1. (a) Expulsion from the Flexible Benefits Program. The plan administrator may expel any person from the Flexible Benefits Program or any part thereof, who submits a fraudulent claim or otherwise defrauds or attempts to defraud any plan of benefits under the program for up to five full plan years.
2. (b) Indebtedness to the Flexible Benefits Program. The plan administrator may deny participation in the Flexible Benefits Program or any part thereof to any person who is indebted to the program from prior enrollments or who has otherwise failed to fulfill contractual agreements. Any person denied participation in the Flexible Benefits Program or any part thereof due to indebtedness to the Flexible Benefits Program or due to the failure to fulfill contractual obligations to the program must repay all outstanding indebtedness or otherwise fulfill contractual obligations to the program prior to being permitted once again to participate in the Flexible Benefits Program. A person who has repaid the indebtedness to the program may resume participation in the Flexible Benefits Program two full plan years from the date the indebtedness is repaid.
3. (c) Grievances. Any person with a grievance concerning action taken under this section may submit a grievance in accordance with §85.17(b) of this title (relating to Grievance Procedure). During a hearing involving subsection (a) of this section, the standard of proof requiring a finding against the participant shall be the preponderance of the evidence.

Source Note:The provisions of this §85.19 adopted to be effective September 1, 1992, 17 TexReg 2874.