Page 58 - 2023 Hickory Crawdads - Benefits Guide_Neat

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. You may also cover your domestic partner and their
dependents. Generally, domestic partners are defined as couples who are unmarried and
unrelated, share a residence, and are emotionally and financially interdependent. In order to
obtain domestic partner coverage, you and your partner are required to complete an affidavit.
If you elect domestic partner coverage, under current federal tax laws, you may 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.
Contact your employer for information regarding domestic partner benefits.

CESSATION OF PARTICIPATION

In general, coverage under the Plan ends upon the last day of the month in which the first to
occur of the following:

 the date you terminate employment with your Employer;
 the date your Employer ceases to participate in the Plan, including by virtue of ceasing to
be a member of Minor League Baseball;
 the date all coverage or coverage for certain benefits is terminated for your particular
employment classification, due to a modification of the Plan;
 the last day of the last period for which any required contribution toward the cost of
coverage was made;
 the date you cease to be eligible for all coverage or coverage for certain benefits provided
that:
o for dependent children who attain age 26, coverage terminates on the first day of
the month following the month in which they turn 26; and
o for an employee who is otherwise ineligible under the Plan but was offered
medical coverage solely on the basis of his or her “full-time employee” status
under the ACA and not the Plan’s general eligibility rules, coverage will
terminate on the last day of the stability period for which the covered employee
was determined to be a “full-time employee” under the ACA during a preceding
measurement period (as determined by the Board in accordance with 26 C.F.R §
54.4980H-3);
 the date you cease to be an active employee for any reason, except for absences covered
by vacation or sick leave; or
 the date the Plan terminates.

Under certain circumstances, your coverage under the Plan may continue after the date
coverage would otherwise end. Please see the section of this booklet entitled
CONTINUATION OF COVERAGE UNDER COBRA for details. In addition, your Employer may
continue coverage during certain periods of absence, such as a leave of absence under the
Family and Medical Leave Act of 1993, military leave, or disability in accordance with its
written personnel policies and practices. Your Employer may require contributions during
periods of absence in accordance with its personnel policies and practices.

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