Health and Welfare Summary Plan Description
12.2 Claims and Appeals for HMO Benefits.
If you believe you are entitled to benefits from the Kaiser HMO or the Blue Shield HMO that the HMO refuses to provide to you, you should file a claim for benefits (and potentially an appeal, if your claim is denied) in accordance with that HMO's claim and appeal procedures. The Plan Office can provide you the claim and appeal procedures for each of these HMOs, or you can obtain them directly from the HMO. The claim and appeal procedures in Appendix C do not apply to benefit claims under the HMOs. The Board has no role in the determination of HMO benefits. Because the passage of time may limit or eliminate your right to claim benefits, do not delay filing a claim if you believe benefits are owed to you that an insurer has refused to pay.