Receiving Your Benefits

If Your Claim Is Denied

Post-Service Claim

If your claim is for the payment of medical services after they have been received, the Plan Administrator will decide within a reasonable time, but not longer than 30 days after the Dental Plan received the claim. This time period may be extended for an additional 15 days if the claim does not contain sufficient information on which to base a decision, or an extension is required for other reasons beyond the Dental Plan’s control.

If an extension is required, you will be notified before the end of the original 30-day period of the circumstances requiring the extension and the date by which a decision is expected. If additional information is required, the Plan Administrator will specifically describe it in the notice and give you a period of at least 45 days to provide it.

The Plan Administrator may secure independent medical or other advice and require such other evidence, as it deems necessary to decide your claim.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.