AMENDMENT TO [HRA NAME] The following is model language to amend an employer’s HRA to comply with certain requirements under PPACA. The sample amendment is generic and does not account for the variations permissible in many employer HRAs. The model amendment should not be used unless approved for a particular plan by the employer’s legal counsel. In particular, the model amendment will not be valid unless the format of the amendment and the appropriate corporate formalities -- such as board of directors’ agreement (or similar requirements in whatever business form the employer maintains) -- have been properly followed. Plan sponsors must also amend their Summary Plan Descriptions (SPDs); that is typically done through a Summary of Material Modifications (SMM). This Amendment is made on the date last below written by [COMPANY NAME], a [TYPE OF ENTITY] organized and existing under the laws of the State of [STATE] (the “Employer”). WHEREAS, the Employer originally established the [HRA NAME] (“HRA”) effective [DATE], which was amended and restated effective [DATE]; and WHEREAS, the Employer reserves the right to amend the HRA; and WHEREAS, the Employer desires to amend the HRA to bring the HRA into compliance with the Patient Protection and Affordable Care Act (“PPACA”). NOW, THEREFORE, the HRA is amended as follows: 1. The following sentence shall be added to the end of Section 2.3, entitled “Termination of Participation”: A Participant shall be permitted to opt out of the HRA and waive future reimbursements from the HRA once each year. 2. Except as provided in this Amendment, no other changes or amendments shall be made to the HRA as previously stated (including all prior amendments) and the remainder thereof shall remain in full force and effect. IN WITNESS WHEREOF, the Employer has executed this Amendment on the ______ day of _________________________, 20____. EMPLOYER: [NAME] By:_________________________________ Title: _______________________________