Receiving Your Benefits

Filing a Claim

Claim Requiring Advance Approval or Pre-Authorization

If a claim is for a benefit requiring advance approval by the Plan Administrator (for example, a scheduled Hospital admission), you will be notified of the Plan Administrator’s decision, adverse or not, within a reasonable period of time appropriate to the medical or dental circumstances, but not later than 15 days after the 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 plan’s control.

If an extension is required, you will be notified before the end of the original 15-day period of the circumstances requiring the extension and the date by which a decision is expected. If additional information is required, within five days of receiving the claim, the Plan Administrator will specifically describe it in the notice and give you a period of at least 45 days to provide it.

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.