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(iii) A description of any additional material or information necessary for the claimant <br />to perfect the claim and an explanation of why such material or information is <br />necessary; <br />(iv) A description of the Plan's review procedures and the time limits applicable to <br />such procedures, including a statement of the claimant's right to bring a civil <br />action following an adverse benefit determination on review; <br />(v) In the case of an adverse benefit determination, (A) If an internal rule, guideline, <br />protocol, or other similar criterion was relied upon in making the adverse <br />determination, either the specific rule, guideline, protocol, or other similar <br />criterion; or a statement that such a rule, guideline, protocol, or other similar <br />criterion was relied upon in making the adverse determination and that a copy of <br />such rule, guideline, protocol, or other criterion will be provided free of charge to <br />the claimant upon request; or (B) If the adverse benefit determination is based on <br />a medical necessity or experimental treatment or similar exclusion or limit, either <br />an explanation of the scientific or clinical judgment for the determination, <br />applying the terms of the Plan to the claimant's medical circumstances, or a <br />statement that such explanation will be provided free of charge upon request. <br />For a group medical claim, the claimant will have 180 days following receipt of a <br />notification of an adverse benefit determination within which to appeal the determination. The <br />appeal process requires the Plan to: <br />(i) provide for a review that does not afford deference to the initial adverse benefit <br />determination; <br />44 City of Roseville MPD <br />