12 will notify you of the extension prior to the end o f the 45 - day period. If, after extending the time period for a first period of 30 days, the Plan Administrator determines that it will still be unable, for reasons beyond the control of the Plan, to make a decision wi thin the extension period, the Plan may extend decision making for a second 30 - day period. Appropriate notice will be provided to you before the end of the first 45 days and again before the end of each succeeding 30 - day period. This notice will explain the circumstances requiring the extension and the date the Plan Administrator expects to render a decision. It will explain the standards on which entitlement to the benefits is based, the unresolved issues that prevent a decision, the additional issues that prevent a dec ision, and the additional information needed to resolve the issues. You will have 45 days from the date of receipt of the Plan Administrator’s notice to provide the information required. If the Plan Administrator determines that all or part of the claim should be denie d (an "adverse benefit determination" ), it will provide a notice of its decision in written or electronic form explaining your appeal rights. An “adverse benefit determination” also i ncludes a rescission, which is a retroactive cancellation or termination of ent itlement to disability benefits. The notice will be provided in a culturally and linguistically appropriate manner and will state: (a) The specific reason or reasons for the adverse determination. (b) Reference to the specific Plan provisions on which the determination is based. (c) A description of any additional material or information necessary for you to perfect the claim and an explanation of why such material or information is necessary. (d) A description of the Plan's review procedures and the time limits applicable to such procedures. This will include a statement of your right to bring a civil action under section 502(a) of ERISA following an adverse benefit determination on review. (e) In the case of a claim for disability benefits, if disab ility is determined by the Plan Administrator (rather than a third party such as the Social Security Administration, then the following additional information will be provided: (i) A discussion of the decision, including an explanation of the basis for di sagreeing with or not following: The views you presented to the Plan of health care professionals treating the claimant and vocational professionals who evaluated you; The views of medical or vocational experts whose advice was obtained on behalf of the Plan in connection with an adverse benefit determination, without regard to whether the advice was relied upon in making the benefit determination; or A disability determination made by the Social Security Administration and presented by you to the Plan. (ii) Either the internal rules, guidelines, protocols, or other similar criteria relied up on to make a determination, or a statement that such rules, guidelines, protocols, or other criteria do not exist. (iii) If the adverse benefit determination is based on a medical necessity or experimental treatment and/or investigational treatment or similar exclusion or limit, an explanation of the scientific or clinical judgment for the determination, applyin g the terms of the Plan to your medical circumsta nces. If this is not practical, a statement will be included that such explanation will be provided to you free of charge, upon request. (iv) A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies o f, all documents, records, and other information relevant to the claim. If your claim has been denied, and you want to submit your claim for review, you must follow the claims review procedure in t he next question. What is the claims review procedure? Upon the denial of your claim for benefits, you may file your claim for review, in writing, with the Plan Administrator. (a) YOU MUST FILE THE CLAIM FOR REVIEW NO LATER THAN 60 DAYS (EXCEPT AS PROVIDED BELOW FOR DISABILITY CLAIMS) AFTER YOU HAVE RECEIVED WRITTEN NOTIFICATION OF THE DENIAL OF YOUR CLAIM FOR BENEFITS. HOWEVER, IF YOUR CLAIM IS FOR DISABILITY BENEFITS AND DISABILITY IS DETERMINED BY THE PLAN ADMINISTRATOR (RATHER THAN A THIRD PARTY SUCH AS THE SOCIAL SECURITY ADMINISTRATION), THEN INSTEAD OF THE ABOVE, YOU MUST FILE THE CLAIM FOR REVIEW NOT LATER THAN 180 DAYS FOLLOWING RECEIPT OF NOTIFICATION OF AN ADVERSE BENEFIT DETERMINATION. IN THE CASE OF AN AD VERSE BENEFIT DETERMIN ATION REGARDING A RE SCISSION OF COVERAGE , YOU MUST REQUEST A REVIEW WITHIN 90 DA YS OF THE NOTICE. (b) You may submit written comments, documents, records, and other information relating to your claim for benefits. (c) You will be provided, upon request a nd free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to your claim for benefits.
BB&N 403(b) Summary Plan Description 2022 Page 14 Page 16