IQVIA Benefits Handbook
CLAIMS REVIEW AND APPEALS PROCEDURES
The procedures for filing claims for benefits are summarized in the respective plan overviews. If you're not satisfied with the outcome of your claim, you can ask to have the claim reviewed.
Almost all of the benefit plans described in this Benefits Handbook have a specific amount of time, by law, to evaluate and respond to benefit claims. These time limits apply to plans subject to ERISA. The period of time the plans have to evaluate and respond to a claim begins on the date the claim is first filed. In addition, there are specific timelines and information requirements that you must comply with when filing a claim, or the claim may be denied and the rights you might otherwise have may be forfeited.
The plan administrator has the authority to control and manage the operation and administration of the plans described in this Benefits Handbook and is the agent for service of legal process. The person or entity responsible for specific operational or administrative duties (such as processing claims) may not be the official "plan administrator." Generally, an insurance company or carrier is the claim administrator, and has final responsibility and authority for responding to claims appeals.
For a list of the persons or entities responsible for processing claims and deciding claims and appeals for the benefit plans offered by IQVIA, see "Other Plan Details."