34 Tex. Admin. Code § 41.50
Appeals Relating to Claims or Other Benefits
Effective Aug 15, 2019Source Note: The provisions of this §41.50 adopted to be effective December 26, 2002, 27 TexReg 12004; amended to be effective October 27, 2003, 28 TexReg 9289; amended to be effective April 28, 2004, 29 TexReg 3969; amended to be effective August 25, 2004, 29 TexReg 8134; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective March 25, 2008, 33 TexReg 2556; amended to be effective April 1, 2011, 36 TexReg 2001; amended to be effective September 1, 2011, 36 TexReg 5380; aTexas Secretary of State
(a) For appeals that relate to claims or other benefits, the following procedures apply:
- (1) A person enrolled in TRS-ActiveCare, other than a person enrolled in a health maintenance organization (HMO) participating in TRS-ActiveCare, who is denied payment of a claim or other benefit ("Claimant") may appeal the denial through a written request filed with the administering firm in accordance with procedures established by the administering firm.
- (2) The final decision by the administering firm or by any external review organization, whichever occurs later, shall be the final decision on the appeal.
- (b) For appeals that relate to claims or other benefits, persons enrolled in an HMO under contract with TRS-ActiveCare shall follow the appeal procedures set out by the HMO.
Source Note:The provisions of this §41.50 adopted to be effective December 26, 2002, 27 TexReg 12004; amended to be effective October 27, 2003, 28 TexReg 9289; amended to be effective April 28, 2004, 29 TexReg 3969; amended to be effective August 25, 2004, 29 TexReg 8134; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective March 25, 2008, 33 TexReg 2556; amended to be effective April 1, 2011, 36 TexReg 2001; amended to be effective September 1, 2011, 36 TexReg 5380; amended to be effective December 22, 2014, 39 TexReg 10029; amended to be effective August 15, 2019, 44 TexReg4189.