Administrative Information

If Your Claim Is Denied

Asking for a Review

If your application for benefits is denied, or if benefits are reduced or terminated, you may ask for a review within 60 days of receiving the denial. You or your duly authorized representative may request, free of charge, copies of all documents, records and other information relevant to the claim. You are encouraged to submit issues and comments to the insurance company. The insurance company will provide you with a written or electronic notification of our decision within a reasonable period of time (not more than 60 days of receipt of your request).

The insurance company will make a final decision according to plan provisions. Normally, you will receive a written reply of the final decision, including specific references to the provision on which it is based, within 90 days. If more time is needed (up to another 90 days), you will be notified of the reasons for the delay and the date you can expect to receive a decision about your claim.

If, in the notice of delay, additional information is requested from you to complete the review, you will have at least 60 days within which to provide the specified information. In such case, the 60-day period for the decision will begin on the date your response is received. If, after the final review, your claim is still denied, you may file suit in a federal or state court.

The insurance company will comply with shorter time limits if required by the state in which the policy was issued.

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.