Page 132 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat

MLB League-Wide Insurance Program
Plan and Summary Plan Description

(“Code”). If the Board chooses to use a look-back measurement period, the look-back
measurement period may vary in length by category of employee and may be changed
prospectively from year to year at the Board’s discretion and to the extent permitted by 26
C.F.R. § 54.4980H-3. If an employee meets the definition of “full-time employee” during the
applicable measurement period, as determined by the Board, the employee will be offered
coverage for the duration of the next stability period that begins immediately following the
measurement period and subject to any administrative period established by the Board. The
length of the stability period and administrative period will comply with 26 C.F.R. § 54.4980H-
3.

Notwithstanding the above, the following individuals are not eligible to participate in the Plan:
(1) employees covered by a collective bargaining agreement other than the Basic Agreement
between the Office of the Commissioner and World Umpires Association effective January 1,
2020, and any predecessor or successor to that agreement; (2) any person performing services
pursuant to an arrangement with a leasing organization, including but not limited to a “leased
employee” within the meaning of Code section 414(n); (3) a non-resident alien with no U.S.
source income; (4) individuals who the Employer classifies as independent contractors and any
other individual the Employer does not treat as an employee for purposes of withholding
federal employment taxes, regardless of any contrary governmental or judicial determination
relating to such employment status or tax withholding; (5) any individual who is eligible for
benefits in the Minor League Trust; and (6) any individuals excluded from participation on
Appendix A.

Dependent Coverage. You may also elect coverage for your spouse and your dependent
children. In general, a “spouse” is a person to whom you are legally married in accordance
with the laws of the State or foreign jurisdiction where the marriage was licensed or performed,
and “dependent children” include your legal children (for example, any biological child,
adopted child, or child for whom you are the legal guardian), foster children, or step children
who are under age 26. See Appendix A for dependent eligibility details specific to your
Employer. To the extent that a child does not qualify as a tax dependent under Code section
152 (for example a child over the age of 18 who is not financially dependent on his or her
parent), under some state tax laws, you will have taxable income equal to the value of the
coverage. Although this income is not actually received by you in your paycheck, it is taxable
to you and must be reported as income on your Form W-2.

Your Employer may also extend coverage for an unmarried dependent child beyond age 26
provided that prior to attaining age 26 he or she was enrolled in the Plan and is incapable of
self-sustaining employment by reason of mental retardation or physical handicap. For a
handicapped child to remain covered, you must submit proof of the child’s inability to engage
in self-sustaining employment by reason of mental retardation or physical handicap within 31
days of the child’s attainment of the age 26. The proof must be in a form approved by your
Employer and must be resubmitted as required by your Employer.

The Board and/or your Employer may in its sole discretion require proof of dependent status,
including but not limited to affidavits attesting to dependent child status.

Domestic Partner Coverage. Some Employers also extend medical coverage to employees’
domestic partners and their dependents. Generally, domestic partners are defined as couples

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