MMC Benefits Handbook
Filing a Claim
How do I file a claim?
Payment of claims under the Plan will be made by the Claims Administrator, Genworth. Claims for benefits under the Plan are to be submitted to the Claims Administrator as provided in the Claim Payments section of the Certificate of Insurance.
Contact the Claims Administrator with any questions regarding a claim or need for claim forms.
Notify the Claims Administrator within 30 days of the date the covered loss starts or as soon as reasonably possible thereafter.
Upon receipt of a notice of claim, the claim forms needed to file proof of loss will be sent. If the claim forms are not received within 15 days, proof of loss can be filed without them with a letter describing the nature and extent of the loss and the covered expense for which claim is made. If the claim is for a continuing loss, written proof of loss must be given to the Claims Administrator within 90 days after the end of each monthly period for which benefits may be payable. For any other loss, written proof must be given within 90 days after the date of such loss. Unless the insured is not legally capable, the required proof must always be given to the Claims Administrator no later than 1 year from the time specified.
The Claims Administrator must receive updates to the insured's Plan of Care on an ongoing basis.
Once the Elimination Period is satisfied, benefit payments will be made on a monthly basis after receipt of claim as long as the insured remains eligible to receive benefits. When a claim is paid, a notice showing the total amount of benefits that have been paid to date will be sent to the insured.
How do I appeal a benefit determination or denied claim?
If a claim under the Plan is denied in whole or in part, the insured will receive written notice. This notice will include the reasons for the denial, with reference to the specific provisions of the Plan on which the denial was based, a description of any additional information needed to process the claim and an explanation of the claims review procedure. If Genworth fails to respond within 90 days, the claim is treated as denied.
Within 60 days after denial, the insured may submit a written request for reconsideration of the claim. Documents or records in support of the appeal should accompany any such request. The insured may review pertinent documents and submit issues and comments in writing. Genworth will review the claim and provide, within 60 days, a written response to the appeal. (This period may be extended by an additional 60 days under certain circumstances.) In the written response, Genworth will explain the reason for the decision, with specific reference to the provisions of the Plan on which the decision is based.