(a) Member appeal procedures based on denial of eligibility due to income are described at OAC 317:2-1-2.

(b) Member appeals related to premium payments and/or out-of-pocket expenses are made to the TPA.  If the member disagrees with the TPA's findings, reconsideration of the finding may be made to the OHCA.  The decision of the OHCA is final.

(c) Employee appeals regarding out-of-pocket expenses are made to the TPA.  If the employee disagrees with the TPA's findings, reconsideration of the finding may be made to the OHCA.  The decision of the OHCA is final.