Sample documents for a Consumer Driven Health Plan (CDHP)

Freedom Benefits maintains a collection of sample documents for all types of small business employee benefit plans. While other content is published and available in its entirety here on this web site, sample documents are available only through personal request to this site’s author Tony Novak.

The sample documents should be reviewed by an attorney before recommendation for use in any specific application. While we are aware that some small businesses use our sample documents as templates rather than samples, we can not endorse that approach.

Purpose

The purpose of this health plan is to furnish employees with health insurance and reimbursement for qualifying medical and health care expenses not reimbursed by any other plan or taken as a tax deduction.

Tax treatment

This is a “combination health plan” that takes advantage of the tax benefits of several different provisions of our tax laws. The plan is expected to qualify as a nondiscriminatory health reimbursement arrangement (HRA) under Notice 2002-45 of the Internal Revenue Code, a Flexible Spending Arrangement (FSA) plan under IRC Section 125 and as an accident and health care plan within the meaning of IRC Section 105(e) of the tax code. Additionally, the amount of the reimbursements paid to employees under this plan will be eligible for exclusion from their income under Section 105(b) of the Code.

Sample plan document table of contents

ARTICLE I. PURPOSE AND ESTABLISHMENT
1.1 Purpose
1.2 Name
1.3 Plan Not Subject to Cafeteria Plan
1.4 Effective Date
1.5 Termination Date
ARTICLE II. DEFINITIONS
2.1 Board of Directors
2.2 Cafeteria Plan
2.3 Code
2.4 Committee
2.5 Employer
2.6 Compensation
2.7 Dependent
2.8 Employee
2.9 Health Savings Account
2.10 High Deductible Health Plan
2.11 Participant
2.12 Plan
2.13 Plan Adviser
2.14 Plan Year
2.15 Qualifying Medical and Health Care Expenses
2.16 Reimbursement Account
2.17 Termination
ARTICLE III. ELIGIBILITY, ENROLLMENT AND TERMINATION
3.1 Eligibility and Enrollment
3.2 Acceptance of Elections
3.3 Termination
ARTICLE IV. REVOCATION AND MODIFICATION OF ELECTED COVERAGE
4.1 Revocation and Modification
4.2 Administrative Modification
4.3 Limitations on Elections of Highly Compensated Employees
ARTICLE V. BENEFITS
5.1 Generally
5.2 Carry-Forward Forfeiture Benefits Not Limited to Expenses Incurred During Plan Year
5.5 Qualifying Health and Medical Care Expenses
5.6 Refund of Duplicate Reimbursement
ARTICLE VI. ADMINISTRATION
6.1 Committee
6.2 Duties and Powers of the Committee
6.3 Delegation and Allocation of Responsibilities of the Committee
ARTICLE VII. CLAIMS PROCEDURE
7.1 Submission of Claims
7.2 Review of Denial of Claims
ARTICLE VIII. FUNDING
8.1 No Obligation to Fund
8.2 No Interest
ARTICLE IX. AMENDMENTS; TERMINATION ARTICLE X. MISCELLANEOUS
10.1 No Employment Contract
10.2 No Assignment
10.3 Choice of Law
10.4 Severability
10.5 Gender, Singular and Plural References
ARTICLE XI. ADOPTION BY MULTIPLE EMPLOYERS
11.1 Method of Adoption
11.2 Delegation Upon Adoption
11.3 Employer Contributions
11.4 Withdrawal or Removal
Appendix A – Schedule of Benefits

In addition to the plan document, a sample corporate resolution to adapt the plan (for the employer’s records) and sample Summary Plan Description (for electronic distribution to employees) are also provided. Sample plan documents are available free of charge to the attorney of Freedom Benefits’ business clients. Plan documents are typically modified to suit your specific business intent.

Other resources available at www.tonynovak.com:
25 reasons that small businesses choose health reimbursement arrangements
HRA plan design approved by IRS
HRA plan helps owner/employees
HRA plan overview
HRA plans for small businesses
HRA vs. HSA: Which is best for me?
IRS approves new HRA plan design
MSAs, HRAs and HSAs: which health plan is right for my small business

(If the links are broken due to an anticipated site update then do a search for a term or phrase).

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