Administrative Information

If Your Claim Is Denied

If all or part of your claim is denied, you are entitled to a written or electronic explanation, and you can request to have your claim reviewed and reconsidered. The written explanation of the denial will be provided by the insurance company and it will state:

Specific reasons for the denial.

Specific references to the plan provisions on which the denial is based.

A description of any additional information they need and why.

The steps you can take to ask for a review of the decision.

This notice will be sent within 90 days of the date you filed your application. However, in special circumstances, the insurance company may need more time (up to another 90 days) to process your application. If an extension is needed, you will be notified of the reasons for the delay and the date you can expect to receive a decision about your claim.

If you wish to review or appeal a denied claim, you can take the following steps.

Send a written request asking the plan administrator to review your application. The request should be sent within 90 days after you receive the denial notice (or you assume your application was denied).

Include additional documentation, comments and reasons why you think your application should not have been denied.

Request copies of the legal plan document and other documents concerning your application for your review.

For more information about claim denials and appeals, see the “Asking for a Review” section of this summary.

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.