{"data":{"id":"us/45-cfr-152.26","jurisdiction":"us","citation":"45 CFR 152.26","heading":"Appeals procedures.","body":"(a) General. A PCIP shall establish and maintain procedures for individuals to appeal eligibility and coverage determinations.\n(b) Minimum requirements. The appeals procedure must, at a minimum, provide:\n(1) A potential enrollee with the right to a timely redetermination by the PCIP or its designee of a determination regarding PCIP eligibility, including a determination of whether the individual is a citizen or national of the United States, or is lawfully present in the United States.\n(2) An enrollee with the right to a timely redetermination by the PCIP or its designee of a determination regarding the coverage of a service or the amount paid by the PCIP for a service.\n(3) An enrollee with the right to a timely reconsideration of a redetermination made under paragraph (b)(2) of this section by an entity independent of the PCIP.","path":["Title 45—Public Welfare","SUBTITLE A—Department of Health and Human Services","SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS","PART 152—PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM","Subpart E—Oversight"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-45.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:21Z","sha256":"63db62a8be49c107b90faf44db448b0a1e8baf48ec98b61b38104b7765b7f89c","source_id":"us-cfr","stale":true,"prev":"us/45-cfr-152.22","next":"us/45-cfr-152.27"},"notice":"GroundRules: Original legal text. Not legal advice."}