Claim for Benefits definition

Claim for Benefits means a request for a Plan benefit or benefits made by a Member in accordance with the Plan’s Appeals Procedures, including any Pre-Service Claims (requests for Prior Authorization) and Post-Service Claims (requests for benefit payment).

Claim for Benefits means a claim for waiting period or benefits for a designated week.

Claim for Benefits means a request for a Plan benefit or benefits made by an Insured in accordance with the Plan’s Appeals Procedures, including any Pre-Service Claims (requests for Prior Authorization) and Post-Service Claims (requests for benefit payment).

Examples of Claim for Benefits in a sentence

• The Member is also entitled to pursue any available remedies under section 502(a) of ERISA or under State law, as applicable, on the basis that the plan has failed to provide a reasonable internal claims and appeals process that would yield a decision on the merits of the Claim for Benefits.

• If a Member chooses to pursue remedies under section 502(a) of ERISA under such circumstances, the Claim for Benefits, Grievance, or Appeal is deemed denied on review without the exercise of discretion by an appropriate fiduciary.F. EXTERNAL APPEAL PROCEDUREA Member who is dissatisfied with a decision rendered in a final internal grievance process shall have the opportunity to pursue an appeal before an external independent review organization if filed within 4 months of the final grievance decision.

• The Claims Administrator may request that the Plan Participant or the Provider furnish certain information relating to the Plan Participant’s Claim for Benefits.

• The Member must submit a Claim for Benefits to obtain reimbursement for Covered Services.

• Following the instructions on the Claim for Benefits form will help ensure timely processing of the Member’s Claim for Benefits.

More Definitions of Claim for Benefits

Claim for Benefits means a request for one or more benefits which is made by a claimant in accordance with the reasonable procedure for submitting benefit claims offered by an insurance company, nonprofit health services corporation, or health maintenance organization. A reasonable procedure includes an external review procedure that complies with this section.

Claim for Benefits means a request for a Plan benefit made by a Claimant in accordance with the Plan’s reasonable procedures for filing benefit claims under Section 4.04 of this Plan.

Claim for Benefits means a request for a plan benefit or benefits made by You or Plan Provider in accordance with the Plan’s processing or Appeals Procedures, including any Pre-Service Claims (requests for Prior Authorization) and Post-Service Claims (requests for benefit payment).‌

Claim for Benefits means any request for a plan benefit or benefits made by a Claimant in accordance with a plan’s reasonable procedures for filing benefit claims.

Claim for Benefits means a request for a Plan benefit or benefits made by a Member in accordance with the Plan’s Appeals Procedures, including any Pre-Service Claims

Claim for Benefits means a request for a Plan benefit or benefits made by a Member in accordance with the Plan’s Appeals

Claim for Benefits means a new, transitional, additional, reopened or continued claim.