Benefits Handbook

If your claim concerns whether or not you or a family member is eligible for coverage under the plan or whether you or a family member has properly enrolled in the plan, you may file a claim with the Plan Administrator for coverage. The claim should be in writing and specify the circumstances under which you do not have coverage, why you believe you should have coverage and include any mitigating factors, documents, records or other information that you believe are relevant to your claim.

Claims for eligibility or enrollment, rather than claims for benefits, should be addressed to the Plan Administrator at the following address:

The plan will evaluate and decide your claim for eligibility or enrollment within 60 days of receipt. If, due to special circumstances, the plan needs more time to decide your claim, the plan will notify you within the 60-day period that more time is needed, why it is needed, and the date by which you can expect a decision. The Plan Administrator can have up to 30 additional days to decide your claim.

The Plan Administrator will send you written notice of its decision within 60 days (or 90 days if an extension applies). This notice must be in plain language that can be understood. It must include all the specific reasons for the denial, refer you to the plan provisions on which the decision is based., If more information is needed from you to decide the claim, it will tell you what that information is, and why it is needed. It also must describe the plan's procedures and deadlines for submitting an appeal of your claim for a full and fair review.

If you believe your claim for eligibility or enrollment was improperly decided, you may file a written appeal with the Benefits Administration Committee within 180 days for the Medical, Dental, Vision, and Long Term Disability plans or within 60 days for all other plans of your notification of a claim denial. A written appeal of a denied claim should include any additional information you would like the Benefits Administration Committee to consider.

The Benefits Administration Committee will make a benefit determination on your appeal no later than the date of the meeting of the committee that immediately follows the plan's receipt of an appeal, unless the appeal is filed within 30 days before the date of the meeting. In such case, the Benefits Administration Committee will make the benefit determination on an appeal no later than the date of the Benefits Administration Committee's second meeting following the plan's receipt of the appeal. If special circumstances require a further extension of time for processing an appeal, a benefit determination on an appeal shall be rendered not later than the third meeting of the Benefits Administration Committee following receipt of the appeal.

Once a final decision on your appeal is made, you will receive a written explanation of the decision. The explanation must be in plain language that can be understood. If your appeal is denied, the explanation will: