Letters of Appeal; Request for a Hearing of a n Appealable Agency Action

R2-8-403. Letters of Appeal; Request for a Hearing of a n Appealable Agency Action A. After receipt of an agency decision, a person who is not satisfied with the agency decision, may submit a letter of appeal: 1. To the ASRS’s vendor for long-term disability benefits, if the appeal relates to a long-term disability decision; or offi- 2. To the ASRS’s designated appeals officer, or such cer’s designee, if the appeal relates to an agency decisio n other than a long-term disability decision or Health Pla n Vendor decision. B. Upon receipt of a letter of appeal, the long-term disability vendor, or the designated appeals officer, or such officer’s designee, shall send a response letter to the person requesting th e appeal notifying the person of: 1. The decision the agency is making in response to the letter of appeal; and 26-1 Page 33 2 A.A.C. 8 Arizona CHAPTER 8. STATE 2. The person’s right to appeal the agency response by submitting a letter of appeal to the ASRS Director or suc h director’s designee. C. A person who is not satisfied with the agency response pursuant to subsection (B) may submit a letter of appeal to th e ASRS Director or such director’s designee within 60 days of the date on the agency response letter. D. Within 30 days of the date the ASRS receives a letter of appeal direc- pursuant to subsection (C), the ASRS director or such tor’s designee shall send a response letter by certified mail t o the person requesting the appeal that includes: 1. The agency action the ASRS is taking in response to th e letter of appeal; and 2. Notice of Appealable Agency Action, as required pursurequest- ant to A.R.S. § 41-1092.03 informing the person ing the appeal, that the person has a right to appeal th e agency action by submitting a Request for Hearing pursuant to subsections (E) and (F). E. For an appealable agency action, a person who is not satisfie d with an agency action pursuant to subsection (D) may file a Request for a Hearing, in writing, with the ASRS. The date th e Request is filed is established by the ASRS date stamp on th e face of the first page of the Request. The Request shall includ e the following: 1. The name and mailing address of the member, employer, or other person filing the Request; per- 2. The name and mailing address of the attorney for the son filing the Request, if applicable; 3. A concise statement of the reasons for the appeal. F. The person requesting a hearing shall file the Request for a Hearing with the ASRS within 30 days after receiving a response letter including a Notice of an Appealable Agenc y Action, pursuant to subsection (E). G. Upon receipt of the Request for a Hearing, the ASRS shall notify the Office of Administrative Hearings as required i n A.R.S. § 41-1092.03(B). H. Pursuant to subsection (B): 1. The long-term disability vendor shall send a response letter to the person requesting the appeal within 120 days of the date the long-term disability vendor receives the letter of appeal; and 2. The designated appeals officer, or such officer’s designee, shall send a response letter to the person requesting th e appeal within 30 days of the date the ASRS receives th e letter of appeal. I. The Board has delegated to each Health Plan Vendor th e authority to: 1. Interpret and apply the terms of the Health Plan Vendor’ s particular Health Plan; 2. Determine whether a particular benefit is included in th e Health Plan and, if included, the amount of payment to b e made under the Health Plan; and 3. Perform a full and fair review of any decision by th e pay- Health Plan Vendor regarding benefits included in or ments to be made under the Health Plan if the decision i s appealed in accordance with the Health Plan Vendor’ s specified procedures. J. An individual who is enrolled in a Health Plan made availabl e by ASRS and who wishes to appeal a decision by the Healt h Plan Vendor shall follow the appeal procedures specified in th e applicable Health Plan description. Historical Note New Section made by final rulemaking at 11 A.A.R. 444, effective January 4, 2005 (Supp. 05-1). Amended by final Supp. Administrative Code ADMINISTRATION RETIREMENT SYSTEM BOARD rulemaking at 23 A.A.R. 487, effective April 8, 2017 (Supp. 17-1). Amended by final rulemaking at 28 A.A.R. 223 (January 21, 2022), with an immediate effective date of January 5, 2022 (Supp. 22-1). Amended by final rulemaking at 32 A.A.R. 608 (March 13, 2026, Issue 11), effective April 18, 2026 (Supp. 26-1).