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. Departments of Labor and the Treasury (the Agencies) issue guidance that temporarily extends the deadlines in place for certain benefit changes and processes associated with election, notification, payment and claims/appeals in connection with COVID-19, which was deemed a National Emergency on March 1, 2020 (the National Emergency). To protect individuals from losing benefits, the Agencies extended deadlines that might have been missed during the National Emergency, which ended on May 11, 2023. The temporary extension of the deadlines expired on July 10, 2023, 60 days after the end of the National Emergency.
If your deadline to file a claim or appeal occurred during the National Emergency (March 1, 2020 - May 11, 2023) and you have exceeded the deadlines outlined in your plan documents or denial notification, you may have additional time to submit your claim or appeal.
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.