Page 97 - 2022 Washington Nationals Flipbook

TABLE OF CONTENTS

INTRODUCTION ......................................................................................................................... 1
ELIGIBILITY TO PARTICIPATE ............................................................................................... 2
CESSATION OF PARTICIPATION ............................................................................................ 3
ELECTIONS AND CONTRIBUTIONS....................................................................................... 4

Special Enrollment Rights ................................................................................................. 5
BENEFITS..................................................................................................................................... 5

Medical Coverage .............................................................................................................. 5
Dental Coverage................................................................................................................. 9
Vision Coverage............................................................................................................... 10
CLAIMS PROCEDURE.............................................................................................................. 10
PRIVACY OF HEALTH INFORMATION................................................................................ 12
CONTINUATION COVERAGE RIGHTS UNDER COBRA ................................................... 12
COBRA Continuation Coverage...................................................................................... 13
Disability Extension Of 18-Month Period Of Continuation Coverage............................ 14
Second Qualifying Event Extension Of 18-Month Period Of Continuation

Coverage .............................................................................................................. 14
Other Coverage Options Besides COBRA Continuation Coverage ................................ 15
If You Have Questions..................................................................................................... 15
Keep Your Plan Informed Of Address Changes.............................................................. 15
California COBRA Participants....................................................................................... 15
CONTINUATION OF COVERAGE DURING MILITARY SERVICE ................................... 16
PLAN ADMINISTRATOR ......................................................................................................... 16
PLAN AMENDMENT OR TERMINATION............................................................................. 16
SUBROGATION......................................................................................................................... 17
General Principle ............................................................................................................. 17
Specific Requirements and Plan Rights........................................................................... 17
Participant Duties and Actions......................................................................................... 18
RECOUPMENT .......................................................................................................................... 18
NO ASSIGNMENT OF BENEFITS ........................................................................................... 18
QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO)............................................. 19
STATEMENT OF ERISA RIGHTS............................................................................................ 19

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