Health plan & appeal guide

National Grid USA Service Company, Inc.

Brooklyn, NY · Form 5500 filing, plan year 2024

Self-funded · federal rules Active Employees Healthcare · 12,013 people

Your employer pays the claims from its own money, so federal law (ERISA) applies — not your state’s insurance rules.

How we know · medium confidence
  • The filing says benefits are paid from the employer's general assets.
  • No medical insurance contract is on file (Schedule A).

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Send your appeal here

    Self-funded plan (federal rules)

    Your employer pays claims from its own money. The insurance company on your card usually just processes claims. Federal law (ERISA) applies, so your state insurance department generally can't overrule the denial.

    Your appeal

    The claims administrator

    Send it to the appeal address on your denial letter or the back of your card. This filing doesn't name the administrator; your card does.

    Plan documents, and a copy of your appeal

    The plan administrator

    RETIREMENT PLANS COMMITTEE OF NATIONAL GRID USA SERVICE COMPANY, INC.
    ATTN: PLAN ADMINISTRATOR
    2 HANSON PLACE
    12 FLOOR
    BROOKLYN, NY 11217
    (917) 636-9931

    The plan administrator is legally responsible for the plan. Ask in writing for the Summary Plan Description and the plan document. The plan administrator must send them within 30 days, or a court can add a penalty of up to $110 a day.

  2. Know your deadlines

    • Internal appeal to the plan180 days from the denial
    • Independent external review4 months from the final denial

    Dates you enter stay on this device.

  3. What happens next

    1. Internal appeal to the plan (send it to the claims administrator on your card)

      File in writing within 180 days of the denial notice. Ask for your complete claim file and the criteria they used. They must give it to you free. They decide within 30 days for care you haven't had yet, 60 days for care you already received.

    2. Independent external review

      If they say no again, request external review within 4 months of that final denial. The plan must send it to an independent review organization it contracts with. Some states let self-funded plans use the state's program instead. Your denial letter has to tell you where to send it. A reviewer outside the plan decides, usually within 45 days, and the plan must follow the decision.

    3. Urgent? Ask for an expedited review

      If waiting could seriously harm your health, say so in writing. The plan must decide within 72 hours, and you can ask for expedited external review at the same time.

    4. If the plan stalls or ignores the rules

      Call the Department of Labor's benefits advisors. They enforce these rules for employer plans and can contact the plan for you, free. After the appeals are finished, a lawyer can sue under ERISA if the denial was wrong.

  4. Get free help

    External review covers denials based on medical judgment ("not medically necessary", "experimental"), cancelled coverage, and surprise-billing disputes. A flat plan exclusion usually isn't eligible, but you can still file the internal appeal.

    If your plan documents say the plan is "grandfathered" (unchanged since March 2010), the external-review rules may not apply.

Both kinds Niagara Mohawk Medical, Prescription Drug, and Life Insurance Plan for Retired Former Represented Empl · 5,050 people

This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.

How we know · medium confidence
  • The filing says benefits are paid from the employer's general assets.
  • The filing says benefits are paid from a trust the plan controls.
  • Medical insurance bought from Aetna is on file, covering about 400 people.
  • Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
  • The insured options cover only about 8% of the 5,050 participants, so most people in this plan are in the self-funded part.

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Which company is on your insurance card?

    It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.

  2. Send your appeal here

    Unlocks after you answer the question above

  3. Know your deadlines

    Unlocks after you answer the question above

  4. What happens next

    Unlocks after you answer the question above

  5. Get free help

    Unlocks after you answer the question above

Self-funded · federal rules Keyspan Benefit Plan for Active Union Employees · 4,609 people

Your employer pays the claims from its own money, so federal law (ERISA) applies — not your state’s insurance rules.

How we know · medium confidence
  • The filing says benefits are paid from the employer's general assets.
  • No medical insurance contract is on file (Schedule A).

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Send your appeal here

    Self-funded plan (federal rules)

    Your employer pays claims from its own money. The insurance company on your card usually just processes claims. Federal law (ERISA) applies, so your state insurance department generally can't overrule the denial.

    Your appeal

    The claims administrator

    Send it to the appeal address on your denial letter or the back of your card. This filing doesn't name the administrator; your card does.

    Plan documents, and a copy of your appeal

    The plan administrator

    RETIREMENT PLANS COMMITTEE OF NATIONAL GRID USA SERVICE COMPANY, INC.
    ATTN: PLAN ADMINISTRATOR
    2 HANSON PLACE
    12 FLOOR
    BROOKLYN, NY 11217
    (917) 636-9931

    The plan administrator is legally responsible for the plan. Ask in writing for the Summary Plan Description and the plan document. The plan administrator must send them within 30 days, or a court can add a penalty of up to $110 a day.

  2. Know your deadlines

    • Internal appeal to the plan180 days from the denial
    • Independent external review4 months from the final denial

    Dates you enter stay on this device.

  3. What happens next

    1. Internal appeal to the plan (send it to the claims administrator on your card)

      File in writing within 180 days of the denial notice. Ask for your complete claim file and the criteria they used. They must give it to you free. They decide within 30 days for care you haven't had yet, 60 days for care you already received.

    2. Independent external review

      If they say no again, request external review within 4 months of that final denial. The plan must send it to an independent review organization it contracts with. Some states let self-funded plans use the state's program instead. Your denial letter has to tell you where to send it. A reviewer outside the plan decides, usually within 45 days, and the plan must follow the decision.

    3. Urgent? Ask for an expedited review

      If waiting could seriously harm your health, say so in writing. The plan must decide within 72 hours, and you can ask for expedited external review at the same time.

    4. If the plan stalls or ignores the rules

      Call the Department of Labor's benefits advisors. They enforce these rules for employer plans and can contact the plan for you, free. After the appeals are finished, a lawyer can sue under ERISA if the denial was wrong.

  4. Get free help

    External review covers denials based on medical judgment ("not medically necessary", "experimental"), cancelled coverage, and surprise-billing disputes. A flat plan exclusion usually isn't eligible, but you can still file the internal appeal.

    If your plan documents say the plan is "grandfathered" (unchanged since March 2010), the external-review rules may not apply.

Both kinds National Grid Benefit Plan for Certain Retired Management Employees of New York Companies · 4,423 people

This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.

How we know · medium confidence
  • The filing says benefits are paid from a trust the plan controls.
  • Medical insurance bought from Aetna, Cigna is on file, covering about 676 people.
  • Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
  • The insured options cover only about 15% of the 4,423 participants, so most people in this plan are in the self-funded part.

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Which company is on your insurance card?

    It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.

  2. Send your appeal here

    Unlocks after you answer the question above

  3. Know your deadlines

    Unlocks after you answer the question above

  4. What happens next

    Unlocks after you answer the question above

  5. Get free help

    Unlocks after you answer the question above

Both kinds Keyspan Benefit Plan for Retired East Union Employees · 1,853 people

This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.

How we know · medium confidence
  • The filing says benefits are paid from a trust the plan controls.
  • Medical insurance bought from Hip Health Plan Of New York is on file, covering about 54 people.
  • We ignored a small insurance contract with Oxford Health Plans (Ny) covering about 6 people; it is too small to be the main plan.
  • Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
  • The insured options cover only about 3% of the 1,853 participants, so most people in this plan are in the self-funded part.

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Which company is on your insurance card?

    It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.

  2. Send your appeal here

    Unlocks after you answer the question above

  3. Know your deadlines

    Unlocks after you answer the question above

  4. What happens next

    Unlocks after you answer the question above

  5. Get free help

    Unlocks after you answer the question above

Both kinds National Grid USA Companies' Retirees Health and Life Insurance Plan I · 1,628 people

This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.

How we know · medium confidence
  • The filing says benefits are paid from the employer's general assets.
  • The filing says benefits are paid from a trust the plan controls.
  • Medical insurance bought from Aetna, Blue Cross Blue Shield is on file, covering about 316 people.
  • Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
  • The insured options cover only about 19% of the 1,628 participants, so most people in this plan are in the self-funded part.

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Which company is on your insurance card?

    It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.

  2. Send your appeal here

    Unlocks after you answer the question above

  3. Know your deadlines

    Unlocks after you answer the question above

  4. What happens next

    Unlocks after you answer the question above

  5. Get free help

    Unlocks after you answer the question above

Both kinds National Grid USA Companies' Retirees Health and Life Insurance Plan II · 1,332 people

This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.

How we know · medium confidence
  • The filing says benefits are paid from the employer's general assets.
  • The filing says benefits are paid from a trust the plan controls.
  • Medical insurance bought from Aetna, Fallon Community Health Plan is on file, covering about 171 people.
  • We ignored a small insurance contract with Blue Cross Blue Shield covering about 9 people; it is too small to be the main plan.
  • Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
  • The insured options cover only about 13% of the 1,332 participants, so most people in this plan are in the self-funded part.

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Which company is on your insurance card?

    It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.

  2. Send your appeal here

    Unlocks after you answer the question above

  3. Know your deadlines

    Unlocks after you answer the question above

  4. What happens next

    Unlocks after you answer the question above

  5. Get free help

    Unlocks after you answer the question above

Both kinds National Grid Benefit Plan for Certain Retired Management and Union Employees of Massachusetts Gas Companies · 1,321 people

This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.

How we know · medium confidence
  • The filing says benefits are paid from the employer's general assets.
  • The filing says benefits are paid from a trust the plan controls.
  • Medical insurance bought from Aetna, Fallon Community Health Plan is on file, covering about 261 people.
  • We ignored a small insurance contract with Cigna covering about 11 people; it is too small to be the main plan.
  • Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
  • The insured options cover only about 20% of the 1,321 participants, so most people in this plan are in the self-funded part.

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Which company is on your insurance card?

    It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.

  2. Send your appeal here

    Unlocks after you answer the question above

  3. Know your deadlines

    Unlocks after you answer the question above

  4. What happens next

    Unlocks after you answer the question above

  5. Get free help

    Unlocks after you answer the question above

Self-funded · federal rules Keyspan Benefit Plan for Active Management Employees · 1,285 people

Your employer pays the claims from its own money, so federal law (ERISA) applies — not your state’s insurance rules.

How we know · medium confidence
  • The filing says benefits are paid from the employer's general assets.
  • No medical insurance contract is on file (Schedule A).

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Send your appeal here

    Self-funded plan (federal rules)

    Your employer pays claims from its own money. The insurance company on your card usually just processes claims. Federal law (ERISA) applies, so your state insurance department generally can't overrule the denial.

    Your appeal

    The claims administrator

    Send it to the appeal address on your denial letter or the back of your card. This filing doesn't name the administrator; your card does.

    Plan documents, and a copy of your appeal

    The plan administrator

    RETIREMENT PLANS COMMITTEE OF NATIONAL GRID USA SERVICE COMPANY, INC.
    ATTN: PLAN ADMINISTRATOR
    2 HANSON PLACE
    12 FLOOR
    BROOKLYN, NY 11217
    (917) 636-9931

    The plan administrator is legally responsible for the plan. Ask in writing for the Summary Plan Description and the plan document. The plan administrator must send them within 30 days, or a court can add a penalty of up to $110 a day.

  2. Know your deadlines

    • Internal appeal to the plan180 days from the denial
    • Independent external review4 months from the final denial

    Dates you enter stay on this device.

  3. What happens next

    1. Internal appeal to the plan (send it to the claims administrator on your card)

      File in writing within 180 days of the denial notice. Ask for your complete claim file and the criteria they used. They must give it to you free. They decide within 30 days for care you haven't had yet, 60 days for care you already received.

    2. Independent external review

      If they say no again, request external review within 4 months of that final denial. The plan must send it to an independent review organization it contracts with. Some states let self-funded plans use the state's program instead. Your denial letter has to tell you where to send it. A reviewer outside the plan decides, usually within 45 days, and the plan must follow the decision.

    3. Urgent? Ask for an expedited review

      If waiting could seriously harm your health, say so in writing. The plan must decide within 72 hours, and you can ask for expedited external review at the same time.

    4. If the plan stalls or ignores the rules

      Call the Department of Labor's benefits advisors. They enforce these rules for employer plans and can contact the plan for you, free. After the appeals are finished, a lawyer can sue under ERISA if the denial was wrong.

  4. Get free help

    External review covers denials based on medical judgment ("not medically necessary", "experimental"), cancelled coverage, and surprise-billing disputes. A flat plan exclusion usually isn't eligible, but you can still file the internal appeal.

    If your plan documents say the plan is "grandfathered" (unchanged since March 2010), the external-review rules may not apply.

Both kinds Keyspan Benefit Plan for Retired West Union Employees · 1,082 people

This employer has both kinds of coverage. The company on your insurance card decides which rules apply to you.

How we know · medium confidence
  • The filing says benefits are paid from a trust the plan controls.
  • Medical insurance bought from Hip Health Plan Of New York, Cigna, Oxford Health Plans (Ny) is on file, covering about 45 people.
  • We ignored a small insurance contract with Aetna, Oxford Health Plans (Ct) covering about 8 people; it is too small to be the main plan.
  • Medical insurance is on file, but the plan also pays benefits from the employer's own money, so some options are likely self-funded.
  • The insured options cover only about 4% of the 1,082 participants, so most people in this plan are in the self-funded part.

Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.

  1. Which company is on your insurance card?

    It’s printed on the front of the card. The filing shows which companies sell insured options here and which ones run the self-funded plan.

  2. Send your appeal here

    Unlocks after you answer the question above

  3. Know your deadlines

    Unlocks after you answer the question above

  4. What happens next

    Unlocks after you answer the question above

  5. Get free help

    Unlocks after you answer the question above

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