(Effective until January 1, 2025)
How can a subscriber appeal a decision regarding the administration of wellness incentive program requirements?
(1) Any subscriber aggrieved by a decision regarding the completion of the wellness incentive program requirements, or request for a reasonable alternative to a wellness incentive program requirement, may appeal that decision to the school employees benefits board (SEBB) wellness incentive program contracted vendor.
(2) Any subscriber who disagrees with a decision in response to an appeal filed with the SEBB wellness incentive program contracted vendor may appeal the decision by submitting a request for a brief adjudicative proceeding to the SEBB appeals unit.
(a) The request for a brief adjudicative proceeding from a current or former school employee must be received by the SEBB appeals unit no later than thirty days after the date of the denial notice. The contents of the request for a brief adjudicative proceeding are to be provided as described in WAC
182-32-2070.
(b) The request for a brief adjudicative proceeding from a self-pay subscriber must be received by the SEBB appeals unit no later than sixty days after the date of the denial notice. The contents of the request for a brief adjudicative proceeding are to be provided as described in WAC
182-32-2070.
(3) The SEBB appeals unit must notify the appellant in writing when the request for a brief adjudicative proceeding has been received.
(4) The brief adjudicative proceeding will be conducted by a presiding officer designated by the director.
(5) If a subscriber fails to timely request a brief adjudicative proceeding, the decision of the SEBB wellness incentive program contracted vendor becomes the authority's final order without further action.
[Statutory Authority: RCW
41.05.021,
41.05.160 and 2020 c 231. WSR 20-16-067 (Admin #2020-04), § 182-32-2040, filed 7/28/20, effective 8/28/20. Statutory Authority: RCW
41.05.021,
41.05.160, 2017 3rd sp.s. c 13, 2018 c 260, and SEBB policy resolutions. WSR 19-14-093 (Admin #2019-01), § 182-32-2040, filed 7/1/19, effective 8/1/19.]
(Effective January 1, 2025)
How can a subscriber appeal a decision regarding the administration of wellness incentive program requirements?
(1) Any subscriber aggrieved by a decision regarding the completion of the wellness incentive program requirements, or request for a reasonable alternative to a wellness incentive program requirement, may appeal that decision to the school employees benefits board (SEBB) wellness incentive program contracted vendor.
(2) Any subscriber who disagrees with a decision in response to an appeal filed with the SEBB wellness incentive program contracted vendor may appeal the decision by submitting a request for a brief adjudicative proceeding to the SEBB appeals unit.
(a) The request for a brief adjudicative proceeding from a current or former school employee must be received by the SEBB appeals unit no later than 30 days after the date of the denial notice. The contents of the request for a brief adjudicative proceeding are to be provided as described in WAC 182-32-2070.
(b) The request for a brief adjudicative proceeding from a continuation coverage enrollee or school board member must be received by the SEBB appeals unit no later than 60 days after the date of the denial notice. The contents of the request for a brief adjudicative proceeding are to be provided as described in WAC 182-32-2070.
(3) The SEBB appeals unit must notify the appellant in writing when the request for a brief adjudicative proceeding has been received.
(4) The brief adjudicative proceeding will be conducted by a presiding officer designated by the director.
(5) If a subscriber fails to timely request a brief adjudicative proceeding, the decision of the SEBB wellness incentive program contracted vendor becomes the authority's final order without further action.
[Statutory Authority: RCW
41.05.021,
41.05.160,
41.05.740, 2023 c 13 § 2, and 2023 c 51 § 3. WSR 24-15-107 (Admin #2024-01), § 182-32-2040, filed 7/22/24, effective 1/1/25. Statutory Authority: RCW
41.05.021,
41.05.160 and 2020 c 231. WSR 20-16-067 (Admin #2020-04), § 182-32-2040, filed 7/28/20, effective 8/28/20. Statutory Authority: RCW
41.05.021,
41.05.160, 2017 3rd sp.s. c 13, 2018 c 260, and SEBB policy resolutions. WSR 19-14-093 (Admin #2019-01), § 182-32-2040, filed 7/1/19, effective 8/1/19.]