1. (a) Any person participating in the flexible benefits program, who is denied reimbursement of eligible expenses, may request the plan administrator or its designee to reconsider the claim. Any additional documentation in support of the claim may be submitted with the request for reconsideration. If the claim is again denied, the claim, accompanied by all related documents and copies of correspondence with the plan administrator or its designee, may be appealed by the person to the executive director of the Employees Retirement System of Texas. An appeal must be filed by the person in writing within 90 days from the date the plan administrator or its designee formally denies the claim and mails notice of this denial and right of appeal to the person.
2. (b) Any person with a grievance regarding eligibility or other matters involving the program may submit a written request to the executive director to make a determination on the matter in dispute.
3. (c) When the executive director reviews any matter arising under this section, all parties involved will be notified in writing of the executive director's determination.
4. (d) Appeals to the executive director will be processed under the provisions of Chapter 67 of this title (relating to Hearings and Disputed Claims) and the Administrative Procedure Act, Chapter 2001, Government Code.
5. (e) As used in this section, the term "person" includes any duly authorized representative of such person.
6. (f) In computing time under this section, the day after any mailing by the plan administrator or its designee or the executive director shall be counted as the first day of the time period. A document is considered to be filed with the executive director when it is received by the executive director or when it is postmarked, whichever is earlier.

Source Note:The provisions of this §85.17 adopted to be effective August 12, 1988, 13 TexReg 3754; amended to be effective July 17, 2003, 28 TexReg 5539; amended to be effective June 14, 2007, 32 TexReg 3356.