2023 Archdiocese of Atlanta Meritain Group Plan Doc - Manual / Resource - Page 98
Appointment of Authorized Representative
A Covered Person is permitted to appoint an authorized representative to act on his or her behalf with respect to a
benefit claim or appeal of a denial. An assignment of benefits by a Covered Person to a provider will not constitute
appointment of that provider as an authorized representative. To appoint such a representative, the Covered Person
must complete a form which can be obtained from the Employer or the Claims Administrator. However, in connection
with a claim involving urgent care, the Dental/Vision Plan will permit a health care professional with knowledge of
the Covered Person’s medical condition to act as the Covered Person’s authorized representative without
completion of this form. In the event a Covered Person designates an authorized representative, all future
communications from the Dental/Vision Plan will be with the representative, rather than the Covered Person, unless
the Covered Person directs the Employer, in writing, to the contrary.
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