Page 58 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat

ERISA INFORMATION AND NOTICE OF YOUR RIGHTS
A. General Plan Information
Name of Plan:
Name, Address of Plan Sponsor:
Plan Sponsor Tax ID Number:
Plan Number:
Type of Plan:
Name, Address, Phone
Number of Plan Administrator:
Name, Address of Registered Agent
for Service of Legal Process:
If Legal Process Involves Claims
For Benefits Under The Group
Policy, Additional Notification of
Legal Process Must Be Sent To:
Sources of Contributions:
Funding Method:
Plan Fiscal Year End:
Type of Administration:
General
Administration
Contract & Claim
Administration
B. Notice of Legal Process
Service of legal process may be made upon the plan administrator at the address listed above.
ERISA Notice
Eye Care Insurance
WASHINGTON NATIONALS BASEBALL CLUB, LLC
1500 S CAPITOL ST SE
WASHINGTON, DC 20003
20-5145890
503
Group Insurance Plan
STEPHANIE GIROUX
WASHINGTON NATIONALS BASEBALL CLUB, LLC
1500 S CAPITOL ST SE
WASHINGTON, DC 20003
202-640-7000
Plan Sponsor
Standard Insurance Company
th
1100 SW 6 Ave
Portland OR 97204-1093
Employer/Member
Standard Insurance Company--Fully Insured
December 31
Plan Sponsor
Standard Insurance Company