Marketplace Appeal Request Form
It is not a dead end when you see that you are not satisfied with the decision of the marketplace. There is a range of decisions which imply the possibility to appeal. If you are eligible to purchase a marketplace plan and enroll in it on the regular basis, prepare to file an appeal. If the marketplace makes a temporary determination about the eligibility after the application has been made, you have the right to give notice of appeal as well.
Remember, that you have the chance to ask someone else to file or take part in the appeal. It can be your relative, lawyer, friend, or any other individual. However, it is not necessary. Thus, your attention must be paid to Marketplace Appeal Request Form which is the subject matter of our today’s blog post.
What is Marketplace Appeal Request Form?
Marketplace Appeal Request Form is a specially designed application filed by everyone who wants to lodge an appeal. Keep in mind that you can complete this request only in definite states. They are Indiana, Alaska, Illinois, Arizona, Georgia, Florida, Delaware, Nebraska, Iowa, Missouri, Kansas, Mississippi, Nevada, Maine, New Hampshire, Michigan, New Mexico, Pennsylvania, North Carolina, Oklahoma, Ohio, South Carolina, Wisconsin, South Dakota, Virginia, Texas, and Utah.
What is the purpose of Marketplace Appeal Request Form?
When you face an immediate necessity to receive some health services and there is a delay that can greatly jeopardize your physical condition, you have the right to ask for the review of the expedited appeal. Moreover, you may appeal SHOP eligibility (Small Business Health Options Program).
When is Marketplace Appeal Request Form due?
After applying in one of the above-mentioned states, your task is to submit the appeal during the period of 90 days of the date on the eligibility determination notice of the marketplace that you are appealing.
Is Marketplace Appeal Request Form accompanied by some other forms?
No. Marketplace Appeal Request Form is completed separately. However, the filers may need to attach also the copies of the testimonials.
How do I complete Marketplace Appeal Request Form?
The form consists of four sections. According to the form, a person who requests the appeal is called the appellant. So, the first section is devoted to the information about the appellant: name, date of birth, street address, city, state, available phone number, and the same information about all other people who appeal with you.
In the second section of the form you must mention the reason of your appeal. Generally, there is the enumeration of possible reasons. You choose the one which is the most suitable for your situation.
The third section is the continuation of the second one and requests more details about the reasons to appeal. In the last section an appellant must sign. There is also the possibility to ask for a faster appeal if such necessity occurs.
Where do I send Marketplace Appeal Request Form?
Send your appeal to the Health Insurance Marketplace in the Department of Health and Human Services.