Submitting an Eligibility Appeal

An appeal allows a member to request a review of an eligibility or enrollment decision that could not be approved through the standard life event process.

Appeals are most commonly submitted when a member misses the deadline to add or remove a dependent, but believes there are circumstances that justify an exception. Appeals may also be submitted for other eligibility-related situations requiring additional review.

In many cases, members begin by submitting the applicable life event through the THT Member Portal. If the life event is outside the allowable submission period, the portal may automatically prompt the member to submit an appeal. Members may also submit an appeal directly by creating a support ticket and uploading supporting documentation.

Option 1 – Submit in Tandem with a Life Event

Option 2 – Submit Through a Support Ticket

If a first-level appeal is denied, members have the right to submit a second-level appeal for additional review. Submit your appeal in writing to Teachers Health Trust through one of the following options:

Submitting an appeal does not guarantee approval. An appeal determination will be sent to the member within 2-4 weeks of submitting the appeal.