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8.05. Decision on appeal of disputed claims (a) Upon its receipt of a notice for a request for a review, the Plan Administrator shall make a prompt decision on the review. The individual who conducts the review shall not be the same individual who made the initial Adverse Benefit Determination. 8.06. Contents of notice of decision on appeal The Plan Administrator shall provide the Claimant or his Authorized Representative with written or electronic Notice of the Plan's benefit determination on review in accordance with the applicable time frames set out in Section 8.06. In the case of an Adverse Benefit Determination, the Notice shall set forth, in a manner calculated to be understood by the Claimant: (a) the specific reason or reasons for the adverse determination; (b) reference to the specific plan provisions on which the benefit determination is based; (c) a statement that the Claimant is entitled to receive without charge reasonable access to any document (1) relied on in making the determination, (2) submitted, considered or generated in the course of making the benefit determination, (3) that demonstrates compliance with the administrative processes and safeguards required in making the determination, or (4) constitutes a statement of policy or guidance with respect to the Plan concerning the denied treatment without regard to whether the statement was relied on; (d) if the adverse determination is based on medical necessity or experimental treatment or a similar exclusion or limit, either an explanation of the scientific or clinical judgment, applying the terms of the Plan to the Claimant's medical condition, or a statement that this will be provided without charge on request; (e) a statement describing the Plan's optional appeals procedures, including the provision for optional arbitration under Section 8.07, and the Claimant's right to receive information about the procedures as well as the Claimant's right to bring a civil action under ERISA sect. 502(a); and (f) the following statement: "You and your Plan may have other voluntary alternative dispute resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency." 8.07. Optional arbitration (a) Any controversy or claim made on or after the Effective Date of this Plan arising out of or relating to a Claim for Benefits payable by the Plan shall, at the option of the Claimant, be settled by arbitration in accordance with the Employee Benefit Plan Claims Arbitration Rules of the American Arbitration Association, which are incorporated into this Plan by reference. In this connection, the Plan Administrator shall make a copy of these rules available for inspection by any concerned person or his Authorized Representative during normal business hours. (b) The Plan may not be required to submit any such claim or controversy to arbitration until the Claimant has first exhausted the plan's internal Claim review and appeals procedures set forth in Sections 8.01-8.07, although the Plan Administrator may voluntarily do so at any point in processing an appeal from a prior Claim denial or other disputed benefit determination. (c) The Company will bear all costs of arbitration, except that the arbitrator shall have the power to apportion among the parties other expenses such as prehearing discovery, travel costs, and attorney's fees. Mayfield Village HRA Plan 0117.doc 13