Reso 2006-995 - Laserfiche WebLink

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VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN 7.02 Requirement for Written Notice of Claim Denial The Plan Administrator shall provide, to every claimant who is denied a claim for benefits, written notice setting forth in a manner calculated to be understood by the claimant: (a) The specific reason or reasons for the denial; (b) Specific reference to pertinent Plan provisions on which the denial is based; (c) A description of any additional material of information necessary for the claimant to perfect the claim and an explanation of why such material is necessary, and (d) An explanation of the Plan's claim review procedure. 7.03 Right to Request Hearing on Benefit Denial Within sixty (60) days after the receipt by the claimant of written notification of the denial (in whole or in part) of his claim, the claimant or his duly authorized representative, upon written application to the Plan Administrator, in person or by certified mail, postage prepaid, may request a review of such denial, may review pertinent documents, and may submit issues and comments in writing. 7.04 Disposition of Disputed Claims Upon its receipt of notice of a request for review. the Plan Administrator shall make a prompt decision on the review. The decision on review shall be written in a manner calculated to be understood by the claim- ant and shall include specific reasons for the decision and specific references to the pertinent plan provi- sions on which the decision is based. The decision on review shall be made not later than sixty (60) days after the Plan Administrator's receipt of a request for a review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered not later than one hundred- twenty (120) days after receipt of a request for review. If an extension is necessary. the claimant shall be given written notice of the extension prior to the expiration of the initial sixty (60) day period. If notice of the decision on the review is not furnished in accordance with this Section, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to legal remedy pursuant to Section 7.05. 7.05 Preservation of Other Remedies After exhaustion of the claims procedures provided under this Plan, nothing shall prevent any person from pursuing any other legal or equitable remedy otherwise available. ARTICLE VIII Amendment or Termination of Plan 8.01 Permanency While the Employer fully expects that this Plan will continue indefinitely. due to unforeseen, future busi- ness contingencies, permanency of the Plan will be subject to the Employer's right to amend or terminate the Plan, as provided in Sections 8.02 and 8.03, below. 8.02 Employer's Right to Amend The Employer reserves the right to amend the Plan at any time and from time-to-time. and retroactively if deemed necessary or appropriate to meet the requirements of the Code. or any similar provisions of subsequent revenue or other laws, or the rules and regulations in effect under any of such laws or to conform with governmental regulations or other policies, to modify or amend in whole or in part any or all of the provisions of the Plan. 24