5.3. ERMUSR 02-09-2010 - Laserfiche WebLink

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6.6 Records and Reports. The Plan Administrator shall be responsible for complying with all reporting, filing and disclosure requirements for the Plan. 6.7 Claim for Benefits. This Section addresses the requirements for claims for reimbursement-type Optional Benefits and the provisions of general applicability. Claims requirements for other Optional Benefits shall be handled in accordance with the governing documents for those Optional Benefits. A Participant may apply to the Claims Administrator for reimbursement of eligible expenses incurred during such Plan Year by completing a claim form and submitting such form to the Claims Administrator (or its designee) via email, facsimile, mail, setting forth at least the following: (a) the amount, date and nature of the expense, including the identity of the individual who incurred the expense; (b) the name of the person or entity to which the expense was paid; (c) the Participant's statement that the expense has not been reimbursed and the Participant will not seek reimbursement for the expense; and (d) such other information as the Claims Administrator may require. Such claim form shall be accompanied by bills, invoices, receipts, or other statements from an independent third party, or by an explanation of benefits ("EOB") issued by a health plan, stating the eligible expense has been incurred and the amount of the expense. The Claims Administrator is entitled to rely on the information provided on the claim form in processing claims under this Plan. Where circumstances beyond the Participant's control prevent submission within the described time frame, notice of a claim with an explanation of the circumstances may be accepted by the Claims Administrator as a timely filing. Claims shall be determined in accordance with Article VI. 6.8 Determination of Benefits. This Section addresses the claims determination and appeal procedures for reimbursement-type Optional Benefits, and the provisions of general applicability. (a) Initial Determination. The Plan Administrator, or Plan Administrator's designee, shall notify a person within thirty (30) days of receipt of a written claim for benefits of that persons eligibility or non-eligibility for benefits under the Plan. If it is determined that a person is not eligible for benefits or for full benefits, the notice shall set forth: (1) the specific reasons for the denial; (2) a specific reference to the provision of the Plan on which the denial is based; (3) a description of any additional information or material necessary for the claimant to perfect the claim and an explanation of why it is needed; and 18