The Health Plan Trustees and the Benefits Committee are authorized and empowered to construe the meaning of any doubtful or ambiguous provisions of the Health Plan, and any construction thereof adopted by the Health Plan Trustees or the Benefits Committee in good faith shall be binding upon SAG, the Producers, the Actors and all beneficiaries.

The Health Plan Trustees and the Benefits Committee are authorized and empowered to decide on a participant’s entitlement to or application for benefits under the Health Plan, and any such decision of the Health Plan Trustees or the Benefits Committee shall be final and binding upon all affected parties.

The Health Plan Trustees and the Benefits Committee are authorized and empowered generally to do all things, execute all such agreements, adopt and promulgate all such reasonable rules and regulations, take all such proceedings and exercise all such rights and privileges as are necessary in the establishment, maintenance and administration of the Health Plan.

Eligibility, Life Insurance and AD&D Appeals
If a claim for life insurance or AD&D benefits, or for Health Plan eligibility is denied in whole or in part, you will be notified, in writing, within 90 days of receipt of your claim. In some instances, an additional 90 days may be required for study. If additional time or information is needed you will be notified in writing of the reasons. In no case will the extension exceed 180 days from the date your claim was received.

The notice of decision will contain specific reasons for the decision and a specific reference to the provisions of the Plan or policy on which the decision is based.

If you have not been notified of action taken on your claim within the 180 day period, you may treat the claim as having been denied and may make an appeal in the following ways:

• Request for Reconsideration of a Denied Claim. If your claim was denied and you have additional medical or other information, you may request the Chief Executive Officer to reconsider the claim. A request for reconsideration must be in writing, submitted to the Chief Executive Officer within 60 days of the denial of the claim, and accompanied by the additional medical or other information upon which you rely.
• Appeal of a Denied Claim. If you have no additional medical or other information or you feel the claim has been incorrectly denied, initially or upon reconsideration as outlined above, you may appeal to the Benefits Committee of the Board of Trustees. An appeal to the Benefits Committee must be in writing, submitted to the Chief Executive Officer within 60 days of the initial denial of the claim or 60 days of the denial of a timely request for reconsideration, whichever is later, and accompanied by a statement giving the reasons the denial is believed to be incorrect.

A decision by the Chief Executive Officer on a request for reconsideration or by the Benefits Committee on an appeal shall be made within 60 days after the receipt of the request. An additional 60 days may be required for special study. However, the decision will be made no later than 120 days after your request is received. The notice of the decision will contain specific reasons for the decision and a specific reference to the provisions of the Health Plan on which the decision is based.

If you have not been notified of action taken on your appeal within the 120 day period, you may treat the appeal as having been denied and may initiate a lawsuit as described under the heading, “STATEMENT OF ERISA RIGHTS” on page 85.

Health and Disability Appeals
If your health claim or Disability Claim is denied in whole or in part, or if you disagree with the decision made on a claim, you may ask for a review. Your request must be made in writing within 180 days after you receive notice of the denial. Appeals involving Urgent Care Claims for mental health or chemical dependency treatment may be made verbally by calling ValueOptions at (866) 277-5383. For other Urgent Care appeals, call the Plan Office at (818) 954-9400, or from outside the Los Angeles area, (800) 777-4013.

If your denied claim is a Disability Claim or for hospital or medical benefits, you may appeal one time to the Benefits Committee of the Board of Trustees. If your denied claim is for another type of health benefit, there are two levels of appeal. The first is to the appropriate carrier listed below. If your claim is denied after the first review, you may file a second appeal with the Plan Office.

Specific information on how to file an appeal with the carriers listed above is contained in their claim denial notices.

Review Process
You have the right to review documents relevant to your claim. Upon request, you will be provided with the identification of medical or vocational experts, if any, that gave advice to the Plan on your claim, without regard to whether their advice was relied upon in deciding your claim.

Your appeal will be reviewed by someone other than the person who originally denied the claim. The decision will be made on the basis of the record, including such additional documents and comments that may be submitted by you. If your claim was denied on the basis of a medical judgment, such as lack of medical necessity, a health care professional with appropriate training and experience in a relevant field of medicine will be consulted.

Notice of Decision on Review
The table below outlines the timing for the appeal decision.

* If your appeal is received within 30 days of the next regularly scheduled Benefits Committee meeting, it will be considered at the second regularly scheduled meeting following receipt of your request. In special circumstances a delay until the third regularly scheduled meeting following receipt of your appeal will be necessary.

The decision on any review of your claim will be given to you in writing. If the appeal is denied, the notice will explain the reason for the decision as described in items 1, 4, 5 and 6 under “Notice of Decision” on page 78. It will also include a statement that you are entitled to receive reasonable access to and copies of all documents relevant to your claim, upon request and free of charge.

Limitation on When a Lawsuit May Be Started
You may start a lawsuit to obtain benefits after you have filed an appeal and a final decision has been reached on the appeal. If two levels of appeal are required, you must receive a final decision on your second appeal. You may also file a lawsuit if the Plan does not reach a decision, or notify you that an extension is necessary within the appropriate time frames previously described.

A lawsuit may not be started more than 90 days after the earlier of: (i) the date you receive the Plan’s written decision on your appeal, or (ii) the end of the appeals and extension time frames previously described.