Page 129 - 2022 Washington Nationals Flipbook

MLB LWIP & Nationals Welfare
Plans and Summary Plan Description

Participating dentists accept the maximum allowable charge as payment in full. This means
that if an out-of-network dentist performs a covered service, you will be responsible for
paying the deductible, any part of the maximum allowable charge that is not covered, and
any amount charged by the out-of-network dentist in excess of the maximum allowable
charge. Please refer to the benefits booklet for more information.

CONTINUATION COVERAGE RIGHTS UNDER COBRA

COBRA Contact:
Benefit Coordinators Corporation
Two Robinson Plaza
Suite 200
Pittsburgh, Pennsylvania 15205
1-800-978-7948
enterpriseservice@benxcel.com

ADDITIONAL INFORMATION

Plan Sponsor Information. The Plan Sponsor is the Washington Nationals Baseball Club,
LLC. The address and telephone number as well as the employer identification number
assigned to the Plan Sponsor by the Internal Revenue Service are as follows:

Address: 1500 S. Capitol St, SE, Washington, DC 20003
Telephone: 202.640.7000
Employer ID #: 20-5145890

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

Plan Name: Washington Nationals Baseball Club LLC Dental Plan
Plan ID #: 502
Plan Type:
Plan Year: This Plan is a welfare benefit plan providing dental benefits.
Begins on January 1 and ends on December 31.

Type of Administration. The Plans are administered by the Plan Sponsor except for the
functions delegated to the various insurers as described in the underlying contracts,
certificates of coverage, and benefits booklets.

Agent For Legal Process. The agent for the service of legal process for the Plan is Damon
Jones at the address set forth above.

CLAIMS ADMINISTRATION AND FUNDING

United Concordia
P.O. Box 69421
Harrisburg, PA 17106-9421
Customer Service: (800) 332-0366

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