Common use of TIMING OF NOTIFICATION OF ADVERSE BENEFIT DETERMINATIONS ON REVIEW Clause in Contracts

TIMING OF NOTIFICATION OF ADVERSE BENEFIT DETERMINATIONS ON REVIEW. (APPEAL DECISIONS) 1. The Plan or the Plan’s Designee shall notify a Member, the Member’s Representative or Health Care Provider acting on behalf of the Member of its Appeal Decision no later than 60 working days after the filing date of the Member, the Member’s Representative ‘s or Health Care Provider’s Appeal. A written Notification must be provided to the Member, the Member’s Representative or Health Care Provider acting on behalf of the Member within 30 days of the Appeal Decision. 2. The Plan or the Plan’s Designee may extend the 60-working day period required for making an Appeal Decision under I.1 with the written consent of the Member, the Member’s Representative or Health Care Provider acting on behalf of the Member who filed the Appeal on behalf of the Member. With the written consent of the Member, the Member’s Representative or Health Care Provider acting on behalf of the Member who filed the Appeal on behalf of the Member, the Plan or the Plan’s Designee may extend the period for making a final decision for an additional period of not longer than 30 working days. The Plan’s extension request must describe the special circumstances necessitating the extension and the date on which the benefit determination will be made.

TIMING OF NOTIFICATION OF ADVERSE BENEFIT DETERMINATIONS ON REVIEW. (APPEAL DECISIONS) 1. The Plan or the Plan’s Plan‟s Designee shall notify a Member, the Member’s Member‟s Representative or Health Care Provider acting on behalf of the Member of its Appeal Decision no later than 60 working days after the filing date of the Member, the Member’s Member‟s Representative ‘s „s or Health Care Provider’s Provider‟s Appeal. A written Notification must be provided to the Member, the Member’s Member‟s Representative or Health Care Provider acting on behalf of the Member within 30 days of the Appeal Decision. 2. The Plan or the Plan’s Plan‟s Designee may extend the 60-working day period required for making an Appeal Decision under I.1 with the written consent of the Member, the Member’s Member‟s Representative or Health Care Provider acting on behalf of the Member who filed the Appeal on behalf of the Member. With the written consent of the Member, the Member’s Member‟s Representative or Health Care Provider acting on behalf of the Member who filed the Appeal on behalf of the Member, the Plan or the Plan’s Plan‟s Designee may extend the period for making a final decision for an additional period of not longer than 30 working days. The Plan’s Plan‟s extension request must describe the special circumstances necessitating the extension and the date on which the benefit determination will be made.

TIMING OF NOTIFICATION OF ADVERSE BENEFIT DETERMINATIONS ON REVIEW. (APPEAL DECISIONS) 1. The Plan or the Plan’s 's Designee shall notify a Member, the Member’s 's Representative or Health Care Provider acting on behalf of the Member of its Appeal Decision no later than 60 working days after the filing date of the Member, the Member’s 's Representative ‘s 's or Health Care Provider’s 's Appeal. A written Notification must be provided to the Member, the Member’s 's Representative or Health Care Provider acting on behalf of the Member within 30 days of the Appeal Decision. 2. The Plan or the Plan’s 's Designee may extend the 60-working day period required for making an Appeal Decision under I.1 with the written consent of the Member, the Member’s 's Representative or Health Care Provider acting on behalf of the Member who filed the Appeal on behalf of the Member. With the written consent of the Member, the Member’s 's Representative or Health Care Provider acting on behalf of the Member who filed the Appeal on behalf of the Member, the Plan or the Plan’s 's Designee may extend the period for making a final decision for an additional period of not longer than 30 working days. The Plan’s 's extension request must describe the special circumstances necessitating the extension and the date on which the benefit determination will be made.