i. Contract approval
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i. Contract approval
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<br />(2) that the day care center provides care for more than 6 individuals <br />(other than individuals residing at the center), and <br /> <br />(3) <br />(h) <br /> <br />of the amount of fee paid to the provider. <br /> <br />If the Participant is married, a statement containing the following: <br /> <br />(1) <br />(2) <br /> <br />the Spouse's salary or wages if he or she is employed, or <br /> <br />if the Participant's Spouse is not employed, that <br /> <br />(i) <br /> <br />he or she is incapacitated, or <br /> <br />(ii) he or she is a full-time student attending an educational <br />institution and the months during the year which he or she <br />attended such institution. <br /> <br />(i) If a Participant fails to submit a claim within the 90 day period <br />immediately following the end of the Plan Year or within the 90 day period <br />immediately following termination of employment, those claims shall not be <br />considered for reimbursement by the Administrator. <br /> <br />ARTICLE VIII <br />BENEFITS AND RIGHTS <br /> <br />8.1 <br /> <br />CLAIM FOR BENEFITS <br /> <br />(a) Any claim for Benefits underwritten by Contracts shall be made to <br />the Employer. If the Employer denies any claim, the Participant or beneficiary <br />shall follow the Employer's claims review procedure. Any other claim for Benefits <br />shall be made to the Administrator. If the Administrator denies a claim, the <br />Administrator may provide notice to the Participant or beneficiary, in writing, <br />within 90 days after the claim is filed unless special circumstances require an <br />extension of time for processing the claim. If the Administrator does not notify the <br />Participant of the denial of the claim within the 90 day period specified above, <br />then the claim shall be deemed denied. The notice of a denial of a claim shall be <br />written in a manner calculated to be understood by the claimant and shall set <br />forth: <br /> <br />(1) specific references to the pertinent Plan provisions on which the <br />denial is based; <br /> <br />(2) a description of any additional material or information necessary <br />for the claimant to perfect the claim and an explanation as to why such <br />information is necessary; and <br /> <br />(3) <br /> <br />an explanation of the Plan's claim procedure. <br /> <br />(b) Within 60 days after receipt of the above material, the claimant <br />shall have a reasonable opportunity to appeal the claim denial to the <br />Administrator for a full and fair review. The claimant or his duly authorized <br />representative may: <br /> <br />(1 ) <br /> <br />request a review upon written notice to the Administrator; <br /> <br />20 <br />
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