Claims Processing And Appeal Notice

If your Explanation Of Benefits indicates your claim(s) was not paid or processed within 15 days of receipt, regulations require we notify you and advise you that your claim has been received and is under review and that we may or may not need additional information.

Within 30 days from receipt of a claim, we will either notify you of the final benefit determination, or inform you, as allowed by regulations, that we will take an additional 15 days to make the benefit determination due to matters beyond the control of the Plan.

We will determine benefits available no later than 105 days from receipt of the claim. If we request information and do not hear back from you or your provider within 60 days of the request, a notice of determination will be made.

If after you receive a notice of determination, you disagree with the determination, you have the right to request a Claim Review or you may submit a request for an appeal to the Plan Administrator. If an appeal is made to the Plan Administrator, it must be submitted in writing within 180 days of receiving the Explanation of Benefits.

Please refer to your Summary Plan Description which outlines the claim filing and appeal procedure. You can automatically be issued the claims processing regulations if you so request.

If you have any questions, please feel free to contact the Flex Account Supervisor by calling 1-800-824-5034.

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