Noblesville Schools Medical Plan 83 Section 6: Questions, Complaints and Appeals Pre-Service Request for Benefits* Type of Request for Benefits or Appeal Timing The Claims Administrator must notify you of the second level appeal decision within: 15 days after receiving the second level appeal *The Claims Administrator may require a one-time extension for the initial claim determination, of no more than 15 days, only if more time is needed due to circumstances beyond control of the Plan. Post-Service Claims Type of Claim or Appeal Timing If your claim is incomplete, the Claims Administrator must notify you within: 30 days You must then provide completed claim information to the Claims Administrator within: 45 days The Claims Administrator must notify you of the benefit determination: • if the initial claim is complete, within: 30 days • after receiving the completed claim (if the initial claim is incomplete), within: 15 days You must appeal an adverse benefit determination no later than: 180 days after receiving the adverse benefit determination The Claims Administrator must notify you of the first level appeal decision within: 30 days after receiving the first level appeal You must appeal the first level appeal (file a second level appeal) within: 60 days after receiving the first level appeal decision The Claims Administrator must notify you of the second level appeal decision within: 30 days after receiving the second level appeal