Receiving Your Benefits

Filing a Claim

Timeframe for Claim Review

Benefits under the medical plan will be paid only if the Plan Administrator or its delegate decides, in its discretion, that you or your covered Dependents are entitled to them. The Plan Administrator will make a decision about your claim in the time frames outlined below and will notify you of its decision in writing.

Claims for benefits under a group health plan fall into four categories: urgent care, a claim requiring advance approval, approval of an ongoing course of treatment, and a claim for the payment of medical or dental services after they have been received (“Post-Service Claim”). The time frame within which you receive notification will depend on what kind of a claim has been made. Please pay attention to the following:

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.