Type of Notice or Extension Timing. If your Claim is incomplete, the Plan must notify you within: 30 days If you are notified that your Claim is incomplete, you must then provide completed Claim information to the Plan within: 45 days after receiving notice The Plan must notify you of any adverse Claim determination: if the initial Claim is complete, within: 30 days* after receiving the completed Claim (if the initial Claim is incomplete), within: 45 days * This period may be extended one time by the Plan for up to 15 days, provided that the Plan both
Type of Notice or Extension Timing. If your Claim is filed improperly, the Plan must notify you within: 5 days* If your Claim is incomplete, the Plan must notify you within: 15 days If you are notified that your Claim is incomplete, you must then provide completed Claim information to the Plan within: 45 days after receiving notice The Plan must notify you of the Claim determination (whether adverse or not): if the initial Claim is complete, within: 15 days** after receiving the completed Claim (if the initial Claim is incomplete), within: 30 days If you require post‐stabilization care after an Emergency within: the time appropriate to the circumstance not to exceed one hour after the time of request * Notification may be oral unless the claimant requests written notification. ** This period may be extended one time by the Plan for up to 15 days, provided that the Plan both
Type of Notice or Extension Timing. If your Claim is filed improperly, the Plan must notify you within: 5 days* If your Claim is incomplete, the Plan must notify you within: 15 days If you are notified that your Claim is incomplete, you must then provide completed Claim information to the Plan within: 45 days after receiving notice The Plan must notify you of the Claim determination (whether adverse or not): if the initial Claim is complete, within: 15 days** after receiving the completed Claim (if the initial Claim is incomplete), within: 30 days If you require post‐stabilization care after an emergency within: the time appropriate to the circumstance not to exceed one hour after the time of request * Notification may be oral unless the claimant requests written notification. ** This period may be extended one time by the Plan for up to 15 days, provided that the Plan both (1) determines that such an extension is necessary due to matters beyond the control of the Plan and (2) notifies you, prior to the expiration of the initial 15‐day period, of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. Post‐Service Claims
