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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 17 The Claims Administrator may secure independent medical or other advice and require such other evidence as it deems necessary to decide your claim. If the Claims Administrator denies your claim, in whole or in part, you will be furnished with a written notice of adverse benefit determination setting forth: (1) the specific reason or reasons for the denial; (2) reference to the specific Plan provision on which the denial is based; (3) a description of any additional material or information necessary for you to complete your claim and an explanation of why such material or information is necessary; and (4) appropriate information as to the steps to be taken if you wish to appeal the Claims Administrator’s determination, including your right to submit written comments and have them considered, and your right to review (on request and at no charge) relevant documents and other information. (c) Appealing a Denial. If your claim is denied in whole or in part, you may appeal to the Plan Administrator for a review of the denied claim. Your appeal must be made in writing within one hundred eighty (180) days of the Plan Administrator’s initial notice of adverse benefit determination or you will lose your right to appeal your denial. If you do not appeal on time, you will also lose your right to file suit in court, as you will have failed to exhaust your internal administrative appeal rights, which is generally a prerequisite to bringing suit. (d) Decision upon Appeal. The Plan Administrator will review and decide your appeal within a reasonable time not longer than sixty (60) days after it is submitted and will notify you of its decision in writing. The individual who decides your appeal will not be the same individual who decided your initial claim denial and will not be that individual’s subordinate. The Plan Administrator may secure independent medical or other advice and require such other evidence as it deems necessary to decide your appeal, except that any medical expert consulted in connection with your appeal will be different from any expert consulted in connection with your initial claim. (The identity of a medical expert consulted in connection with your appeal will be provided.) If the decision on appeal affirms the initial denial of your claim, you will be furnished with a notice of adverse benefit determination on review setting forth: (1) the specific reason(s) for the denial; (2) the specific Plan provision(s) on which the decision is based; (3) a statement of your right to review (on request and at no charge) relevant documents and other information; if the Plan Administrator relied on “internal rule, guideline, protocol, or other similar criterion” in making the decision, a description of the specific rule, guideline, protocol, or other similar criterion or a statement that such a rule, guideline, protocol, or other similar criterion was relied on and that a copy of such rule, guideline, protocol, or other similar criterion will be provided free of charge to you upon request.