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2009_0921_Packet
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2009_0921_Packet
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1/9/2012 3:13:41 PM
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10/13/2009 9:30:05 AM
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Article 6. Claims Procedure <br />Section 61 Written Claim for Benefits. Benefit payments for the Medical <br />Reimbursement and Dependent Care Reimbursement portions of the Plan shall not be made <br />under this Plan until the Employer or its agent has received a claim for benefits that satisfies all <br />requirements of the separate benefit plan under which such benefit is claimed to be due. Claims <br />for benefits under the health, dental plan and/or life insurance plan(s) shall be administered in <br />accordance with the claims procedures set forth in the plan documents for the health, dental plan <br />and/or life insurance plan(s). <br />Section 6.2 Claims Procedure. The Plan shall establish and maintain reasonable <br />procedures governing the filing of benefit claims, notification of benefit determinations, and <br />appeal of adverse benefit determinations (hereinafter collectively referred to as claims <br />procedures). <br />If the claimant or the claimant's representative fail to follow the claims procedures set out <br />by the Plan, the claimant will be notified of such failure as soon as possible, but not later than <br />five (5) days following the failure. Notification may be oral, unless written notification is <br />requested by the claimant or authorized representative. <br />In the case of a post-service claim (i.e., the claimant has already received service), the <br />Plan administrator will notify the claimant of the Plan's adverse benefit determination within a <br />reasonable period of time, but not later than 30 days after receipt of the claim. This period may <br />42 City of Roseville MPD <br />
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