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YOURPEOPLE, INC.

Timeline for a Concurrent Care Decision

For Administrators and Employees

If a group health plan has approved an ongoing course of treatment, an adverse benefit determination occurs when the plan reduces or terminates such treatment before the treatment ends. The plan administrator must notify the claimant in advance of the reduction or termination.

A claimant’s request to extend the course of treatment beyond the period of time or number of treatments and is a claim involving urgent care shall be decided as soon as possible. The plan administrator must notify the claimant of the benefit determination within 24 hours after receipt of the claim by the plan when such claim is made to the plan at least 24 hours prior to the expiration of the prescribed period of time or number of treatments.

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