BUSINESS TRAVEL ACCIDENT INSURANCE

IQVIA Benefits Handbook

If you wish to file a claim for benefits, you should follow the claim procedures described in the section of this SPD that describes the BTA benefits. To complete your claim filing, CHUBB must receive the claim information it requests from you (or your authorized representative), your attending physician and IQVIA. If you or your authorized representative has any questions about what to do, you or your authorized representative should contact CHUBB directly.

Claim Procedures

Death and Non-Disability Claims

In the event that your claim is denied, either in full or in part, CHUBB will notify you in writing within 90 days after your claim was filed. Under special circumstances, CHUBB is allowed an additional period of no more than 90 days (180 days in total) within which to notify you of its decision. If such an extension is required, you will receive a written notice from CHUBB indicating the reason for the delay and the date you may expect a final decision. CHUBB's notice of denial shall include all of the following:

The specific reason(s) for denial with reference to those plan provisions on which the denial is based.

A description of any additional material or information necessary to complete the claim and why that material or information is necessary.

A description of the plan's procedures and applicable time limits for appealing the determination, including a statement of your right to bring a lawsuit under Section 502(a) of ERISA following an adverse determination from CHUBB on appeal.

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

Disability Claims

CHUBB will give you notice of the decision no later than 45 days after the claim is filed. This time period may be extended twice by 30 days if CHUBB both determines that such an extension is necessary due to matters beyond the control of the plan and notifies you of the circumstances requiring the extension of time and the date by which CHUBB expects to render a decision. If such an extension is necessary due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information and you will be afforded at least 45 days within which to provide the specified information. If you deliver the requested information within the time specified, any 30-day extension period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, CHUBB may decide your claim without that information.

If your claim for benefits is wholly or partially denied, the notice of adverse benefit determination under the plan will include all of the following:

The specific reason(s) for the determination.

References to the specific plan provision(s) on which the determination is based.

Descriptions of additional material or information necessary to complete the claim and why such information is necessary.

Descriptions of plan procedures and time limits for appealing the determination, and your right to obtain information about those procedures and the right to bring a lawsuit under Section 502(a) of ERISA following an adverse determination from CHUBB on appeal.

Disclosure of any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or state that such information will be provided free of charge upon request).

For adverse determinations of benefits based on a determination of disability, an explanation of the decision, including an explanation of the basis for disagreeing with or not following:

The views presented by the claimant to the plan of health care professionals treating the claimant and vocational professionals who evaluated the claimant;

The views of medical or vocational experts whose advice was obtained on behalf of the plan in connection with a claimant's adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination; and

A disability determination regarding the claimant presented by the claimant to the plan made by the Social Security Administration.

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. Notices will be provided in a culturally and linguistically appropriate manner.

Appeal Procedures

Death Appeals and Non-Disability Appeals

If you or your authorized representative appeal a denied claim, it must be submitted within 90 days after you receive CHUBB's notice of denial. You have the right to all of the following:

Submit a request for review, in writing, to CHUBB.

Upon request and free of charge, reasonable access to and copies of all relevant documents as defined by applicable U.S. Department of Labor regulations.

Submit written comments, documents, records and other information relating to the claim to CHUBB.

CHUBB will make a full and fair review of the claim and all new information submitted whether or not presented or available at the initial determination, and may require additional documents as it deems necessary or desirable in making such a review.

A final decision on the review shall be made no later than 60 days following receipt of the written request for review. If special circumstances require an extension of time for processing, you will be notified of the reasons for the extension and the date by which the plan expects to make a decision. If an extension is required due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the necessary information and the date by which you need to provide it to us. The 60-day extension of the appeal review period will begin after you have provided that information.

The final decision on review shall be furnished in writing and shall include the reasons for the decision with reference, again, to those summary of benefits' provisions upon which the final decision is based. It will also include a statement describing your access to documents and describing your right to bring a lawsuit under Section 502(a) of ERISA if you disagree with the determination.

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim. See "Judicial Review."

Disability Appeals

You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be sent to the address specified in the claim denial. A decision on review will be made no later than 45 days following receipt of the written request for review. If CHUBB determines that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). CHUBB will notify you in writing if an additional 45-day extension is needed.

If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information and you will be afforded at least 45 days to provide the specified information. If you deliver the requested information within the time specified, the 45-day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, CHUBB may decide your appeal without that information.

You will have the opportunity to submit written comments, documents or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination.

The plan cannot deny disability benefits on appeal based on new or additional evidence that was not included when the disability benefit was denied at the claims stage, without giving you notice and a fair opportunity to respond. The review will be conducted by CHUBB and will be made by a person different from the person who made the initial determination and such person will not be the original decision maker's subordinate. In the case of a claim denied on the grounds of a medical judgment, CHUBB will consult with a health professional with appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained by the plan in connection with the denial of your claim, CHUBB will provide you with the names of each such expert, regardless of whether the advice was relied upon.

A notice that your request on appeal is denied will contain all of the following information:

The specific reason(s) for the determination.

References to the specific plan provisions on which the determination is based.

A statement disclosing any internal rule, guidelines, protocol or similar criterion relied on in making the adverse determination (or a statement that such information will be provided free of charge upon request).

For adverse determinations of benefits based on a determination of disability, an explanation of the decision, including an explanation of the basis for disagreeing with or not following:

The views presented by the claimant to the plan of health care professionals treating the claimant and vocational professionals who evaluated the claimant;

A disability determination regarding the claimant presented by the claimant to the plan made by the Social Security Administration.

The statement that you are entitled to receive upon request and without charge, reasonable access to or copies of all documents, records or other information relevant to the determination.

A statement describing your right to bring a lawsuit under Section 502(a) of ERISA if you disagree with the decision.

The statement that "You or your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency."

Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim. See "Judicial Review."

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