Current through Register Vol. 24-18, September 15, 2024
(1) Any
employee who disagrees with a decision that denies eligibility for, or
enrollment in, a benefit offered under the salary reduction plan may appeal
that decision by submitting a written request for administrative review to
their state agency. The state agency must receive the written request for
administrative review no later than 30 days after the date of the denial. The
contents of the written request for administrative review are to be provided as
described in WAC
182-16-2070.
(a) Upon receiving the written request for
administrative review, the state agency must perform a complete review of the
denial by one or more staff who did not take part in the decision resulting in
the denial.
(b) The state agency
must render a written decision within 30 days of receiving the written request
for administrative review. The written decision must be sent to the employee
who submitted the written request for review and must include a description of
appeal rights. The state agency must also send a copy of the state agency's
written decision to the state agency's administrator (or designee) and to the
PEBB appeals unit. If a state agency fails to render a written decision within
30 days of receiving the written request for administrative review, the request
for administrative review may be considered denied as of the 31st day and the
original underlying state agency decision may be appealed to the PEBB appeals
unit by following the process in this section.
(2) Any employee who disagrees with the state
agency's decision in response to a written request for administrative review,
as described in this section, may request a brief adjudicative proceeding to be
conducted by the authority by submitting a written request to the PEBB appeals
unit.
(a) The PEBB appeals unit must receive
the request for a brief adjudicative proceeding no later than 30 days after the
date of the state agency's written decision on the request for administrative
review. If a state agency fails to render a written decision within 30 days of
receiving a written request for administrative review, the PEBB appeals unit
must receive the request for a brief adjudicative proceeding no later than 30
days after the date the request for administrative review was deemed denied.
The contents of the request for a brief adjudicative proceeding are to be
provided as described in WAC
182-16-2070.
(i) The PEBB appeals unit must notify the
appellant in writing when the request for a brief adjudicative proceeding has
been received.
(ii) Once the PEBB
appeals unit receives a request for a brief adjudicative proceeding, the PEBB
appeals unit will send a request for documentation and information to the
applicable state agency. The state agency will then have two business days to
respond to the request and provide the documentation and information requested.
The state agency will also send a copy of the documentation and information to
the employee.
(iii) The brief
adjudicative proceeding will be conducted by a presiding officer designated by
the director.
(b) If an
employee fails to timely request a brief adjudicative proceeding, the state
agency's prior written decision becomes the authority's final order without
further action.
(3) Any
employee aggrieved by a decision regarding a claim for benefits under the
flexible spending arrangement or limited purpose flexible spending arrangement
(FSA) or dependent care assistance program (DCAP) offered under the salary
reduction plan may appeal that decision to the authority's contracted vendor by
following the appeal process of that contracted vendor.
(a) Any employee who disagrees with a
decision in response to an appeal filed with the contracted vendor that
administers the FSA, limited purpose FSA, and DCAP under the salary reduction
plan may request a brief adjudicative proceeding by submitting a written
request to the PEBB appeals unit. The PEBB appeals unit must receive the
request for a brief adjudicative proceeding no later than 30 days after the
date of the contracted vendor's appeal decision. The contents of the request
for a brief adjudicative proceeding are to be provided as described in WAC
182-16-2070.
(i) The PEBB appeals unit must notify the
appellant in writing when the request for a brief adjudicative proceeding has
been received.
(ii) The brief
adjudicative proceeding will be conducted by a presiding officer designated by
the director.
(b) If an
employee fails to timely request a brief adjudicative proceeding, the
contracted vendor's prior written decision becomes the authority's final order
without further action.
(4) Any employee aggrieved by a decision
regarding the administration of the premium payment plan offered under the
salary reduction plan may request a brief adjudicative proceeding to be
conducted by the authority by submitting a written request to the PEBB appeals
unit for a brief adjudicative proceeding.
(a)
The PEBB appeals unit must receive the request for a brief adjudicative
proceeding no later than 30 days after the date of the denial notice by the
PEBB program. The contents of the request for a brief adjudicative proceeding
are to be provided as described in WAC
182-16-2070.
(i) The PEBB appeals unit must notify the
appellant in writing when the notice of appeal has been received.
(ii) The brief adjudicative proceeding will
be conducted by a presiding officer designated by the director.
(b) If an employee fails to timely
request a brief adjudicative proceeding, the PEBB program's prior written
decision becomes the authority's final order without further action.
