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X. Permissible Medical Benefit Payments <br /> I�enefi�s eligible for reimbursemenr consist of: <br /> [� All Medical Expenses eligible under IRC Section 213*other than direct long-term care expenses, and including <br /> � non-prescription medications allowed under IRS guidance. <br /> ❑ The following Medical Expenses (select onl}�the expenses you wish to cover under the VantageCare IZetirement Health <br /> Savings Plan): <br /> ❑ Medical Insurance Premiums <br /> ❑ Medical Out-of-Pocket Expenses* <br /> ❑ Medicare Part B Insurance Premiums <br /> ❑ Medicare Parc D Insurance Premiums <br /> ❑ Medicare Supplemental Insurance Premiums <br /> ❑ 1'rescription Drug lnsurance Premiums <br /> ❑ COBRA Insurance Premiums <br /> ❑ Dental Insurance Premiums <br /> ❑ Dental Out-of-Pocket Expenses* <br /> ❑ Vision Insurance Premiums <br /> ❑ Vision Out-of-Pocket Espenses* <br /> ❑ Qualified Lonb Terin Care Insurance Premiums <br /> ❑ Non-Prescription medications allowed under IRS guidance* <br /> ❑ Other qualifying medical expenses (describe)* <br /> *See Section V.A.for a discussion of nondzscrimination rules which ma��apply ta non-collectively bargained,self-insured Plans. <br /> XI. Benefits After the Death of the Participant <br /> In the event.of a Participant's death,the following shall apply: <br /> A. Surviving Spouse and/or Surviving Dependents <br /> The surviving spouse and/or surviving eligible dependents(as defined in Section XILD.) of the deceased Participant are <br /> immediately eligible to maintain the account and utilize i�co fund eligible medical benefits specified in Section X above. <br /> Upon notification of a Participant's death, the Participant's account balance will be transferred into the Vantagepoint <br /> Money Market Fund* (or another fund selected by the Employer). The account balance ma}>be reallocated by the <br /> surviving spouse or dependents. <br /> *Please read the curre�at Urtntage�oint Mutual Funds prospectus carefull7�prior to investing.An investment in this fund is�seitl�er <br /> insured norguaranteed and tliere can be no assurance tbat tl�e F:�nd will be able to m�intain a stable net asset vals�e of$1.00�er sl�are. <br /> L'antagepointMutual Frr�sdr are distributcd b��ICMA-RC Services,LLC,a wholl��-owned brnkcr-dcaler affiliatc afICMA Retircment <br /> Corporatinn.MemberFINRA/SIPC. <br /> If a Participant's account balance has noc been full}�utilized upon the death of the eligible spouse, che account balance <br /> may continue to be utilized to pay benefits of eligible dependents. Upon the death oFall eligible dependents, �he <br /> account will revert to the Plan to be applied as specified in Section VIII. <br /> � ��� II <br /> , , <br /> �. <br /> � �'�s," � <br /> ' � ��, �. <br /> ` ��_�. �,,,n�.'��.� � <br />