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CLAIMS PROCEDURES FOR DENTAL COVERAGE OOTICE OF CLAIM. Written notice of a claim for Dental Expense Benefits must be given within 20 days after the claim occurs. The notice must be sent to the Company's Home Office and should include: (1) the Group Policyholder's (or Participating Employer's) name and Policy number; (2) the Covered Employee's name, address and certificate number, if available; and (3) the name and relationship of the claimant. If it is not reasonably possible to send notice in the time required, the claim will not be reduced or denied solely for this reason; provided notice is sent as soon as reasonably possible. CLAIM FORMS. When notice of claim is received, the Company will send forms for filing the required proof to the Covered Employee. If the Covered Employee does not receive these forms within 15 days, the proof of claim requirement may be met by giving the Company a written statement of the nature and extent of the claim within the time limit stated in the Proof of Claim provision. PROOF OF CLAIM. The Company must be given written proof of claim within 90 days after the date of services. If it is not reasonably possible to give written proof in the time required, the claim will not be reduced or denied solely for this reason; provided proof is filed as soon as reasonably possible. In any event, proof of the claim must be given no later than one year from such time, unless the claimant was legally incapacitated. Proof of claim may include: (1) a description of the services provided and the Dentist's charges for those services; (2) study models, treatment records or charting; and (3) copies of x -rays or other diagnostic materials. W cePEAL PROCEDURE. The Covered Employee may request a claim review or appeal a claim decision within 60 days after iving the written notice; by sending the Company a written request, along with any written comments or other items to support the appeal. The Company will make its decision within 60 days of its receipt of the appeal; or within 120 days, if an unusual circumstance requires an extension of time to investigate and consider the appeal. TIME OF PAYMENT. The Company will pay any Dental Expense Benefits within 45 days after receipt of acceptable Proof of Loss. If benefits have not been assigned, the Company has the option either to pay the Covered Employee or the provider of services, unless prior to payment the Covered Employee requests otherwise in writing. The Covered Employee or any assignee will be notified in writing within 45 days after receipt of a claim if the claim or any part of it is contested or denied. The notice will identify the contested portion of the claim and the reasons for the contest or denial. The Company will pay or deny any claim within 120 days of its receipt and pay or deny any contested claim within 60 days after receipt of any additional information requested from the Covered Employee or his assignees. Upon written notice, the Company will investigate a Covered Employee's claim of improper billing by a provider of services. If the Company determines the billing was improper, the Company will notify the provider, make an appropriate reduction in the amount of the payment to the provider and pay the Covered Employee the lesser of 20% of the reduction or $500. • GL 1 -18 -CP FL 25 09/01/01