Adverse Benefits Determination definition

Adverse Benefits Determination means any denial, reduction or termination of Benefits by Delta Dental for which a Claim has been filed.
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Adverse Benefits Determination means any denial of a request for benefits or any rescission or termination of benefits, in each case in whole or in part, all as more specifically described in the Department of Labor regulations, specifically, 29 C.F.R. § 2560.503-7(m)(4).
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Adverse Benefits Determination means any denial, reduction or termination of Benefits by
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Examples of Adverse Benefits Determination in a sentence

  • Piedmont will make a preliminary determination as to whether the Adverse Benefits Determination is eligible for an external appeal.

  • The Notice of Adverse Benefits Determination, issued pursuant to Section 1850.210(a)-(e) shall 358 contain the following information: 359 360 1.

  • A Notice of Adverse Benefits Determination, issued pursuant to Section 1850.210(g), shall 375 specify the following: 376 (1) The reason that the medical necessity criteria were not met, including a citation of the 377 applicable regulation.

  • If an appeal is not made within the above referenced timeframe all rights to appeal the Adverse Benefits Determination and to file suit in court will be forfeited.

  • The review of the Adverse Benefits Determination will take into account all new information, whether or not presented or available at the initial determination.

  • An appeal of an Adverse Benefits Determination must be made in writing within 180 days upon receipt of the notice that the claim was denied.

  • Similarly, in his 1996 essay “How My Schooling Taught Me Contempt for the Earth,” Bigelow describes how his education condemned him to 12 years inside a building and made him care- less and ignorant of his own surroundings.

  • Berg complains that the Notice of Adverse Benefits Determination did not allow full and fair review of his claim.

  • Within two (2) business days, provide to DHS Office of Appeals and Hearings the Notice of Adverse Benefits Determination and Notice of Appeal Resolution that is the subject of the fair hearing.

  • The Claimant, or the Claimant’s Authorized Representative, may request access to all relevant documents in order to evaluate whether to request review of an Adverse Benefits Determination and, if review is requested, to prepare for such review.


More Definitions of Adverse Benefits Determination

Adverse Benefits Determination means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of any of the following:
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Related to Adverse Benefits Determination

  • Claim Determination Period means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.

  • Eligibility Determination means an approval or denial of eligibility and a renewal or termination of eligibility as set forth in OAR 410-200-0015;¶

  • Event Determination Date means either:

  • Disability benefits means any cash payments which are payable to a covered individual for all or part of a period of disability pursuant to P.L.1948, c.110 (C.43:21-25 et al.).

  • Specific learning disability (SLD) means a heterogeneous group of conditions wherein there is a deficit in processing language, spoken or written, that may manifest itself as a difficulty to comprehend, speak, read, write, spell, or to do mathematical calculations and includes such conditions as perceptual disabilities, dyslexia, dysgraphia, dyscalculia, dyspraxia and developmental aphasia.

  • specific learning disabilities means a heterogeneous group of conditions wherein there is a deficit in processing language, spoken or written, that may manifest itself as a difficulty to comprehend, speak, read, write, spell, or to do mathematical calculations and includes such conditions as perceptual disabilities, dyslexia, dysgraphia, dyscalculia, dyspraxia and developmental aphasia;

  • Benchmark Determination Date means (a) if the Benchmark is LIBOR, the LIBOR Determination Date, (b) if the Benchmark is Term SOFR, the date that is two Business Days before the first day of the applicable Accrual Period, (c) if the Benchmark is Compounded SOFR, the date that is five Business Days before the last day of the applicable Accrual Period and (d) if the Benchmark is any other rate, the date determined by the Trust according to Section 2.16 of the Indenture.

  • Disability Benefit means the benefit set forth in Article 8.