Page 9 - 2021 Miami Marlins Front Office Benefits Guide

MEDICAL COVERAGE 80/60 HDHP with H.S.A.

80/60 HDHP with H.S.A.

Plan Provision In-Network Out-of-Network

If you enroll in our 80/60 HDHP with H.S.A. option, the Marlins will
contribute annually into your Health Savings Account (H.S.A.). The
Employer contribution will be distributed on a quarterly basis.
Yearly Employer Contribution Amount
Company Contribution to HSA
• Employee only - $500
• Employee + Child(ren) - $1,000
• Employee + Spouse - $1,000
• Employee + Family- $1,200
Annual Deductible
1
Individual $2,600 Combined with In-Network
Family $5,200 Combined with In-Network

Out-of-Pocket Maximum (Includes Deductible)
Individual $5,000 $10,000
Family $10,000 $20,000

Lifetime Maximum Unlimited

Preventive Care 100% Not covered

Primary Physician Office Visit 80% after Deductible 60% after Deductible

Specialist Office Visit 80% after Deductible 60% after Deductible

X-Ray and Lab 80% after Deductible 60% after Deductible

Inpatient Hospital Services 80% after Deductible 60% after Deductible

Outpatient Hospital Services 80% after Deductible 60% after Deductible

Urgent Care 80% after Deductible 60% after Deductible

Emergency Room Care 80% after Deductible

1 For those enrolled as a family under the HDHP, the family deductible and out-of-pocket maximums apply to the family on a combined basis.

Note: This is a 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.
The above is a brief summary of this benefit option.
Click here for more detailed information on this available benefit option.

Miami Marlins Front Office Employee Benefit Guide Page 9