Alternate Dispute Resolution (ADR)

Update effective January 1, 2026

What’s Changing?

Effective January 1, 2014, an external Alternate Dispute Resolution process was added to supplement the dispute resolution process described in the Concordia Disability and Survivor Plan, Concordia Retirement Plan, and Concordia Retirement Savings Plan (the Plans). Beginning in 2026, the Concordia Health Plan will also include a new Alternate Dispute Resolution provision.

Under the ADR process, any unresolved dispute a member or employer may have that is related to one of the Plans may be considered and resolved by an impartial party (either JAMS* or U.S. Arbitration and Mediation). If you have a dispute regarding your coverage, benefits, or eligibility under the Health Plan, and the issue is not resolved through the internal appeals process, you may now submit the claim for binding arbitration (or, if both sides agree, non-binding mediation) with a neutral third party. The goal is to help settle disputes outside the courtroom. The ADR process does not apply to final, binding claim decisions made by an independent reviewer under the Affordable Care Act.

The ADR process provides for binding arbitration but also allows non-binding mediation. The Plans allow a limited time period to bring a dispute to ADR, and the dispute first must have been considered by the Concordia Plan Services (CPS) Appeals Review Committee. Any decision rendered through the ADR process is considered final and is the exclusive method of resolving such disputes. Previously the Plans provided that all determination made by the CPS Appeals Review Committee were considered final, subject to the synodical dispute resolution section of the Synod Handbook (and the ADR process likewise will be subject to that section of the Handbook). Concordia Plan Services will pay any case management fees associated with the ADR. The professional fees of the arbitrator or mediator are to be equally shared. Other details of the ADR provision may be found in the Plans.

*Founded in 1979, JAMS is an acronym for Judicial Arbitration and Mediation Services

How the ADR Process Works

  1. Start with an Appeal:
    All disputes must first go through the Appeals Review Committee (ARC). This step is required before any outside review can occur. Details on how to initiate an appeal are included as part of a denial letter.
  2. Next Step – Arbitration or Mediation:
    If the ARC doesn’t resolve the issue, you can submit your claim to one of two outside neutral organizations:
    • Judicial Arbitration and Mediation Services (JAMS), or
    • U.S. Arbitration and Mediation

Arbitration is final and legally binding. (If both sides agree, non-binding mediation can be used instead). Information on how to contact these organizations will be included in the ARC denial letters.

Individual Cases Only:
The ADR process is for individual disputes only. Class actions or group claims are not allowed.

Damages:
Punitive or exemplary damages are not available.

Timing and Deadlines

If you choose to pursue arbitration, you must do so within one year from the ARC denial. Please see the ‘Determination of individual rights’ section of the Concordia Health Plan for specific requirements. Late claims will not be accepted.

Who Pays for ADR?

  • Concordia Plan Services will cover all case management fees.
  • Each side pays half of the arbitrator’s or mediator’s professional fees.
  • Concordia will not seek reimbursement from you for its share of the cost or attorney’s fees.

Why This Matters

ADR offers a quicker and more private way to resolve disagreements about your benefits. While we hope most issues can be resolved internally, this process offers additional fairness and structure when more help is needed.

The updated Plan language will be available soon here.

Questions? Contact us at: 888-927-7526 or [email protected]