Benefit Plans Administrative Services BPAS 3/9/2020

6.4 Access to Relevant Documents. In order(1) to evaluate whether to request review of an adverse determination, and (2) if review is requested, to prepare for such review,the claimant or the claimant's Authorized Representative will have access to all relevant documents. Relevant: A document, record or other information is"relevant" if it was relied upon in making the determination,or was submitted to the Plan,considered by the Plan,or generated in the course of making the benefit determination without regard to whether it was relied upon. 6.5 Appealing a Denied Claim. If a claim is denied, in whole or part,the claimant or the claimant's Authorized Representative may request the denied claim be reviewed. (a) Requesting Review. The claimant or the claimant's Authorized Representative has a period of one-hundred eighty (180) days to appeal the claim determination. The appeal request must be in writing and should be sent to the address specified in the notification of adverse decision described above. (b) Full and Fair Review. The clamant will have the right to review the claim file and to present evidence and testimony. The claimant will be provided, free of charge, with new or additional evidence considered,relied upon,or generated by the Plan in connection with the claim as soon as possible and sufficiently in advance of the date on which the notice of final internal adverse benefit determination is required to give the claimant a reasonable opportunity to respond prior to that date. Before the Plan issues a final internal adverse benefit determination based on a new or additional rationale,the claimant will be provided, free of charge, with the rationale as soon as possible and sufficiently in advance of the date on which the notice of final internal adverse benefit determined is required to give the claimant a reasonable opportunity to respond prior to that date. The review of the adverse benefit determinations will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. (c) Consultation with Independent Medical Expert. In the case of a claim denied on the grounds of a medical judgment, a health professional with appropriate training and experience will be consulted. The health care professional who is consulted on appeal will not be the individual who was consulted, if any, during the initial determination or a subordinate of that individual. Disclosure: If the advice of a medical or vocational expert was obtained by the Plan in connection with the claim denial, the names of each such expert shall be provided, regardless of whether the advice was relied upon. (d) Time Frame for Decision. If claimant or the claimant's Authorized Representative requests a review of a denied claim within the time frame described above, the Plan Administrator shall review the claim and make a determination no later than sixty (60) days from the date the review request was received. (e) Decision. The review of the claim will be conducted by the Plan Administrator. It will be made by a person different from the person who made the initial determination and such person will not be a subordinate of the original decision maker. The information in the administrative record shall be reviewed. Additional information submitted shall be ©2017 Hitesman&Wold,P.A. 18 Funded Post-Employment HRA Basic Plan Document(Single Employer Non-ERSA)