Page 29 - 2022 MLB Umpire Benefit Guide Flipbook 1

MLB League-Wide Insurance Program
Plan and Summary Plan Description

• the date you cease to be an active employee for any reason, except for absences covered by
vacation or sick leave; or
• the date the Plan terminates.

Under certain circumstances, your coverage under the Plan may continue after the date coverage
would otherwise end. Please see the section of this booklet entitled CONTINUATION OF
COVERAGE UNDER COBRA for details. In addition, your Employer may continue coverage
during certain periods of absence, such as a leave of absence under the Family and Medical
Leave Act of 1993, military leave,or disability in accordance with its written personnel policies
and practices. Your Employer may require contributions during periods of absence in
accordance with its personnel policies and practices. See Appendix A for cessation of
participation information specific to your Employer.

Notwithstanding the above, the Board may, in its sole discretion, terminate your, your spouse’s
or domestic partner’s, or your dependent’s coverage under the Plan if you, your spouse or
domestic partner, or your dependent provides false information or makes misrepresentations in
connection with a claim for benefits; permits a non-participant to use a membership or other
identification card for the purpose of wrongfully obtaining benefits; or obtains or attempts to
obtain benefits by means of false, misleading or fraudulent information, acts or omissions.
Pleasesee the SpecialRules Relating toRescissionsof Coveragesubsection in thesection of this
booklet entitled BENEFITS for additional details.

ELECTIONS AND CONTRIBUTIONS

As an eligible employee under the Plan, you may enroll in one of the medical benefit option(s)
available through Highmark Blue Cross and BlueShield and,depending on your Employer, you
may enroll in the dental option available through MetLife. (See Appendix A for the specific
option(s) offered by your Employer.) Under the Plan, there are four types of coverage: (1)
individual coverage; (2) employee and child(ren) coverage; (3) employee and spouse coverage;
and (4) family coverage. If you have individual coverage, only your expenses are covered, not
those of other members of your family. If you have the employee and child(ren) coverage, only
the expenses of you and your enrolled dependent childrenare covered. If you have the employee
and spouse coverage, only theexpenses of you and your enrolled spouse are covered. If you have
family coverage,only theexpenses of you,your enrolled spouse,and enrolled dependent children
are covered.

To receive benefits under the Plan, you must elect coverage for you, your spouse or domestic
partner (if your Employer offers this benefit - see Appendix A for details), and your eligible
dependent children by completing and returning the necessary forms identifying your spouse or
domesticpartner and any eligible dependent children in accordance with the rulesestablished by
your Employer.

You must pay also the portion of the premium designated by your Employer.

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