Citi Benefits Handbook
Claims and Appeals for CVS Caremark
The amount of time CVS Caremark 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.
On May 4, 2020, the U.S. Department of Labor and the Treasury issued guidance that temporarily extends the deadlines in place for certain benefit changes and processes associated with election notification, payment and claims/appeals. To protect individuals from losing benefits, the agencies are adjusting the deadlines that may be missed during the “Outbreak Period,” which is defined as the period beginning March 1, 2020 and ending 60 days after the end of the National Emergency, which has yet to be announced.
If your deadline to file a claim or appeal falls within the defined Outbreak Period, you will have additional time to submit your claim, as the deadline will be recalculated to extend through the Outbreak Period.
For more information, contact the Claims Administrators as detailed under “Claims Administrators” in the Administrative Information section. Or, call the Citi Benefits Center via ConnectOne at 1 (800) 881-3938 for additional help. From the Benefits menu, select the appropriate option. See the For More Information section for detailed instructions, including TDD and international assistance.
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.