Navia Benefit Solutions will send you a written notice of the resolution of your appeal within 30 calendar days. Appeals are approved only if the extenuating circumstances and supporting documentation are within IRS regulations and the document that governs the Limited Purpose FSA. To file a first-level appeal with Navia Benefit Solutions, use one of the methods below: • Email: [email protected] • Fax: 1-425-451-7002 or toll-free fax 1-866-535-9227 • Mail: Navia Benefit Solutions, PO Box 53250, Bellevue, WA 98015 If you receive a denial of your appeal from Navia Benefit Solutions and you disagree with that decision, you may appeal that decision by submitting a written request to the PEBB Appeals Unit for a Brief Adjudicative Proceeding (BAP). The PEBB Appeals Unit must receive your request for a BAP no later than 30 calendar days after the date of the Navia Benefit Solutions decision on your appeal. The contents of your request for a BAP are to be provided as described in WAC 182-16-2050. Include a copy of the denial notice you received from Navia Benefit Solutions with your appeal, along with any supporting documentation. You may submit the Employee Request for Review/Notice of Appeal form with your appeal, which is available at hca.wa.gov/pebb-appeals. You may send the form and any supporting documents by one of the following methods: • Hand Delivery: Health Care Authority th 626 8 Ave SE Olympia, WA 98501 • Fax: 360-763-4709 • Mail: Health Care Authority PEBB Appeals PO Box 45504 Olympia, WA 98504-5504 Back to the Table of Contents 12