Contracts & Agreements_211-2002 - Laserfiche WebLink

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In the case of a Plan established and maintained pursuant to a collective bargaining agreement, such Plan will be deemed to comply with ERISA's claims requirements if the bargaining agreement sets forth or incorporates by reference: (1) provisions concerning the filing of claims and the initial disposition of claims, and (2) a grievance and arbitration procedure to which adverse benefit determinations are subject. If the bargaining agreement includes only grievance and arbitration procedure, then the provisions included herein concerning the filing and initial disposition of claims will apply but the appeal procedures will be superseded by the terms of the bargaining agreement. Important: The stated claims procedures herein address the periods within which claims determinations must be decided, not paid. Benefit payments must be made within reasonable periods of time following Plan approval as governed by ERISA. Urgent Claim - defined below Claimant Makes Initial Incomplete Claim Request Plan Receives Completin Information Claimant Makes Initial Complete Claim Request Plan Responds to Appeal 0#000 �*• �,# �,k __ Within not more than 24 hours (and as soon as possible taking into account the medical exigencies), Plan notifies Claimant of material needed to complete the claim request. Notification may be oral unless Claimant requests a written notice. Claimant will have a reasonable period of time, but not less than 48 hours, to provide the required information to complete the claim. Plan notifies Claimant, in writing or electronically, of its benefit determination as soon as possible and not later than 48 hours after the earlier of: (1) receipt of the completing information, or (2) the period of time Claimant was allowed to provide the completing information. Oral notice can be given in addition to written or electronic notice. Written or electronic notice of a benefit denial or reduction (an "adverse benefit determination '') must be provided to the Claimant not later than 3 days after oral notification. Within not more than 72 hours (and as soon as possible taking into account the medical exigencies), Plan responds with written or electronic benefit determination. Oral notice can be given in addition to written or electronic notice. Written or electronic notice of a benefit denial or reduction (an "adverse benefit determination") must be provided to the Claimant not later than 3 days after an oral notification. See "Appeal Procedures" subsection. An appeal for an urgent claim may be made orally or in writing. Within not more than 72 hours (and as soon as possible taking into account the medical exigencies), after receipt of Claimant's appeal. Citv of Redlands