|(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.
(b) Any participant with a grievance regarding eligibility
or other matters involving the TexFlex program may submit a written
request to the executive director or the executive director's designee
to make a determination on the matter in dispute.
(c) When the executive director or the executive director's
designee reviews any matter arising under this section, information
available to ERS will be considered. When the executive director or
the executive director's designee completes the review and makes a
decision, all parties involved will be notified in writing of the
(d) Any participant aggrieved by the executive director's
or the executive director's designee's decision may appeal the decision
to the Board's designee provided the decision grants a right of appeal.
(1) Appeals of the Board's designee's decision will
be conducted under the provisions of Chapter 67 of this title (relating
to Hearings and Disputed Claims) and Chapter 1551, Insurance Code.
(2) A notice of appeal to the Board's designee must
be in writing and filed with ERS within 30 days from the date the
executive director's or the executive director's designee's decision
is served on the participant in accordance with §67.7 of this
title (relating to Filing and Service of Documents and Pleadings).
|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; amended to be effective March 15, 2010, 35 TexReg 2205; amended to be effective September 8, 2020, 45 TexReg 6240