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Stand Up for Your Rights with a Marketplace Appeal Request Form

Marketplace Eligibility Appeal Request Form

It is not a dead end when you see that you are not satisfied with the decision of a health insurance marketplace. There is a range of decisions which give the possibility to appeal. If you are eligible to purchase a marketplace plan and enroll in it on a regular basis, prepare to file an appeal. If the marketplace makes a temporary determination about your 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, attention must be paid to the Marketplace Appeal Request Form which is the subject matter of our today’s blog post.

What is the Marketplace Appeal Request Form?

The 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 certain 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 the Marketplace Appeal Request Form?

When you face the 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 a review of an expedited appeal. Moreover, you may appeal SHOP eligibility (Small Business Health Options Program).

When is a 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 a Marketplace Appeal Request Form accompanied by some other forms?

No. A Marketplace Appeal Request Form is completed separately. However, filers may need to attach copies of the testimonials.

How do I complete a 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 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. 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 a necessity occurs.

Where do I send a Marketplace Appeal Request Form?

Send your appeal to the Health Insurance Marketplace in the Department of Health and Human Services.