Citi Benefits Handbook
Claims and Appeals for Express Scripts
The amount of time Express Scripts will take to make a decision on a claim will depend on the type of claim.
1 Time period allowed to make a decision is suspended pending receipt of additional information.
If your claim is denied in whole or in part, you will receive a written explanation detailing:
- The specific reasons for the denial;
- Specific reference to the Plan documentation on which the denial is based;
- A description of additional material or information you must provide to complete your claim and the reasons why that information is necessary;
- The steps to be taken to submit your claim for review;
- The procedure for further review of your claim; and
- A statement explaining your right to bring a civil action under Section 502(a) of ERISA after exhaustion of the Program's appeals procedure.