Section 182-16-2040 - [Effective 1/1/2025] 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 public employees benefits board (PEBB) wellness incentive program contracted vendor.(2) Any subscriber who disagrees with a decision in response to an appeal filed with the PEBB wellness incentive program contracted vendor may appeal the decision by submitting a request for a brief adjudicative proceeding to the PEBB appeals unit. (a) The request for a brief adjudicative proceeding from a current or former employee must be received by the PEBB 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 182-16-2070.(b) The request for a brief adjudicative proceeding from a retiree, a continuation coverage enrollee, a retired employee or retired school employee continuing PEBB health plan coverage when their employer group ceases participation, or a survivor must be received by the PEBB 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 182-16-2070.(3) The PEBB 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 PEBB wellness incentive program contracted vendor becomes the authority's final order without further action.Wash. Admin. Code § 182-16-2040
Adopted by WSR 18-22-033, Filed 10/29/2018, effective 1/1/2019Amended by WSR 19-17-073, Filed 8/20/2019, effective 1/1/2020Amended by WSR 20-16-062, Filed 7/28/2020, effective 1/1/2021Amended by WSR 24-18-076, Filed 8/29/2024, effective 1/1/2025