(A) A claim for benefits under the plan must be submitted in writing to the plan administrator and/or insurance carrier in accordance with procedures established by the plan administrator and/or insurance carrier as communicated in writing to retiree participants, spouses and/or dependents.
(B) The plan administrator and/or insurance carrier shall provide adequate notice to any participant whose claims for benefits under the plan have been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the party. The plan administrator and/or insurance carrier has responsibility for the resolution of disputes with the insurance carrier involving payment of benefits under the portion of the plan assigned to the plan administrator and/or insurance carrier. The plan administrator and/or insurance carrier shall afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review of the decision denying the claim.
(Ord. 08-03, passed 9-4-2008)