2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 75
Statute of Limitations for Plan Claims and Appeals
Please note that no legal action may be commenced or maintained to recover benefits under the Plan more than 12
months after the final review/appeal decision by the Plan Administrator has been rendered (or deemed rendered).
Appointment of Authorized Representative
A Covered Person is permitted to appoint an authorized representative to act on his or her behalf with respect to a
benefit claim or appeal of a denial. An assignment of benefits by a Covered Person to a provider will not constitute
appointment of that provider as an authorized representative. To appoint such a representative, the Covered Person
must complete a form which can be obtained from the Plan Administrator or the Third Party Administrator. However,
in connection with a claim involving urgent care or services rendered by a Participating Provider, the Plan will permit
a health care professional with knowledge of the Covered Person’s medical condition to act as the Covered Person’s
authorized representative without completion of this form. In the event a Covered Person designates an authorized
representative, all future communications from the Plan will be with the representative, rather than the Covered
Person, unless the Covered Person directs the Plan Administrator, in writing, to the contrary. Please note that
designation of an authorized representative is not an assignment, as described in the Assignments Prohibited section
below.
Physical Examinations
The Plan reserves the right to have a Physician of its own choosing examine any Covered Person whose Illness or
Injury is the basis of a claim. All such examinations will be at the expense of the Plan. This right may be exercised
when and as often as the Plan Administrator may reasonably require during the pendency of a claim. The Covered
Person must comply with this requirement as a necessary condition for coverage.
Assignment Prohibited
No right or any other interest under this Plan (including any right to assert benefits claim, appeals, statutory violations
or fiduciary breach claims) shall be assigned to any third party, including any providers. Any attempt to assign your
rights under this Plan shall be null and void. This Plan, will, in its discretion, make payments directly to healthcare
providers as a courtesy. The payment of benefits directly to a healthcare provider, if any, will be done as a convenience
to you and your covered Dependent(s) and will not constitute an assignment of rights, benefits or any other interest
under the Plan or a waiver of this anti-assignment provision.
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