This letter means that we have determined that the payment you made with your Choice Strategies Card was not for an allowed expense under your plan. Therefore, we are requesting that you refund your account within 30 days to:
Attn: Refunds Department
76 McNeil Road, 2nd Floor
Waterbury, Center, VT 05677
THE EMPLOYER RETIREMENT INCOME SECURITY ACT (ERISA) PROVIDES YOU WITH THE RIGHT TO APPEAL A CLAIM DENIED IN WHOLE OR IN PART BY YOU MAKING A WRITTEN REQUEST WITHIN 180 DAYS AS OUTLINED IN THE PLAN’S SUMMARY PLAN DESCRIPTION.
CLAIMS APPEAL PROCESS - You have the right to appeal this determination. If you disagree with this determination, you must submit proof that the claim for benefits is covered and payable under the Plan’s provisions and that sufficient funds were available in your account to cover the claim at the time of claim denial. As part of your appeal, you must include (1) all facts and theories supporting your claim, (2) a statement of the reason(s) for disagreement with the handling of the claim, and (3) any material or information that the claim does not fall within the referenced Plan provision. If you do so, it may be that some review of an adverse determination in compliance with the Employee Retirement Income Security Act of 1974 (“ERISA”) and the regulations issued there under, Claimant will be provided free of charge with a complete description of the Plan’s review procedures and application time limits upon request. Any appeal filed must be in writing and addressed to: Choice Strategies/ 76 McNeil Rd. 2nd Floor Waterbury Center, VT 05677. If claimant provides the Plan with all information needed to address the appeal, the Plan will respond to the appeal no later than 180 days after receipt of the appeal. You are entitled to receive, free of charge upon request, reasonable access to, and copies of, all documents, records and other information relevant to your claim for benefits. If you received an adverse benefit determination following the appeal, you have the right to bring a civil action under section 502 (a) of ERISA.