any third-party administrator of the Plan will supersede the procedures set forth below as long as such procedures comply with applicable law. 11.2 Filing A Claim (i) All claims for reimbursement from your Dependent Care spending accounts must be submitted during the Plan Year in which the expenses were incurred on or before 90 days immediately following the close of the Plan Year. (ii) With the claim form, you must submit a bill or receipt from the provider which gives the following information: (a) name and address of the provider and - in some cases - the provider's taxpayer identification number and signature; (b) the date(s) services were provided; (c) the type of service provided; and (d) who received the service. (iii) Instead of submitting a claim as set forth in (ii) above, the Plan Administrator has established a debit card program for the processing and reimbursement of all eligible benefits, and the details of such program will be explained to you if and when the program is established. 11.3 Notification Of Your Claim If any claim made under this Plan is wholly or partially denied, the Administrator will notify the person making such claim (the "claimant") of his or her decision in writing. You will receive a response to your claim within 90 days after your claim is submitted. More time may be required if there are special circumstances. If so, the Plan Administrator will contact you within the 90-day period. This notice will include an explanation as to why extra time is required and the date you can expect a decision. The extension will not exceed an additional 90 days. If the Plan Administrator fails to notify you within the designated time period, your claim will be considered to have been denied. Despite the foregoing, any claim made in connection with a Qualified Benefit Plan other than the Dependent Care Flexible Spending Account will be subject to review thereunder as required in Section 3.2 and will not be subject to review under this Article. 11.4 Claim Denial If all or part of your claim is denied, you will receive written notification explaining the reasons for the denial, reference to specific Plan provisions on which the denial is based, a description of any additional information or material needed to complete your claim and an explanation of why the information is necessary, and appropriate information about the Plan's claims review procedures, including a statement of your right to bring a lawsuit following a denial on review. 11.5 Appealing A Denied Claim If your claim is denied and you wish to appeal, you must file your appeal with the Plan Administrator within 60 days after you receive the denial. Your appeal should include any additional information that you wish the Plan Administrator to consider. If your appeal is not filed within this 60-day period, you will not be able to appeal your claim. The Plan Administrator will notify you in writing within 60 days after your appeal is received. If there are special circumstances, more time may be necessary to review your appeal. You may be asked to wait an additional 60 days for a decision. If all or part of your claim on appeal is denied, you will receive written notification explaining the reasons for the denial and reference to the specific Plan provisions on which the denial 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, and a statement of your right to bring a lawsuit following a denial on review. The decision will be final and binding on all parties. If you do not receive a written response from the Plan Administrator within the designated time period, your appeal will be considered to have been denied. Page 17
Summary Plan Description for Achieva Section 125 and FSA Plan Page 16 Page 18