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2016-129N
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2016-129N
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Last modified
9/26/2016 12:02:26 PM
Creation date
9/26/2016 12:02:22 PM
Metadata
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Template:
Official Documents
Official Document Type
Plan
Approved Date
08/16/2016
Control Number
2016-129N
Agenda Item Number
8.RR.
Entity Name
IRC Board of County Commissioners
Subject
Health Care Flexible Spending Account Plan
Section 125 of Internal Revenue Code
Effective 10/1/2015
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Claims Procedure <br /> A Participant shall make a claim for Benefits by making a request in accordance with the Claim for <br /> Benefits section. <br /> If a claim is wholly or partially denied, notice of a decision shall be furnished to the Participant <br /> within a reasonable period of time, not to exceed ninety(90) days after receipt of the claim by the <br /> Benefit Administrator or its designee, unless special circumstances require an extension of time for <br /> processing the claim. If an extension of time is required, written notice of the extension shall be <br /> furnished to the Participant prior to the termination of the initial ninety(90) day period. In no <br /> event shall the extension exceed a period of ninety(90) days from the end of the initial period. The <br /> extension notice shall indicate the special circumstances requiring an extension of time and the <br /> date on which the Benefit Administrator or its designee expects to render a decision. <br /> The Benefit Administrator or its designee shall,upon request,provide a Participant who is denied <br /> a claim for benefits written notice setting forth, in a manner calculated to be understood by the <br /> claimant,the following: <br /> a. a specific reason or reasons for the denial; <br /> b. specific reference to pertinent Plan provisions upon which the denial is based; <br /> c. a description of any additional material or information necessary for the claimant to perfect <br /> the claim and an explanation of why that material or information is necessary; <br /> d. an explanation of the Plan's claim review procedure. <br /> The purpose of the review procedure is to provide a procedure by which a Participant, under the <br /> Plan, may have reasonable opportunity to appeal a denial of a claim to the Benefit Administrator or <br /> its designee for a full and fair review. To accomplish that purpose, the Participant, or his duly <br /> authorized representative may: <br /> a. request review upon written application to the named fiduciary; <br /> b. review pertinent Plan documents; and <br /> c. submit issues and comments in writing. <br /> A Participant or his duly authorized representative shall request a review by filing a written <br /> application for review with the Benefit Administrator or its designee at any time within sixty(60) <br /> days after receipt of written notice of the denial of the claim. <br /> 6 <br />
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