Texas Administrative Code
Title 34 - PUBLIC FINANCE
Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS
Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS
Subchapter C - TEXAS SCHOOL EMPLOYEES GROUP HEALTH (TRS-ACTIVECARE)
Section 41.50 - Appeals Relating to Claims or Other Benefits
Universal Citation: 34 TX Admin Code ยง 41.50
Current through Reg. 49, No. 38; September 20, 2024
(a) For appeals that relate to claims or other benefits , the following procedures apply:
(1) A person enrolled in TRS-ActiveCare,
other than a person enrolled in a health maintenance organization (HMO)
participating in TRS-ActiveCare, who is denied payment of a claim or other
benefit ("Claimant") may appeal the denial through a written request filed with
the administering firm in accordance with procedures established by the
administering firm.
(2) The final
decision by the administering firm or by any external review organization,
whichever occurs later, shall be the final decision on the appeal.
(b) For appeals that relate to claims or other benefits, persons enrolled in an HMO under contract with TRS-ActiveCare shall follow the appeal procedures set out by the HMO.
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