A member may request the summary and their own claim detail
What the document says“upon request of a participant or beneficiary, shall provide to such participant or beneficiary-- ``(1) the summary document described in subsection (b)(2)(B)(ii); and”
On request, a group health plan must give a participant or beneficiary the member summary document, and the difference between what the plan paid the manager and what the pharmacy was paid, for a claim made by or on behalf of that person.
What the document actually says“upon request of a participant or beneficiary, shall provide to such participant or beneficiary-- ``(1) the summary document described in subsection (b)(2)(B)(ii); and”
If a member asks, the plan must hand over the short document.
The member may also ask about their own claim. What they get is the gap between what the plan paid and what the pharmacy got.
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