Page 103 - 2022 Washington Nationals Flipbook

MLB LWIP & Nationals Welfare
Plans and Summary Plan Description

Special Enrollment Rights

You may be able to enroll or make an election change pursuant to a special enrollment
right. The following describes your special enrollment rights:

If you decide not to enroll yourself, your spouse, or your dependent child(ren) in medical
and/or, if offered, dental coverage under the Plan because the individual has other health
insurance or group health plan coverage, and either (1) the individual has a loss of eligibility
for that other coverage, or (2) the prior coverage was continuation coverage and the
continuation period has been exhausted, you will be able to enroll for medical and/or dental
coverage under the Plan, as applicable, if you enroll within 31 days after losing or exhausting
the prior coverage.

If you have a new spouse or dependent child as a result of marriage, birth, adoption, or
placement for adoption, you will be able to enroll yourself, your spouse and (if applicable)
your eligible newborn or new adoptive dependent child in medical and/or, if offered, dental
coverage under the Plan, if you do so within 31 days after the marriage, birth, adoption, or
placement for adoption.

In addition, if you, your spouse, or your dependent child(ren) lose coverage or gain eligibility
for coverage under Medicaid or CHIP, you will be able to enroll you, your spouse, and your
dependent child(ren) in medical coverage (but not dental coverage) under the Plan if you,
your spouse, and your dependent child(ren) are eligible but not enrolled provided that you
make an election to add coverage not later than 60 days after you, your spouse, or your
dependent child(ren) loses or gains coverage under Medicaid or CHIP.

Medical and dental coverage added on special enrollment must take effect no later than the
first day of the month after the enrollment, except for coverage added in connection with a
birth, adoption or placement for adoption, which will take effect retroactive to the date of the
birth, adoption or placement.

BENEFITS

Special Note. Benefits under the Plan are solely provided through a contract of insurance
between the Board or the Nationals and an insurer. The rights of each participant,
beneficiary, or other person claiming benefits under the Plan are defined and limited by the
insurance policy that is in force at any particular time for the provision of such benefits. A
claimant may enforce rights under that policy directly against the insurer after exhausting
administrative remedies in the section of this booklet entitled CLAIMS PROCEDURE. The
Board and the Nationals, as applicable, also retain the right, as policyholder, to take action in
their discretion to enforce the policy of insurance on behalf of participants and beneficiaries.

Medical Coverage

This section briefly summarizes the medical benefits available under the LWIP and describes
some important rules regarding your annual elections under the Plan as a whole. For a more
complete description of the benefits available under each coverage option, please refer to the
separate descriptive booklets that you have received from the Board, the Nationals, insurance
companies, and other organizations contracted to provide benefits.

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