Section 405IAC10-11-13. Appeals

   (a) In the event that the office takes an action as defined in 405 IAC 10-5-1 that the HIP Link member or applicant believes was taken erroneously, such person or entity may request an administrative hearing under 405 IAC 1.1. An action taken by the employer's insurance plan shall not be considered an action by the office that may be appealed under this section except as in accordance with subsection (e).

  (b) An aggrieved HIP Link member who:

(1) files an appeal prior to the effective date of the adverse action; and

(2) remains enrolled in a HIP Link eligible ESI plan;

may continue receiving HIP Link benefits in accordance with this rule until the administrative law judge issues a decision after the hearing under 405 IAC 1.1-1-6. A member continuing benefits under this section must continue to comply with the eligibility requirements under this rule.

  (c) A HIP Link member shall not be eligible to continue receiving benefits under this section if the action resulted from a determination by the office that:

(1) the ESI plan is no longer available to the HIP Link member; or

(2) the ESI plan no longer meets the requirements under section 10 of this rule.

  (d) If the administrative law judge overturns the action on appeal, the office shall make corrective payments to the HIP Link member back to the date of the erroneous determination, when applicable.

  (e) For any dispute regarding services provided under the HIP Link member's ESI plan, the HIP Link member must first exhaust the ESI plan's internal appeals procedure prior to pursuing further remedy or appeals with the office.

  (f) A HIP Link employer or other entity may appeal an action by the state under IC 4-21.5. (Office of the Secretary of Family and Social Services; 405 IAC 10-11-13; filed Apr 6, 2016, 11:20 a.m.: 20160504-IR-405150325FRA)

*