Page 54 - 2022 MLB Umpire Benefit Guide Flipbook 1

APPENDIX A
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Name of Club/Baseball Related Entity: Office of the Commissioner of Baseball

Eligible Employees: All active employees working at least 30 hours per week, with the
exception of the CFO, unless otherwise modified by the Employer.

Eligible Retirees: All Retired Employees that are not eligible for Medicare, unless otherwise
modified by the Employer. A “Retired Employee” is any former eligible full-time employee,
excluding the CFO, who has terminated active employment (for reasons other than cause, as
determined by the Plan Administrator in its sole discretion) with an Employer at or after age 55
and who was a full-time employee for at least 10 years.

Eligible Dependents: The following dependents of Eligible Employees are eligible for
dependent coverage under the Plan:
• spouses; or
• same-sex or opposite-sex domestic partners; and
• children (including your legal children, foster children, or step-children) under age 26;
and
• unmarried disabled dependent children age 26 and older.

No dependents of Eligible Retirees are eligible for coverage.

Employee/Retiree Contributions: Your Employer (or former Employer) pays the full premium
cost of this coverage. You are not required to contribute towards your or your dependent’s (if
eligible) premium cost.

Insurance Effective Date: January 1, 2016.

Effective Date of Coverage: First of the month coinciding with, or next following, regular full-
time employment.

Date Coverage Terminates: Last day of the month in which loss of eligibility occurs, the date
the Plan is terminated, or, in the case of an Eligible Retiree, you reach age 65 or otherwise
become eligible for Medicare.

Medical Options Offered:

• Non-Grandfathered PPO Option- Value Plan

This program generally provides 70% payment of all reasonable and customary physician
and hospital costs for in-network covered expenses after a $4,500 individual and $9,000
family deductible. The program covers 100% of all reasonable and customary costs for
in-network routine preventative care services with no participant cost sharing. The
program also provides 50% payment of all reasonable and customary physician and
hospital costs for out-of-network expenses after a $9,000 individual and $18,000 family

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