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Health Insurance Market Appeals/Complaints

Code: LH-3500.0200-300

Programs that are responsible for hearing appeals and resolving grievances that have been filed by people who have applied for health insurance through the Marketplace and disagree with a decision that has been made. Applicants have the right to appeal eligibility decisions, whether they can enroll in a Marketplace plan outside the regular open enrollment period, whether they are eligible for lower costs based on income, the amount of savings they are eligible for, whether they are eligible for Medicaid or CHIP, whether they are eligible for an exemption from the requirement to have health insurance, and whether the Marketplace made a timely determination regarding their eligibility after they applied. Employers that get a notice from the Marketplace stating they may be subject to the fee can file an appeal if they believe they offered coverage to an employee that is both affordable and meets minimum value standards. These appeals only relate to Marketplace determinations and do not affect issues related to the actual insurance plans available in a particular state.

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