XXXXXX OF NOTIFICATION OF ADVERSE BENEFIT DETERMINATIONS ON REVIEW (GRIEVANCE 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 benefit determination on review of an Adverse Decision in accordance with the following, as appropriate.
Appears in 4 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement
XXXXXX OF NOTIFICATION OF ADVERSE BENEFIT DETERMINATIONS ON REVIEW (GRIEVANCE 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 benefit determination on review of an Adverse Decision in accordance with the following, as appropriate.
Appears in 2 contracts
Samples: In Network Group Contract, In Network Group Contract
XXXXXX OF NOTIFICATION OF ADVERSE BENEFIT DETERMINATIONS ON REVIEW (GRIEVANCE 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 benefit determination on review of an Adverse Decision in accordance with the following, as appropriate.
Appears in 1 contract
Samples: Member Contract
