If an administrative claim is denied which impacts your benefits coverage, you can file an administrative appeal by completing and submitting a Benefits Administrative Appeal Form. Your completed form should include any additional documentation not provided in your initial administrative claim. An appeal will not be a review of your initial claim.
Your appeal should include issues, comments, documents, records, and other information relating to your dispute that you want considered. You may request reasonable access to, and copies of, all documents, records, and other information relevant to your dispute, without charge. You will receive notice of the decision within 60 days after the date the Committee receives your written request for appeal. Include this completed form and your additional documentation with your Help Desk Ticket created for the administrative appeal or mail to this form and your additional documentation to:
Albertsons Companies, Inc.
Administrative Claims Committee
Attn: Director of Benefits Delivery
6080 Tennyson Parkway, Suite 300
Plano, TX 75074
If you have questions about the administrative appeal process, call the Benefits Service Center at 888-255-2269. Press 2, then press 2 again to speak to a Benefits Service Center Agent.
NOTE: This is not an appeal for plan benefits under ERISA. Benefit claims must be sent to the Claims Administrator for your plan. You can find contact information for the Claims Administrator for your plan or program on your medical plan ID card, in your benefits enrollment materials, Summary Plan Description (SPD) or the Contacts page on this website. Claims for benefits are subject to federal rules for claims and appeals procedures as outlined under ERISA.