Adverse Benefit Determination

Adverse Benefit Determination. A denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of a participant's eligibility to participate in the Plan.

Adverse Benefit Determination. Means any of the following: (i) a denial, reduction, or termination of a benefit by the Deferral Program, or a failure of the Deferral Program to provide or make payment (in whole or in part) for a benefit; and (ii) a denial, reduction, or termination of a benefit by the Deferral Program, or a failure of the Deferral Program to provide or make payment (in whole or in part) for a benefit resulting from the application of any utilization review.

Adverse Benefit Determination. Means any of the following: (ii) a denial, reduction, or termination of a benefit by the Plan, or a failure of the Plan to provide or make payment (in whole or in part) for a benefit; and (iii) a denial, reduction, or termination of a benefit by the Plan, or a failure of the Plan to provide or make payment (in whole or in part) for a benefit resulting from the application of any utilization review.