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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 67 2) the individual’s right to request review and reconsideration of the action or determination; 3) the process for initiating a review or reconsideration; 4) the time frame that applies to the review or reconsideration; and 5) the circumstances under which enrollment, if applicable, may continue pending review and reconsideration. Notification of Eligibility Denials Within 5 business days of determining an eligibility denial, TexCare sends the applicant an eligibility denial notification letter explaining:

1) the reason for the denial;

2) the member’s right to request review by TexCare of the decision and the time frames for the review process;

3) the member’s right to request impartial reconsideration by HHSC, if he or she disagrees with TexCare’s review decision, and the time frames for the reconsideration process; and how to request review and reconsideration

Notification of Disenrollment Within ten calendar days of determining a member should be disenrolled, TexCare sends the applicant a disenrollment notification letter explaining:

1) the reason for disenrollment;

2) the effective date of the disenrollment;

3) the member’s right to request review by the TexCare of the decision and the time frames for the review process;

4) the member’s right to request impartial reconsideration by HHSC, if he or she disagrees with TexCare’s review decision, and the time frames for the reconsideration process; and

5) how to request review and reconsideration.

Requesting a Review

The applicant or member must submit a written request for review.