ICC18 LR14GP-CTD-2 5 CTD-12995 (11/25) also notify you if we have new or additional rationale for an adverse appeal determination. We will then provide you with a reasonable opportunity to review and respond to this new information before making our decision. The time period we have to make our determination will be tolled while we are waiting for your response. If we send an adverse benefit determination following our review of the appeal, the notice of the determination will be written in an understandable manner and include the following:  The specific reason(s) for the adverse benefit determination.  Reference to the specific provision on which the determination is based.  A statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim.  A statement of your right to bring a civil action and any contractual statute of limitations period, including the specific calendar date on which such limitations period will expire.  If an internal rule, guideline, protocol or other similar criterion was relied upon in making the adverse benefit determination, then a copy of any such rule, guideline, protocol or other criterion will be provided free of charge.  The following statement: “You and your plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency." Executed at our Home Office: 250 Marquette Avenue, Suite 900 Minneapolis, MN 55401 Amelia (Amy) J. Vaillancourt Melissa A. O'Donnell President Secretary