You or your covered family member file a claim by calling MetLife. The claim needs to be filed within 90 days of the date care is received.

You or your covered family member will speak with a care manager who is a registered nurse who will obtain the necessary information to make a decision regarding benefits eligibility. You or your covered family member will be notified of the decision within 10 business days of receipt of all the necessary information.

In some cases, the care manager may also contact a representative or others who may have relevant information about your or your covered family member's condition. In the event that necessary information is not available through these channels, MetLife may arrange an onsite visit at its own expense.

You need to contact MetLife to develop a plan of care.

There are special rules, procedures and deadlines that apply to appeals of benefit determinations and denied claims and you have special legal rights under ERISA. Please refer to the Administrative Information section for a description of the appeal process.