Claims For Benefits
The law provides that each welfare plan that is
subject to ERISA must set up reasonable rules
for filing a claim for benefits. To that end, this
Summary Plan Description includes a detailed
explanation of the claims filing and appeals
procedures. The general rules and procedures,
as well as your rights under ERISA, that relate
to filing claims for benefits under the MILA
National Health Plan have been described. In
addition, the procedures for you to follow if your
claim is denied in whole or in part and you wish
to appeal the decision have been supplied
A claim for benefits is a request for Plan benefits made in accordance with the Plan’s claims procedures. In order to file a claim for benefits offered under this Plan, you must complete a claim form from the applicable Claims Administrator – Cigna, CVS Caremark, Aetna or First American Administrators (FAA), a wholly owned subsidiary of EyeMed Vision Care. However, if you receive In-Network benefits from a participating provider (as described in the applicable sections of this SPD), you will not have to submit a claim. All claims for benefits must have been filed prior to the end of the second calendar year following the date the claim was incurred in order to be eligible for payment under the Plan. In general, under the Plan’s rules, simple inquiries about the Plan’s provisions that are unrelated to any specific benefit claim will not be treated as a claim for benefits.
