Common use of Informal Review Clause in Contracts

Informal Review. An Insured who has received an Adverse Benefit Determination of a Claim for Benefits may request an Informal Review. All Informal Reviews must be made to SHL’s Member Services Department within 180 days of the Adverse Benefit Determination. Informal Reviews not filed in a timely manner will be deemed waived. The Informal Review is a voluntary level of appeal. Upon the initiation of an Informal Review, an Insured must provide Member Services with at least the following information:  The Insured’s name (or name of Insured and Insured’s Authorized representative), address, and telephone number;  The Insured’s SHL membership number and Group name; and  A brief statement of the nature of the matter, the reason(s) for the appeal, and why the Insured feels that the Adverse Benefit Determination was wrong. The Member Services Representative will inform the Insured that upon review and investigation of the relevant information, SHL will make a determination of the Informal Review. The determination will be made as soon as reasonably possible but will not exceed thirty (30) days unless more time is required for fact-finding. If the determination of the Informal Review is not acceptable to the Insured and the Insured wishes to pursue the matter further, the Insured may file a 1st Level Formal Appeal.

Informal Review. An Insured who has received an Adverse Benefit Determination of a Claim for Benefits may request an Informal Review. All Informal Reviews must be made to SHL’s Member Services Department within 180 days of the Adverse Benefit Determination. Informal Reviews not filed in a timely manner will be deemed waived. The Informal Review is a voluntary level of appeal. Upon the initiation of an Informal Review, an Insured must provide Member Services with at least the following information:  The • the Insured’s name (or name of Insured and Insured’s Authorized representative), address, and telephone number;  The • the Insured’s SHL membership number and Group name; and  A • a brief statement of the nature of the matter, the reason(s) for the appeal, and why the Insured feels that the Adverse Benefit Determination was wrong. The Member Services Representative will inform the Insured that upon review and investigation of the relevant information, SHL will make a determination of the Informal Review. The determination will be made as soon as reasonably possible but will not exceed thirty (30) days unless more time is required for fact-finding. If the determination of the Informal Review is not acceptable to the Insured and the Insured wishes to pursue the matter further, the Insured may file a 1st Level Formal Appeal.

Informal Review. An Insured who has received an Adverse Benefit Determination of a Claim for Benefits may request an Informal Review. All Informal Reviews must be made to SHL’s Member Services Department within 180 days of the Adverse Adv erse Benefit Determination. Informal Reviews not filed in a timely manner will be deemed waived. The Informal Review is a voluntary level of appeal. Upon the initiation of an Informal Review, an Insured must provide Member Services with at least the following information:  • The Insured’s name (or name of Insured and Insured’s Authorized representative), address, and telephone number;  • The Insured’s SHL membership SHLmembership number and Group name; and  • A brief statement of the nature of the matter, the reason(s) for the appeal, and why the Insured feels that the Adverse Benefit Determination was wrong. The Member Services Representative will inform the Insured that upon review and investigation of the relevant information, SHL will SHLwill make a determination of the Informal Review. The determination will be made as soon as reasonably possible but will not exceed thirty (30) days unless more time is required for fact-finding. If the determination of the Informal Review is not acceptable to the Insured and the Insured wishes to pursue the matter further, the Insured may file a 1st Level Formal Appeal.