Page 128 - 2022 Washington Nationals Flipbook

MLB LWIP & Nationals Welfare
Plans and Summary Plan Description

APPENDIX C

Dental Benefits

Name of Club/Baseball-Related Entity: Washington Nationals Baseball Club, LLC

ELIGIBILITY TO PARTICIPATE

Eligible Employees: All active employees working a minimum of 35 hours per week (“Full-
Time Employees”)

Eligible Dependents:
 spouses;
 children (including your biological children, adopted children, foster children, or
step-children) until the end of the calendar year in which the child turns age 26; and
 disabled dependent children of any age who are and continue to be both incapable of
self-sustaining employment and dependent on the Employee.

Insurance Effective Date: January 1, 2017

New Hire Effective Date: Coverage will become effective on the first of the month
coinciding with, or next following, 30 days of regular Full-Time employment; however, the
effective date of coverage will be an Eligible Employee’s date of hire if the employee was
employed by the Lerner Corporation immediately before becoming an Eligible Employee.

CESSATION OF PARTICIPATION

Your coverage will end on the last day of the month in which termination (or loss of
eligibility) occurs, except as set forth above with respect to dependents turning age 26.

ELECTIONS AND CONTRIBUTIONS

You are required to contribute towards the cost of the coverage you elect at the rates
established each year by the Nationals.

BENEFITS

Dental Option Offered: Concordia Flex
This program generally pays 100% of costs up to the maximum allowable charge for Class I
Services, 80% of costs up to the maximum allowable charge for Class II Services (except
general anesthesia), and 50% of the costs up to the maximum allowable charge for Class III
Services and Orthodontics. Class II and Class III services are covered after a $50 per
member deductible (not to exceed $150 per family). Class I, II and III Services and
Orthodontics are subject to a $1,500 annual maximum per person, and there is a separate
$1,000 lifetime maximum per person for Orthodontics. Orthodontics are also limited to
dependent children under age 19.

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