Claims Procedures Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 55 Regular Post-Service Pharmacy Claims See Section 13 (Outpatient Prescription Drugs). Other General Claims Procedures Your medical Claim must be submitted within one year from the date you received the health care services. If you are not capable of submitting a Claim within one year, you must submit the Claim as soon as reasonably possible. If your Claim relates to an inpatient stay, the date you were discharged counts as the date you received the health care service for Claims purposes. You will receive a decision within 30 days of submitting your Claim. If we need more information on a Claim, we will reach out to you to request that additional information, but we will still make a decision on your Claim within 30 days. If you submit the requested additional information after a decision has been made, we may adjust our decision and reprocess your Claim accordingly. Claims for medical (non-pharmacy) Benefits will be reviewed by Surest. If more time is needed to decide your Claim, we may request a one-time extension of not more than 15 days. If a Claim for a welfare benefit is denied or ignored, in whole or in part, a Participant has a right to know why this was done, to obtain copies of documents (without charge) relating to the decision, and to appeal any denial, all within certain time schedules. Notice of Adverse Claim Determination If your medical Claim is denied in whole or in part, you will receive a written notice of denial. The notice will be written in an understandable and, where required by law, in a culturally and linguistically appropriate manner and will include all of the following: • Information sufficient to identify the medical Claim involved (including the date of service, the health care Provider, and the medical Claim amount [if applicable]); you can also request from the Claims Administrator the diagnosis and treatment codes, and their explanation. • The specific reason or reasons for the denial, the denial code and its meaning and a description of the Plan standard, if any, that was used in denying the Claim and a discussion of the decision. • The specific reference to the relevant Plan provision on which the decision is based. • A description of additional information needed to support your medical Claim and an explanation of why it is needed. • Information about how to appeal your Claim, if you want to pursue it further; you may contact the Center for Consumer Information & Insurance Oversight (CCIIO) to raise complaints - in addition to avenues through the State such as ombudsman. • A statement about available external review processes, including information on how to initiate the review.