Current through Register Vol. 24-18, September 15, 2024
(1) Any school
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 school employees benefits board (SEBB) organization. The SEBB
organization must receive the written request for administrative review no
later than 30 days after the date of the decision resulting in denial. The
contents of the written request for administrative review are to be provided as
described in WAC
182-32-2070.
(a) Upon receiving the written 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 30 days of receiving the
written request for administrative review. The written decision must be sent to
the school employee who submitted the written request for review and must
include a description of 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 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
SEBB organization decision may be appealed to the SEBB appeals unit by
following the process in this section.
(2) Any school employee who disagrees with
the SEBB organization'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 SEBB appeals unit.
(a)
The SEBB appeals unit must receive the request for a brief adjudicative
proceeding no later than 30 days after the date of the SEBB organization's
written decision on the request for administrative review. If a SEBB
organization fails to render a written decision within 30 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 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
182-32-2070.
(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 documentation and information
requested. The SEBB organization will also send a copy of the documentation and
information to the school employee.
(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 adjudi-cative proceeding, the SEBB organization's prior
written decision becomes the authority's final order without further
action.
(3) Any school
employee aggrieved by a decision regarding a claim for benefits under the
medical 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 school employee who disagrees with a
decision in response to an appeal filed with the contracted vendor that
administers the medical FSA, limited purpose FSA, and DCAP under the salary
reduction plan may request a brief adjudicative proceeding by submitting a
written request to the SEBB appeals unit. The SEBB 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
182-32-2070.
(i) The SEBB appeals unit must notify the
appellant in writing when the request for a brief adjudicative proceeding has
been received.
(ii) 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 adjudi-cative proceeding, the
contracted vendor's prior written decision becomes the authority's final order
without further action.
(4) Any school 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 SEBB appeals
unit for a brief adjudicative proceeding.
(a)
The SEBB 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
SEBB program. The contents of the request for a brief adjudicative proceeding
are to be provided as described in WAC
182-16-2070.
(i) The SEBB 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 a school employee fails to
timely request a brief adjudi-cative proceeding, the SEBB program's prior
written decision becomes the authority's final order without further
action.
