WAC 182-16-2040. How can a subscriber appeal a decision regarding the administration of wellness incentive program requirements?

(1) Any subscriber aggrieved by a decision made by the public employees benefits board (PEBB) wellness incentive program contracted vendor 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 PEBB program. (2) Any subscriber who disagrees with a decision in response to an appeal filed with the PEBB program 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.