IQVIA Benefits Handbook
HEALTH CARE AND DEPENDENT CARE FLEXIBLE SPENDING ACCOUNTS
Initial Benefit Determination
When you file a claim for reimbursement from the Health Care or the Dependent Care Flexible Spending Account (FSA), the plan has up to 30 days to evaluate and respond to claims for benefits. The 30-day period begins on the date the claim is first filed. This period may be extended by 15 days, as long as the claim administrator or its delegate:
- Determines that an extension is necessary due to matters beyond the claim administrator's control.
- Notifies you within the initial period of the circumstances requiring the extension and the date by which the plan expects to render a decision.
In addition, the notice of extension must include the additional information needed to resolve the claim. (See "Claims Review and Appeals Procedures" for information on the types of information included in the notice.) You'll be given at least 45 days from receipt of the notice within which to provide the specified information.
Appeal Procedures
You (or an authorized representative) will have at least 180 days after receiving the denial notice to file an appeal.
You must submit a written request for a review of the denial of the claim. You can submit written comments, documents, records or other information relating to the claim for benefits. All documents you submit will be considered upon review. In your request for a review, state the reasons that you believe your claim was improperly denied and include all additional information that you consider relevant in support of your claim.
After receiving a request for review, a final decision will be rendered within 60 days. The claims administrator will render the decision and will notify you (or your authorized representative).
Notices Following Appeal
The claims administrator will provide you with written notification of the determination on appeal. (See the "Claims Review and Appeals Procedures" section for the types of information that will be included in the notice.) In deciding whether to appeal, you may obtain access to copies of (free of charge) relevant information in your claim file upon request.
Legal Action
This administrative appeal process must be completed before you begin any legal action regarding your claim. See "Judicial Review."