Page 76 - 2023 Down East Wood Ducks - Benefits Guide.docx_Neat

Telephone: (212) 931-7852
Employer ID #: 26-6217877

Plan Administrator Information. The Plan Administrator and named fiduciary is the
Board of Trustees of the Major League Baseball League-Wide Insurance Program. The
address and telephone number are as follows:

Address: 1271 Avenue of the Americas
New York, NY 10020
Telephone: (212) 931-7852

Plan Information. The official Plan name, Plan identification number, and Plan Year (fiscal
year used for plan records) for the Plan are as follows:

Plan Name: Major League Baseball League-Wide Insurance Program
Plan ID #: 501
Plan Year: Begins on January 1 and ends on December 31.

Type Of Plan. The Plan is a multiple employer welfare benefit plan providing medical
benefits.

Claims Administration And Funding.

Medical

The Board has contracted with Highmark Blue Cross Blue Shield to provide medical benefits
and claims services under the Plan. Benefits are paid entirely by the insurance company in
accordance with the terms of the Plan and are guaranteed under the policy.

Highmark Blue Cross Blue Shield
120 Fifth Avenue Place
Pittsburgh, PA 15222

Send non-network claims to:

Highmark Blue Cross Blue Shield
P.O. Box 1210
Pittsburgh, PA 15230

Customer Service: (800) 701-2324

To locate a participating provider, visit www.highmarkbcbs.com.

Dental

The Board has contracted with United Concordia to provide dental benefits and claims
services under the Plan. Benefits are paid entirely by United Concordia in accordance with
the terms of the Plan and are guaranteed under the policy.

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