THE GROUP LONG-TERM CARE PLAN

Appeal Procedure

A denied claim may be appealed by submitting a written request for the appeal to U.S. Care. You must make the request within 60 days after the date of the denial.

If you have not received a written denial, the request must be made within 150 days after you first submitted the claim. Send the written request to:

U.S. Care
ATTN: Group Long-term Care Appeals Department
Route MN08-W225
P.O. 1459
Minneapolis, MN 55459-1459

The request must explain why you believe an appeal is in order and it must include supporting facts and any other pertinent information. U.S. Care will let you review any pertinent documents which legally can be disclosed in preparing the request.

U.S. Care will act upon the request within 60 days after receiving it. U.S. Care may ask for additional time, but a decision will be given within 120 days after the date of the written request for appeal.

You will receive a written explanation of the reasons for U.S. Care's decision. If U.S. Care decides that benefits should have been paid, U.S. Care will take whatever action is necessary to pay them as soon as possible.

No legal action may be taken until all the claim review procedures have been completed. No legal action may be taken to gain benefits from the Group Long-term Care Plan four years after the service or supplies were provided.

Revised