122 Federal Notice Effective for plans that are new or renewing on or after January 1, 2014, the requirements listed below apply: If your plan includes coverage for Clinical Trials, the following applies: The clinical trial benefit has been modified to distinguish between clinical trials for cancer and other life threatening conditions and those for non-life threatening conditions. For trials for cancer/other life threatening conditions, routine patient costs now include those for covered persons participating in a preventive clinical trial and Phase IV trials. This modification is optional for certain grandfathered health plans. Refer to your plan documents to determine if this modification has been made to your plan. Pre-Existing Conditions: Any pre-existing condition exclusions (including denial of benefit or coverage) will not apply to covered persons regardless of age. Some Important Information about Appeal and External Review Rights under PPACA If you are enrolled in a non-grandfathered plan with an effective date or plan year anniversary on or after September 23, 2010, the Patient Protection and Affordable Care Act of 2010 (PPACA), as amended, sets forth new and additional internal appeal and external review rights beyond those that some plans may have previously offered. Also, certain grandfathered plans are complying with the additional internal appeal and external review rights provisions on a voluntary basis. Please refer to your benefit plan documents, including amendments and notices, or speak with your employer or UnitedHealthcare for more information on the appeal rights available to you. (Also, please refer to the Claims and Appeal Notice section of this document.) What if I receive a denial, and need help understanding it? Please call the Claims Administrator at the number listed on your health plan ID card. What if I don't agree with the denial? You have a right to appeal any decision to not pay for an item or service. How do I file an appeal? The first denial letter or Explanation of Benefits that you receive from the Claims Administrator will give you the information and the timeframe to file an appeal. What if my situation is urgent? If your situation is urgent, your review will take place as quickly as possible. If you believe your situation is urgent, you may request an expedited review, and, if applicable, file an external review at the same time. For help call the Claims Administrator at the number listed on your health plan ID card. Generally, an urgent situation is when your health may be in serious jeopardy. Or when, in the opinion of your doctor, you may be experiencing severe pain that cannot be controlled while you wait for a decision on your appeal. Who may file an appeal? Any member or someone that member names to act as an authorized representative may file an appeal. For help call the Claims Administrator at the number listed on your health plan ID card. Can I provide additional information about my claim? Yes, you may give the Claims Administrator additional information supporting your claim. Send the information to the address provided in the first denial letter or Explanation of Benefits. Can I request copies of information relating to my claim? Yes. There is no cost to you for these copies. Send your request to the address provided in the first denial letter or Explanation of Benefits. What happens if I don't agree with the outcome of my appeal? If you appeal, the Claims Fiduciary will review its decision. The Claims Fiduciary will also send you its written decision within the time allowed. If