Claims for Benefits/Appealing a Denial of Claims for Benefits

At the end of each summary plan description contained on this site, there is a section that explains how to apply for benefits. If you or your beneficiary applies for benefits and either part or all of the request is denied, you have the right to appeal that decision, provided the appeal is made in accordance with the provisions of the plan and applicable laws (e.g. appeals must be filed within required time periods). Appeals are generally decided by the provider of the benefit involved, which is the insurance carrier or vendor for most benefits, or the University or its Plan Administration Committee for some benefits.

Appeals to Insurance Carriers

For the following plans, appeals regarding benefits or other issues affecting  plan participants or other persons should be made directly to the insurance carrier providing benefits under the Plan:

• The Health Plan
• The Dental Plan
• The Basic and Group Supplemental Life Insurance Plan
• The Travel Accident and Personal and Family Accident Insurance Plan
• The Flexible Spending Account
• The Long Term Disability Plan
• The Individual Disability Insurance Benefit Plan

Details of appeal procedures may vary, but generally the following procedures apply:

• If a claim for benefits is either wholly or partially denied, you will be notified in writing. The notice will state the reasons why the claim was denied and the deadline for requesting review, which is different for different types of plans and/or claims.
• If you wish to appeal, you are entitled to review all documents pertaining to your claim free of charge and may also submit comments pertaining to your claim.
• Your appeal of the denial should be addressed to the carrier as directed in the denial of benefits notice.
• The carrier will decide the appeals in the time and manner required by law. For example, post-service claim appeals under the Health Plan will be decided within 60 days of an appeal.

Appeals may be submitted to the following carriers:

Appeals to the University

For the following plans, appeals regarding benefits or other issues affecting plan participants or other persons should be made to the University’s Plan Administration Committee:

• Supplemental Death Benefit
• The Boston University Retirement Plan
• The Supplemental Retirement and Savings Plan
• The Flexible Benefits Program
• The Severance Pay Plan

For the following plan, appeals regarding benefits or other issues affecting plan participants or other persons should be made to the Office of the Senior Vice President for Operations:

• The Tuition Remission Plan

For appeals to the University, the following procedures will apply:

• If a claim for benefits is either wholly or partially denied, you will be notified in writing. The notice will state the reasons why the claim was denied and the deadline for requesting review.
• After receiving the notice, you or your beneficiaries may request, in writing, a review of your claim by the University’s Plan Administration Committee or Office of the Senior Vice President for Operations, as applicable, by submitting an appeal to:

Plan Administration Committee (or Office of the Senior Vice President for Operations)
c/o Plan Administrator
Boston University Human Resources
25 Buick Street
Boston, MA 02215