CLAIMS AND APPEALS PROCEDURES
The SUP Welfare Plan provides the following benefits for active and retired members and their dependents that are eligible for them: death and burial benefits, hospital, medical, and surgical benefits, dental benefits, vision care benefits, prescription drug benefits, hearing aid benefits, temporary disability benefit, training benefits, alcohol/substance abuse benefit, and rehabilitation benefit.
The SUP Welfare Plan will pay benefits to the eligible employee, pensioner or dependent. If a claim is denied, the Plan participant has the right to appeal the claim. The procedures for filing a claim or appealing the denial vary according to the benefit. If your claim is denied in whole or in part, the Plan Office will notify you of such in writing. The notice will explain in detail the reasons for denial with special reference to Plan provisions upon which the denial is based, a description of any information or material necessary to perfect the claim and why such is necessary an explanation of the right to petition for review.
To file an appeal of a denied claim, you must file a request for review within 60 days of your receipt of the denial notice. An appeal must be in writing and should state in clear and concise terms the reason or reasons for disputing the denial. This letter should also be accompanied by any pertinent documentation not already furnished to the Welfare Plan. Your appeal will then be presented and discussed by the Board of Trustees at their next quarterly meeting. You will be advised of the Trustees decision in writing as soon as practical. The decision for review from the Trustees will be in writing and will include a specific reason for the decision with specific references to the pertinent provisions of the Plan on which the decision is based.
Active members, retirees, and dependents of the Plan who may have questions on the appeals procedure are encouraged to call or write the Welfare Pan for more detailed information.