Covered Event Determination Sample Clauses

Covered Event Determination. The Claims Administrator shall review the notification and supporting informa- tion to determine whether there is agreement by the Claims Adminis- trator with the sponsor’s representa- tion of the event as a covered event (Covered Event Determination) based on a review of the contract conditions for covered events and exclusions. (1) If the Claims Administrator be- lieves the event is an exclusion as set forth in § 950.14(b), the Claims Adminis- trator shall request within 30 days of receipt of the notification of a covered event information in the sponsor’s pos- session that is relevant to the exclu- sion. The sponsor shall provide the re- quested information to the Adminis- trator within 20 days of receipt of the Administrator’s request. (2) The sponsor’s failure to provide the requested information in a com- plete or timely manner constitutes a basis for the Claims Administrator to disagree with the sponsor’s covered event notification as provided in para- graph (c) of this section, and to deny a claim for covered costs related to the