All Other Grievance Situations Not Including Urgent Care Sample Clauses

All Other Grievance Situations Not Including Urgent Care. (i) Denial of a Claim for Benefits. If a Subscriber or Covered Dependent makes a claim for Benefits under the Group’s dental plan and the claim is denied in whole or in part, the Subscriber or the Covered Dependent, or his/her service provider, will receive written notification within 30 days after Delta Dental receives the claim, unless special circumstances require an extension of time for processing. The claims decision will be sent on a form entitled “Explanation of Benefits.” If additional time is necessary for processing a claim for Benefits, Delta Dental will notify the Subscriber or the Covered Dependent and his/her service provider of the extension and the reason it is necessary within the initial 30-day period. If an extension is needed because either the Subscriber or Covered Dependent or his/her service provider did not submit information necessary to make a Benefits determination, the notice of extension will describe the required information. The Subscriber or Covered Dependent, or his/her service provider, will have 45 days from receipt of the notice to provide the specified information.

All Other Grievance Situations Not Including Urgent Care. (i) Denial of a Claim for Benefits. If a Subscriber or Covered Dependent makes a claim for Benefits under the Group’s dental plan and the claim is denied in whole or in part, the Subscriber or the Covered Dependent, or his/her service provider, will receive written notification within 30 days after the Company receives the claim, unless special circumstances require an extension of time for processing. The claims decision will be sent on a form entitled “Explanation of Benefits.” If additional time is necessary for processing a claim for Benefits, the Company will notify the Subscriber or the Covered Dependent and his/her service provider of the extension and the reason it is necessary within the initial 30-day period. If an extension is needed because either the Subscriber or Covered Dependent or his/her service provider did not submit information necessary to make a Benefits determination, the notice of extension will describe the required information. The Subscriber or Covered Dependent, or his/her service provider, will have 45 days from receipt of the notice to provide the specified information.