Page 134 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat

MLB League-Wide Insurance Program
Plan and Summary Plan Description

this booklet entitled BENEFITS for additional details.

ELECTIONS AND CONTRIBUTIONS

As an eligible employee under the Plan, you may enroll in one of the medical benefit option(s)
available through Highmark Blue Cross and Blue Shield and, depending on your Employer,
you may enroll in the dental option available through MetLife. (See Appendix A for the
specific option(s) offered by your Employer.) Under the Plan, there are four types of coverage:
(1) individual coverage; (2) employee and child(ren) coverage; (3) employee and spouse
coverage; and (4) family coverage. If you have individual coverage, only your expenses are
covered, not those of other members of your family. If you have the employee and child(ren)
coverage, only the expenses of you and your enrolled dependent children are covered. If you
have the employee and spouse coverage, only the expenses of you and your enrolled spouse
are covered. If you have family coverage, only the expenses of you, your enrolled spouse, and
enrolled dependent children are covered.

To receive benefits under the Plan, you must elect coverage for you, your spouse or domestic
partner (if your Employer offers this benefit – see Appendix A for details), and your eligible
dependent children by completing and returning the necessary forms identifying your spouse
or domestic partner and any eligible dependent children in accordance with the rules
established by your Employer.

You must pay also the portion of the premium designated by your Employer.

Special Enrollment Rights

You may be able to enroll or make an election change pursuant to a special enrollment
right. The following describes your special enrollment rights:

If you decide not to enroll yourself, your spouse, or your dependent child(ren) in medical
and/or, if offered, dental coverage under the Plan because the individual has other health
insurance or group health plan coverage, and either (1) the individual has a loss of eligibility
for that other coverage, or (2) the prior coverage was continuation coverage and the
continuation period has been exhausted, you will be able to enroll for medical and/or dental
coverage under the Plan, as applicable, if you enroll within 31 days after losing or exhausting
the prior coverage.

If you have a new spouse or dependent child as a result of marriage, birth, adoption, or
placement for adoption, you will be able to enroll yourself, your spouse and (if applicable)
your eligible newborn or new adoptive dependent child in medical and/or, if offered, dental
coverage under the Plan, if you do so within 31 days after the marriage, birth, adoption, or
placement for adoption.

In addition, if you, your spouse, or your dependent child(ren) lose coverage or gain eligibility
for coverage under Medicaid or CHIP, you will be able to enroll you, your spouse, and your
dependent child(ren) in medical coverage (but not dental coverage) under the Plan if you, your
spouse, and your dependent child(ren) are eligible but not enrolled provided that you make an
election to add coverage not later than 60 days after you, your spouse, or your dependent
child(ren) loses or gains coverage under Medicaid or CHIP.

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