h. Contract approval
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h. Contract approval
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<br />for processing the claim. The notice of a denial of a claim shall be written in a <br />manner calculated to be understood by the claimant and shall set 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) an explanation of the Plan's claim procedure. <br /> <br />(c) Appeal. Within 60 days after receipt of the above material, the <br />claimant 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) request a review upon written notice to the Administrator; <br /> <br />(2) review pertinent documents; and <br /> <br />(3) submit issues and comments in writing. <br /> <br />(d) Review of appeal. A decision on the review by the Administrator <br />will be made not later than 60 days after receipt of a request for review, unless <br />special circumstances require an extension of time for processing (such as the <br />need to hold a hearing). in which event a decision should be rendered as soon as <br />possible, but in no event later than 120 days after such receipt. The decision of <br />the Administrator shall be written and shall include specific reasons for the <br />decision, written in a manner calculated to be understood by the claimant, with <br />specific references to the pertinent Plan provisions on which the decision is <br />based. <br /> <br />(e) Forfeitures. Any balance remaining in the Participant's <br />Dependent Care Flexible Spending Account or Health Flexible Spending Account <br />as of the end of the time for claims reimbursement for each Plan Year shall be <br />forfeited and deposited in the benefit plan surplus of the Employer pursuant to <br />Section 6.3 or Section 7.8, whichever is applicable, unless the Participant had <br />made a claim for such Plan Year, in writing, which has been denied or is <br />pending; in which event the amount of the claim shall be held in his account until <br />the claim appeal procedures set forth above have been satisfied or the claim is <br />paid. If any such claim is denied on appeal, the amount held beyond the end of <br />the Plan Year shall be forfeited and credited to the benefit plan surplus. <br /> <br />22 <br />
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