Page 57 - 2022 MLB Umpire Benefit Guide Flipbook 1

Type B Services, 50% of costs up to the reasonable and customary charge for out-of-network
Type C Services, and 50% of costs up to the reasonable and customary charge for out-of-network
OrthodonticServices.

For residents of Louisiana, Mississippi and Texas, this program generally provides 100% of
costs up to the reasonable and customary charge (as defined in the benefit booklet) for out-of-
network Type A Services, 90% of costs up to the reasonable and customary charge for out-of-
network Type B Services, 60% of costs up to the reasonable and customary charge for out-of-
network Type C Services, and 50% of costs up to the reasonable and customary charge for out-

of-network Orthodontic Services.

Type B and Type C Services are covered after a $50 individual or $150 family deductible. Type
A, Type B, and Type C Services are subject to a $3,000 annual limit per person. Orthodontic
Services are only covered for children under age 19 and are subject to a $3,000 lifetime limit per
person.

COBRA Contact:
Human Resources
1271 Avenue of the Americas
New York, NY 10020
Telephone: 212-931-7852

DBl/ 89014857.2