Page 30 - 2022 MLB Umpire Benefit Guide Flipbook 1

MLB League-Wide Insurance Program
Plan 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 children ) 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 spouseor 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 children )losecoverage or gaineligibilityfor
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
children ) 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 and an insurer. The rights of each participant, beneficiary, or other person
claimingbenefits under the Plan are defined and limited by theinsurance policy that isinforceat
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 also retains the right, as policyholder, to take
action in its discretion to enforce the policy of insurance on behalf of participants and
beneficiaries.

Medical Coverage

Thissection briefly summarizes themedical benefitsavailable under the Plan and describessome
important rules regarding your annual elections under the Plan. 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, your Employer, insurance companies,and other
organizations with which the Board has contracted to provide benefits.

Page 5
DBl/ 83359462.5