Page 7 - 2022 MLB Umpire Benefit Guide Flipbook 1
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Medical Plan Benefits Summary
Benefit In-Network Out-of-Network
Calendar Year Deductible
(Single / Family) $0 / $0 $500 / $1,000
Coinsurance 100% 70%
Out-of-Pocket Maximum $2,000/ $4,000 $2,000/ $4,000
(Single / Family)
Lifetime Maximum Benefit Unlimited Unlimited
Physician Office Visit $30 Copay 70% after deductible
Preventive Care
Adult
Routine Physical Exams 100% 70% after deductible
Routine Gynecological Exams 100% 70% after deductible
Mammograms, as required 100% 70% after deductible
Pediatric
Routine Physical Exams 100% 70% after deductible
Pediatric Immunizations 100% 70% after deductible
Emergency Room Services 100% after $100 Copay (waived if admitted)
Ambulance 100% (no deductible)
Inpatient Hospital Stay 100% 70% after deductible
Outpatient Hospital Services 100% 70% after deductible
Maternity 100% 70% after deductible
Infertility Counseling, Testing,
Treatment 100% 70% after deductible
Assisted Fertilization Procedures 100% 70% after deductible
Medical/Surgical Expenses 100% 70% after deductible
Spinal Manipulations $30 Copay 70% after deductible
Diagnostic Services (lab/x-ray/other
100% 70% after deductible
tests)
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