Page 36 - 2022 MLB Umpire Benefit Guide Flipbook 1

MLB League-Wide Insurance Program
Plan and Summary Plan Description

adverse benefit determination relates to a (a) medical judgment as determined by the external
reviewer, or (b) rescission of coverage. If your claim for benefits has been denied and you
received a final adverse benefit determination in response to your subsequent appeal, the
notification of final adverse benefit determination will provide instructions on how to request an
external review. You may also contact Highmark Blue Cross Blue Shield or the Plan
Administrator for more information on how to request an external review.

Statute of Limitations. Any lawsuit seekingbenefitsunder this Plan must be brought within three
years of when you or your representative (as applicable) first submitted the claim. In the event
that you do not submit a claim for benefits by the claim deadline applicable to a particular
benefit, then the claim will be deemed denied as of the claim deadline and the three year Statute
of Limitations will begin to run from the claim deadline.

PRIVACY OF HEALTH INFORMATION

The receipt, use and disclosure of protected health information by the Plan is governed by
regulations issued under HIPAA and the Health Information Technology for Economic and
Clinical Health Act. In accordance with these regulations, the Plan Administrator, certain
employees of the Plan and the Plan’s business associates may receive, use and disclose protected
health information in order to carry out payment, treatment and health care operations under the
Plan. These entities and individuals may use protected health information for such purposes
without your consent or written authorization. In addition, your protected health information
may be shared with the Plan Sponsor without your consent or written authorization for
administrative purposes. In the normal course, if your protected health information is used or
disclosed for any other purpose, your written authorization for such use or disclosure will be
required. See Appendix B, HIPAA PRIVACY & SECURITY OF PROTECTED HEALTH
INFORMATION,for more information.

CONTINUATION COVERAGE RIGHTS UNDER COBRA

When your eligibility for coverage in the Plan ends, you may have the right to COBRA
continuation coverage, which is a temporary extension of health coverage under the Plan. This
section generally explains COBRAcontinuation coverage, when it may becomeavailable to
you and your family, and what you need to do to protect the right to receive it. When you
become eligible for COBRA, you may also become eligible for other coverage options that may
cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated
Omnibus Budget Reconciliation Act of 1985 (“COBRA”). COBRAcontinuation coverage can
become available to you when you would otherwise lose yourgroup health coverage. It can also
become available to other members of your family who are covered under the Plan when they
would otherwise lose their group health coverage. For additional information about your rights
and obligations under the Plan and under federal law, you should contact your Employer.

You may have other options available to you when you lose group health coverage. For

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