General
Personnel
Plan Year N/A N/A
Dependent Care
Flexible Spending
Account
All General
Personnel
Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care Flexible
Spending Account
All General
Personnel
Plan Year $3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical Insurance OptOut AllowanceAll General
Personnel
Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee
opts-out of Core Coverage
pursuant to Section 6.3.
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager
JAMIER\09000.25600\10323005.2

UTILITIES PERSONNEL
as of July 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health Insurance All Utilities
Personnel
Plan Year $2,273
(Employee+2 or
more)
N/A

OTHER AVAILABLE BENEFITS
Dental Insurance All Utilities
Personnel
Plan Year N/A N/A
Vision Insurance All Utilities
Personnel
Plan Year N/A N/A
Dependent Care Flexible
Spending Account
All Utilities
Personnel
Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care Flexible
Spending Account
All Utilities
Personnel
Plan Year $3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical Insurance OptOut AllowanceAll Utilities
Personnel
Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee
opts-out of Core Coverage
pursuant to Section 6.3.
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager
JAMIER\09000.25600\10323005.2

CONFIDENTIAL PERSONNEL
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health Insurance All Confidential
Personnel
Plan Year $2,708
(Employee+2 or
more)
N/A

OTHER AVAILABLE BENEFITS
Dental Insurance All Confidential
Personnel
Plan Year N/A N/A
Vision Insurance All Confidential
Personnel
Plan Year N/A N/A
Dependent Care Flexible
Spending Account
All Confidential
Personnel
Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care Flexible
Spending Account
All Confidential
Personnel
Plan Year $3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical Insurance OptOut AllowanceAll Confidential
Personnel
Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee
opts-out of Core Coverage
pursuant to Section 6.3.
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager
JAMIER\09000.25600\10323005.2

EXECUTIVE PERSONNEL
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health Insurance All Executive
Personnel
Plan Year $2,708
(Employee+2 or
more)
N/A

OTHER AVAILABLE BENEFITS
Dental Insurance All Executive
Personnel
Plan Year N/A N/A
Vision Insurance All Executive
Personnel
Plan Year N/A N/A
Dependent Care Flexible
Spending Account
All Executive
Personnel
Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care Flexible
Spending Account
All Executive
Personnel
Plan Year $3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical Insurance OptOut AllowanceAll Executive
Personnel
Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee
opts-out of Core Coverage
pursuant to Section 6.3.
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

JAMIER\09000.25600\10323005.2

MANAGEMENT PERSONNEL
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health Insurance All Confidential
Personnel
Plan Year $2,708
(Employee+2 or
more)
N/A

OTHER AVAILABLE BENEFITS
Dental Insurance All Management
Personnel
Plan Year N/A N/A
Vision Insurance All Management
Personnel
Plan Year N/A N/A
Dependent Care Flexible
Spending Account
All Management
Personnel
Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care Flexible
Spending Account
All Management
Personnel
Plan Year
(+Grace
Period)
$3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical Insurance OptOut AllowanceAll Management
Personnel
Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee
opts-out of Core Coverage
pursuant to Section 6.3.
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager
JAMIER\09000.25600\10323005.2

POLICE PERSONNEL
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health Insurance All Police
Personnel
Plan Year $2,273
(Employee+2 or
more)
N/A

OTHER AVAILABLE BENEFITS
Dental Insurance All Police
Personnel
Plan Year N/A N/A
Vision Insurance All Police
Personnel
Plan Year N/A N/A
Dependent Care Flexible
Spending Account
All Police
Personnel
Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care Flexible
Spending Account
All Police
Personnel
Plan Year $3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical Insurance OptOut AllowanceAll Police
Personnel
Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee
opts-out of Core Coverage
pursuant to Section 6.3.
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager
JAMIER\09000.25600\10323005.2

SUPERVISORY PERSONNEL
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS

MANDTORY BENEFITS (CORE COVERAGE)
Health Insurance All Supervisory
Personnel
Plan Year $2,708
(Employee+2 or
more
N/A

OTHER AVAILABLE BENEFITS
Dental Insurance All Supervisory
Personnel
Plan Year N/A N/A
Vision Insurance All Supervisory
Personnel
Plan Year N/A N/A
Dependent Care Flexible
Spending Account
All Supervisory
Personnel
Plan Year
(+Grace
Period)
$7,500 per
year
$3,750 for
married person
filing separate tax
return
N/A
Health Care Flexible
Spending Account
All Supervisory
Personnel
Plan Year $3,400 per
year
$680 Carryover to
next Plan Year*
N/A

CASH-OUT OPTION
Medical Insurance OptOut AllowanceAll Supervisory
Personnel
Plan Year Family
$600.00/month
Employee +1
$400.00/month
Employee Only
$200.00/month
Available only if Employee
opts-out of Core Coverage
pursuant to Section 6.3.
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager
JAMIER\09000.25600\10323005.2

RETIREES
as of January 1, 2026

BENEFIT ELIGIBLE

EMPLOYEE

SUBGROUP

PERIOD OF

COVERAGE

MAXIMUM LEVEL

OF COVERAGE

LIMITATIONS
MAXIMUM CITY CONTRIBUTION - The City will contribute an Employer Allowance of up to a maximum of $1,500 that can be applied to any of the benefits listed below.

Dental Insurance Retiree Plan Year N/A N/A
Vision Insurance Retiree Plan Year N/A N/A
Dependent Care
Flexible Spending
Account
Retiree Plan Year
(+Grace
Period)

N/A N/A
Health Care Flexible
Spending Account
Retiree Plan Year N/A N/A

CASH-OUT OPTION
Medical Insurance
Opt-Out Allowance
Retiree Plan Year Up to $1,500 Available only if a
Retiree elects benefits
having an aggregate cost
lessthan his or
her allowance
*Carryover amount subject to annual adjustment as may be permitted under Code Section 125.

Reviewed by: Approved by:

Rebekah Kramer Jacob Ellis
Assistant City Manager City Manager
JAMIER\09000.25600\10323005.2

CERTIFICATION OF CITY OF CORONA
TO CITY OF CORONA SECTION 125 CAFETERIA PLAN
The CITY OF CORONA is the sponsor of the CITY OF CORONA SECTION 125 CAFETERIA PLAN. Certain benefits provided under the Cafeteria Plan constitute group health plans or health care components subject to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and its implementing regulations. The health care components of the Cafeteria Plan include the following separate group health plans:
 All Group Health Plans offered by CalPERS and in accordance with PEMHCA  The City of Corona Health Care Flexible Spending Account Plan  Delta Care PMI
 Reliance Standard Dental Insurance
 Eye Med Vision Care
The Cafeteria Plan (excluding the non-health care components) and the health care components included in the Cafeteria Plan are Group Health Plans within the meaning of HIPAA (collectively, the “Plan”). The Plan and the City of Corona desire to exchange health information protected under HIPAA for purposes related to administration of the Plan. The City of Corona, acting in its capacity as plan sponsor of the Plan (“Plan Sponsor”) makes the following certifications for purposes of administering the Plan as required by the “Standards for Privacy of Individually Identifiable Health Information,” 45 CFR § 164.102 et seq. (the “Privacy Rule”):

The plan document of the Plan has been amended to incorporate the following provisions and Plan Sponsor agrees to:
• not use or further disclose any protected health information (“PHI”) received from the Plan (including any health insurance issuer or HMO with respect to the Group Health Plan) except as permitted or required by the Plan documents or required by law; • ensure that any agents or subcontractors to whom it discloses any PHI agree to the same restrictions and conditions that apply to the Plan Sponsor with respect to such information; • not use or disclose PHI for employment-related actions and decisions; • not use or disclose PHI in connection with any other benefit plan, program, or arrangement of the City of Corona except to the extent such other benefit plan, program or arrangement is part of an organized health care arrangement of which the Plan also is a part; • report to the Plan any use or disclosure-of PHI that is inconsistent with the uses and disclosures specified in the Plan of which it becomes aware; • give individuals access rights to PHI in its possession in accordance with the policies and procedures of the Plan;
• permit individuals to request amendment of their PHI in the Plan Sponsor’s JAMIER\09000.25600\10323005.2
possession, and to make any necessary amendments, in accordance with the policies and procedures of the Plan;
• make information available to provide any necessary accounting of disclosures of PH1 in accordance with the policies and procedures of the Plan; • make its internal practices, books, and records relating to the use and disclosure of PHI from the Plan available to the Secretary of the Department of Health and Human Services for purposes of determining the Plan’s compliance with the Privacy Rule; • if feasible, to return to the Plan or destroy any PHI from the Plan that it maintains in any form, and shall retain no copies of the PHI when the PHI is no longer needed for the purpose for which disclosure was originally made. If it is not feasible to return or destroy the PHI, the Pian Sponsor agrees that it shall further limit any uses and disclosures to those purposes that make the return or the destruction of the information not feasible; and • agrees to ensure that adequate separation between the Plan Sponsor and the Plan is established.