The University has the authority to determine benefit eligibility under this plan. Benefits are paid only if you meet the eligibility and participation requirements.
If you have eligibility questions or if you’ve had a claim denied on grounds of ineligibility, email the Benefits Office at firstname.lastname@example.org to verify your eligibility status.
If you are/were ineligible for coverage because of the delayed entry of your appointment and/or distribution information, your department is responsible for filing an appeal for coverage. You must notify your department’s graduate appointee coordinator or payroll coordinator within two working days of being informed by the Benefits Office that you do /did not have coverage.
Please keep in mind that if you did not start working for the University on or before the first date of the quarterly coverage period, your insurance effective date may be delayed.
LifeWise Assurance Company (LifeWise), as the plan administrator, has the authority to determine benefit eligibility for dependents under this plan. Benefits are paid only if eligibility and participation requirements are met.
If you have dependent eligibility questions or a family member has had a claim denied on grounds of ineligibility, contact LifeWise at 1-800-971-1491 (toll-free) or 1-800-842-5357 (TDD for hearing-impaired). A customer service representative will help you resolve the eligibility issue, eliminating the need to file a formal appeal.
If you’d rather communicate in writing or your eligibility issue can’t be resolved with a phone call, you may file a written appeal. You have 90 days after receiving an eligibility determination notice (from the plan administrator) to submit a written appeal. The appeal must include:
Send dependent eligibility appeals via US Postal Service (this is not a campus address) to:
LifeWise Assurance Company
PO Box 91102
Seattle, WA 98111
A customer service representative will review your appeal and notify you of the eligibility determination as soon as possible, but no later than 60 days after receiving your appeal.
The plan administrator (LifeWise) pays claims in accordance with plan provisions. If you believe your claim has been incorrectly paid or if the plan administrator has notified you in writing that a claim has been denied, you or your authorized representative may request a review of the claim by appealing in writing within 180 days of receiving notice of payment or the rejection of the claim. You’ll be notified of the decision in writing as soon as possible and not later than 60 days after receiving your appeal.
In your appeal, include:
If you are dissatisfied with the plan administrator's final written decision, you have the right to submit the matter to an external review by an Independent Review Organization (IRO). You must provide a written request to the plan administrator within 4 months of receiving their written final decision.