Page 99 - Touching All the Bases- Power point 2023 Umpires_Neat

APPENDIX A

Name of Club/Baseball-Related Entity: Office of the Commissioner of Baseball

Eligible Employees: All active Umpires working at least 30 hours per week, unless otherwise
modified by the Employer are eligible for Medical and Dental Benefits.

Eligible Retirees: All Retired Umpires that are not yet age 65, unless otherwise modified by the
Employer are eligible for Medical Benefits only. A “Retired Umpire” is any Umpire who
terminates employment and the sum of his age and the number of his years of service equals at
least 65 on his termination date.

Eligible Dependents:

The following dependents of Eligible Employees are eligible for coverage:
• spouses; or
• same-sex or opposite-sex domestic partners; and
• children (including your legal children, foster children, or step-children) under age 26; and
• unmarried disabled dependent children age 26 and older.

Only spouses or domestic partners (same-sex or opposite-sex) of Eligible Retirees, and surviving
spouses or domestic partners (same-sex or opposite-sex) of deceased Eligible Retirees are eligible
for coverage.

Employee Contributions: Your Employer pays the full premium cost of this coverage. You are
not required to contribute towards your or your dependent’s premium cost.

Insurance Effective Date: January 1, 2021.

New Hire Effective Date: Date of hire.

Date Coverage Terminates: The date in which loss of eligibility occurs, the date the Plan is
terminated, the date an applicable collective bargaining agreement no longer includes the health
benefits, or in the case of an Eligible Retiree, the date you attain age 65 or otherwise become
eligible for Medicare, unless otherwise modified by the Employer.

Medical Option Offered: 100/70 PPO

This program generally provides 100% payment of reasonable and customary physician and
hospital costs for in-network covered expenses with no annual deductible and $30 copayments for
certain services. The program also provides 70% payment of all reasonable and customary
physician and hospital costs for out-of-network expenses after a $500 individual and $1,000 family
deductible.

There is an annual $2,000 individual and $4,000 family out-of-pocket limit for both in-network
and out-of-network covered services. The out-of-pocket limit, under this benefit option, refers to

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