HOW TO FILE A CLAIM FOR YOUR BENEFITS

HOW TO FILE A CLAIM FOR YOUR BENEFITS

WHAT THE LAW DOES

The Employee Retirement Income Security Act of 1974 (ERISA)
protects the interests of participants and their beneficiaries who depend
on benefits from private employee benefit plans. ERISA sets standards
for administering these plans, including a requirement that financial and
other information be disclosed to plan participants and beneficiaries and
requirements for the processing of claims for benefits under the plans.
Although some employee benefit plans are not covered by the Act (such
as church or government plans, etc.), if you are one of the millions of
participants and beneficiaries in employee benefit plans that fall under
the Act's protection, you have certain rights if your claim for benefits is
denied. Your plan must give you the reason for denial in writing and in
a manner you can understand. It also must give you a reasonable
opportunity for a fair and full review of the decision. This folder
outlines the steps you may take to file a claim and what to do if you are
denied benefits.

OBTAIN A COPY OF YOUR SUMMARY PLAN DESCRIPTION

The first step you should take is to carefully read your plan's
summary plan description. This is a document which your plan
administrator must furnish you. It gives you a detailed summary of your
plan--how it works, what benefits it provides, how they may be obtained
and how they may be lost. The summary plan description also is
required to spell out your rights and protections under ERISA.

FILING YOUR CLAIM

You or your beneficiary may be required to first file a claim to
receive the benefits you are entitled to under an employee welfare
benefit plan or a pension plan. An employee welfare benefit plan is a
plan, fund, or program which provides medical, surgical, hospital,
sickness, accident, disability, death, severance, unemployment, vacation,
apprenticeship, day care center, scholarship funds, pre-paid legal
benefits, etc. A pension plan is a fund or program which provides
retirement income to employees, or results in a deferral of income by em-
ployees for periods extending to the termination of covered employment
or beyond. Each plan covered by ERISA must have procedures for filing
a claim and must tell you what those procedures are. This information
must be included in the summary plan description. If for any reason
information concerning the filing of a claim has not been provided, you
may give notification that you have a claim by writing to an officer of
your employer, or the unit where claims are normally filed, or the plan
administrator.

WHAT YOUR PLAN REQUIRES

All plans have standards you must meet to qualify for benefits. Your
pension plan will probably say that you must have worked a certain
number of years and/or be a certain age before you can start receiving
benefits. Some employee welfare benefit plans may require you to file a
claim or notify the plan administrator immediately when you enter a
hospital or see a doctor. Some plans may require that you pay a medical
bill and the plan will repay you when it is presented with a copy of the
bill marked "paid."
But be sure to contact your plan administrator or other plan official
for complete information on filing a claim for your benefits.