Page 129 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat
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TABLE OF CONTENTS
INTRODUCTION ......................................................................................................................... 1
ELIGIBILITY TO PARTICIPATE ............................................................................................... 1
CESSATION OF PARTICIPATION ............................................................................................ 3
ELECTIONS AND CONTRIBUTIONS ....................................................................................... 4
Special Enrollment Rights ................................................................................................. 4
BENEFITS ..................................................................................................................................... 5
Medical Benefit .................................................................................................................. 5
Dental Coverage ............................................................................................................... 10
CLAIMS PROCEDURE .............................................................................................................. 10
PRIVACY OF HEALTH INFORMATION ................................................................................ 12
CONTINUATION COVERAGE RIGHTS UNDER COBRA ................................................... 12
COBRA Continuation Coverage ...................................................................................... 13
Disability Extension Of 18-Month Period Of Continuation Coverage ............................ 14
Second Qualifying Event Extension Of 18-Month Period Of Continuation
Coverage .............................................................................................................. 15
Other Coverage Options Besides COBRA Continuation Coverage ................................ 15
If You Have Questions..................................................................................................... 15
Keep Your Plan Informed Of Address Changes .............................................................. 16
California COBRA Participants ....................................................................................... 16
CONTINUATION OF COVERAGE DURING MILITARY SERVICE ................................... 16
PLAN ADMINISTRATOR ......................................................................................................... 16
PLAN AMENDMENT OR TERMINATION ............................................................................. 17
ADDITIONAL INFORMATION ................................................................................................ 17
THIRD PARTY LIABILITY ...................................................................................................... 19
General Principle ............................................................................................................. 19
Specific Requirements and Plan Rights ........................................................................... 19
Participant Duties and Actions ......................................................................................... 19
RECOUPMENT .......................................................................................................................... 20
NO ASSIGNMENT OF BENEFITS ........................................................................................... 20
QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO) ............................................. 21
STATEMENT OF ERISA RIGHTS ............................................................................................ 21
DB1/ 116860387.5
