Submission of Formal Grievances. Any Member who has a grievance against Company for any matter arising out of a Subscriber Certificate or for covered Dental Care Services rendered thereunder may submit a formal written statement of the grievance to Company. Such written statement shall be specifically identified as a grievance, shall be submitted to Company within one (1) year from occurrence of the events upon which the grievance is based, and shall contain a statement of the action requested, the Member's name, address, telephone number, Member number, signature and the date. The statement should be sent to the Company's Grievance Coordinator at 0000 Xxxx Xxxxxx Xxxxx, Xxxxx 000 Xxxxx, XX 00000. More information on and assistance with Company's grievance procedures may be obtained by calling Company's Member Services Department at Company's telephone number (000) 000-0000.
Appears in 2 contracts
Samples: Agreement and Certificate of Benefits, Agreement and Certificate of Benefits
Submission of Formal Grievances. Any Member who has a grievance against Company for any matter arising out of a Subscriber Certificate or for covered Dental Care Services rendered thereunder may submit a formal written statement of the grievance to Company. Such written statement shall be specifically identified as a grievance, shall be submitted to Company within one (1) year from occurrence of the events upon which the grievance is based, and shall contain a statement of the action requested, the Member's ’s name, address, telephone number, Member number, signature and the date. The statement should be sent to the Company's ’s Grievance Coordinator at 0000 Xxxx Xxxxxx Xxxxx, Xxxxx 000 000, Xxxxx, XX 00000. More information on and assistance with Company's ’s grievance procedures may be obtained by calling Company's ’s Member Services Department at Company's telephone number (000) 000-0000.
Appears in 1 contract
Samples: Dental Plan Agreement
Submission of Formal Grievances. Any Member who has a grievance against Company for any matter arising out of a Subscriber Certificate or for covered Dental Care Services rendered thereunder may submit a formal written statement of the grievance to Company. Such written statement shall be specifically identified as a grievance, shall be submitted to Company within one (1) year from occurrence of the events upon which the grievance is based, and shall contain a statement of the action requested, the Member's name, address, telephone number, Member number, signature and the date. The statement should be sent to the Company's Grievance Coordinator at 0000 Xxxx Xxxxxx Xxxxx, Xxxxx 000 Xxxxx, XX 00000. More information on and assistance with Company's grievance procedures may be obtained by calling Company's Member Services Department at Company's telephone number (000) 000-0000.
Appears in 1 contract
Samples: Compbenefits Company Agreement and Certificate of Benefits