Current through Register Vol. 24-18, September 15, 2024
(1) An eligibility,
premium surcharges, or enrollment decision made by a school employees benefits
board (SEBB) organization may be appealed by submitting a written request for
administrative review to the SEBB organization. The SEBB organization must
receive the request for administrative review no later than thirty days after
the date of the denial notice. The contents of the request for administrative
review are to be provided as described in WAC
182-32-2070.
(a) Upon receiving the request for
administrative review, the SEBB organization 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 SEBB
organization must render a written decision within thirty days of receiving the
written request for administrative review. The written decision must be sent to
the school employee or school employee's dependent who submitted the request
for administrative review and must include a description of the appeal rights.
The SEBB organization must also send a copy of the SEBB organization's written
decision to the SEBB organization's administrator (or designee) and to the SEBB
appeals unit. If the SEBB organization fails to render a written decision
within thirty days of receiving the written request for administrative review,
the request for administrative review may be considered denied as of the
thirty-first day and the original underlying SEBB organization decision may be
appealed to the SEBB appeals unit by following the process in this
section.
(c) The SEBB organization
may reverse eligibility, premium surcharges, or enrollment decisions as
permitted by WAC
182-30-060.
(2) Any current or former school
employee or school employee's dependent who disagrees with the SEBB
organization's decision in response to a written request for administrative
review, as described in subsection (1) of this section, may request a brief
adjudicative proceeding to be conducted by the authority by submitting a
written request to the SEBB appeals unit.
(a)
The SEBB appeals unit must receive the request for a brief adjudicative
proceeding no later than thirty days after the date of the SEBB organization's
written decision on the request for administrative review. If the SEBB
organization fails to render a written decision within thirty days of receiving
a written request for administrative review, the SEBB appeals unit must receive
the request for a brief adjudicative proceeding no later than thirty 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
182-32-2070.
(i) The SEBB appeals unit must notify the
appellant in writing when the request for a brief adjudicative proceeding has
been received.
(ii) Once the SEBB
appeals unit receives a request for a brief adjudicative proceeding, the SEBB
appeals unit will send a request for documentation and information to the
applicable SEBB organization. The SEBB organization will then have two business
days to respond to the request and provide the requested documentation and
information. The SEBB organization will also send a copy of the documentation
and information to the appellant.
(iii) The brief adjudicative proceeding will
be conducted by a presiding officer designated by the director.
(b) If a school employee fails to
timely request a brief adjudicative proceeding, the SEBB organization's prior
written decision becomes the authority's final order without further
action.
