Page 10 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat
P. 10
MINOR LEAGUE FIELD PERSONNEL PPO
Minor League Field Personnel
Plan Provision In-Network Out-of-Network
Company Contribution to HSA N/A
Annual Deductible
Individual $250 $500
Family $500 $1,000
Out-of-Pocket Maximum (Excludes Deductible)
Individual $750 $1,500
Family $2,000 $4,000
Lifetime Maximum Unlimited
Preventive Care 100% Not covered
Primary Physician Office Visit $20 copay 80%*
Specialist Office Visit $20 copay 80%*
X-Ray and Lab 90%* 80%*
Inpatient Hospital Services 90%* 80%*
Outpatient Hospital Services 90%* 80%*
Urgent Care $20 copay 80%*
Emergency Room Care 90% after $50 copay
Click here for more detailed information on this available benefit option.
Note: This is only a brief summary only of your coverage. In-network services are based on negotiated charges; out-of-network services are based on reasonable and
customary (R&C) charges.
2023 Washington Nationals Benefit Guide Page 10
