Right to a fair hearing
Compiled text through May 15, 2022
Register checked through Jul 29, 2026
No later Register activity identified in this check.
Dates and status
- Compiling agency
- Executive Department
- Text status
- Source receipt
- Compiled text through
- May 15, 2022
- Register checked through
- July 29, 2026/Vol. XLVIII, Issue 30 (2026-07-29)
- Activity status
- No later Register activity identified in this check.
- Source snapshot
- Jun 6, 2026
(a)Applicants and participants shall be entitled to a fair hearing to have a contractor's determination after reconsideration reviewed on the following grounds:
(1)denial of benefits;
(2)failure to determine the applicant's eligibility or, if found eligible, failure to issue a card or authorize services within three days from the date the applicant met his/her registration fee, premium or deductible requirement;
(3)discontinuance or suspension of coverage, in whole or in part;
(4)computation of his/her cost-sharing responsibilities;
(5)any other grounds affecting the applicant or participant's coverage, including a determination of the receipt of medical assistance or equivalent or better public or private insurance benefits.
(b)Notwithstanding the above, participants have no right to a hearing when the contractor discontinues payment to a provider or the panel authorizes a mass change.