Executive Medical Reimbursement Plan

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

MEMORANDUM OF EXECUTIVE MEDICAL REIMBURSEMENT PLAN

**TO:** All Eligible Executives

**FROM:** The Management Board

**DATE:** {{date}}

**SUBJECT:** Implementation of Executive Medical Reimbursement Plan

1. Purpose and Objective

The Executive Medical Reimbursement Plan (the “Plan”) is established by {{company_name}} (the “Company”) to provide supplemental health benefits to its eligible executive employees. This Plan aims to reimburse executives for certain out-of-pocket medical expenses not fully covered by the Company’s primary group medical insurance plan, thereby enhancing the overall well-being and acknowledging the valuable contribution of our executive team.

2. Eligibility

2.1. This Plan applies to all employees holding an executive position as determined by the Company’s human resources department. Eligible positions include, but are not limited to, {{executive_positions_list}}.

2.2. Eligibility commences on the date of official executive appointment or {{effective_date_of_plan}}, whichever is later. Employees must remain in an eligible executive position to continue participating in the Plan.

3. Reimbursable Expenses

3.1. The Plan covers a range of medical expenses, subject to an annual maximum reimbursement limit of {{annual_maximum_reimbursement_amount}} ({{currency}}). Reimbursable expenses include, but are not limited to:

a. Specialist consultations not fully covered by primary insurance.

b. Prescription medications where a co-payment or deductible applies.

c. Dental treatments, including advanced procedures.

d. Optical services, including prescription eyewear and contact lenses.

e. Approved rehabilitation services and physiotherapy sessions.

f. Out-of-pocket medical expenses exceeding the primary health insurance’s annual limit.

3.2. Expenses must be incurred by the eligible executive or their direct dependents ({{number_of_dependents}}) as covered under the primary medical insurance.

4. Exclusions

4.1. The following expenses are specifically excluded from reimbursement:

a. Cosmetic surgery or procedures not deemed medically necessary.

b. Experimental treatments or unproven alternative therapies.

c. Over-the-counter medications without a doctor’s prescription.

d. Services provided by non-registered medical practitioners.

e. Expenses covered by other insurance policies or third parties.

5. Reimbursement Process

5.1. To claim reimbursement, executives must submit a completed 'Executive Medical Reimbursement Claim Form' (available from the HR Department) along with original receipts or detailed invoices within {{days_to_submit_claim}} days of the expense being incurred.

5.2. All claims must clearly state the nature of the service, the date of service, the amount paid, and proof of payment.

5.3. Reimbursements will be processed within {{processing_days}} business days of receipt of a complete and valid claim. Payments will be made via {{payment_method}} to the executive's designated bank account.

6. Annual Limits and Carry-Over

6.1. The maximum annual reimbursement per executive is {{annual_maximum_reimbursement_amount}} ({{currency}}). This limit is reset annually on {{plan_year_start_date}}.

6.2. Unused reimbursement amounts cannot be carried over to subsequent plan years.

7. Plan Administration and Amendments

7.1. The Human Resources Department is responsible for the administration of this Plan.

7.2. The Company reserves the right to amend, modify, or terminate this Plan at any time, with {{notice_period}} days' written notice to eligible executives. Any such changes will be communicated in writing.

8. Confidentiality

All medical information and claims submitted under this Plan will be treated with the strictest confidentiality, in accordance with applicable privacy laws and the Company’s data protection policy.

9. Acknowledgment and Agreement

By participating in this Plan, the executive acknowledges and agrees to the terms and conditions set forth herein.

Signature Block

_____________________________

{{authorised_signatory_name}}

{{authorised_signatory_title}}

Date: {{date}}

For and on behalf of {{company_name}}