Common use of Manner and Content of Notification of Benefit Determination Clause in Contracts

Manner and Content of Notification of Benefit Determination. The Plan Administrator will provide a Claimant with written or electronic notification of any Adverse Benefit Determination. The notification will include the following: (A) The specific reason(s) for the Adverse Benefit Determination; (B) Reference to the specific Agreement provisions on which the determination is based; (C) A description of any additional material or information necessary for the Claimant to perfect the claim and an explanation of why such material or information is necessary; and (D) A description of the Agreement’s review procedures in accordance with the terms of this Agreement and the time limits applicable to such procedures (including the address to which appeals should be mailed), including a statement of the Claimant’s right to bring a civil action following an Adverse Benefit Determination on review.