Post-Service Appeals of Eligibility Which Are Not Related to Specific
Medical, Behavioral Health or Prescription Drug Claims
Ordinarily, decisions on such types of eligibility appeals
will be made at the next regularly scheduled meeting of
the Board of Trustees following receipt of your request for
review. However, if your request for review is received
within 30 days of the next regularly scheduled meeting,
your request for review will be considered at the second
regularly scheduled meeting following receipt of your
request.
In special circumstances, a delay until the third regularly
scheduled meeting following receipt of your request for
review may be necessary. You will be advised in writing in
advance if this extension will be necessary. Once a decision
on review of your claim has been reached, you will be
notified of the decision as soon as possible, but no later
than five days after the decision has been reached.
