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Jefferson Pilot Life Ins.#1
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RFP No. 01-10-01 Employee Dental, Life, Insurance
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Jefferson Pilot Life Ins.#1
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Last modified
6/18/2012 10:02:26 PM
Creation date
12/28/2010 3:46:06 PM
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CityClerk-Bids_RFP_RFQ
Project Name
Employee Insurance
Bid No. (xx-xx-xx)
01-10-01
Project Type (Bid, RFP, RFQ)
RFP
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CLAIMS PROCEDURES <br />(continued) <br />&EVIEW PROCEDURE. Within 60 days after receiving a denial notice, the Insured Employee may request a claim review by <br />sending the Company a written request, along with any written comments or other items to support the claim. The Insured Employee <br />may review certain non - privileged information relating to the request for review. <br />The Company will review the claim and send the Insured Employee a written notice of their decision within 60 days after receiving <br />the request for review; or within 120 days, if special circumstances require an extension. The notice will state the reasons for the <br />Company's decision under the terms of this Policy. <br />RIGHT OF RECOVERY. If benefits have been overpaid on any claim, full reimbursement to the Company is required within 60 <br />days. If reimbursement is not made, the Company has the right to: <br />1. reduce future benefits until full reimbursement is made; and <br />2. recover such overpayments from the Insured Employee or his or her estate. <br />Such reimbursement is required whether the overpayment is due to fraud, the Company's error in processing a claim, the Insured <br />Employee's receipt of Other Income Benefits, or any other reason. <br />LEGAL ACTIONS. No legal action to recover any benefits may be brought until sixty days after the required written proof of claim <br />has been given. No legal action may be brought after the expiration of the applicable statute of limitations, from the time written <br />proof of claim must be given. <br />• <br />• <br />GL3001 -LTD -8 98 FL <br />12 01 /01 /01 <br />
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