Appeal Eligibility Decision
You have the right to request an appeal if you think Washington Healthplanfinder’s eligibility decision about your health insurance coverage is wrong. An appeal is a hearing before a Presiding Officer in which you are able to present your case for your eligibility determination.
Eligibility decisions you can appeal include:
- The amount of your premium tax credit
- The amount of your cost-sharing reduction
- As an employer, whether the insurance you provide your employees meets the coverage requirements and whether that insurance coverage is affordable for your employees
- Failure to provide timely notice of an eligibility decision
If you’re an employer who recently received notification that one of your employees was found eligible for a tax credit, you may fill out an Employer Request for Hearing Form. The hearing will be held with you and the employee, and adjudicated by the Washington Health Benefit Exchange Presiding Officer.
You have 90 days from the date on your letter to request an appeal or you may lose your right to a hearing. The hearing will be held on the phone, so you don’t have to attend in person. You have the right to bring documents and witnesses that support your position. You may also ask someone to represent you during the appeal, although it isn’t required. Your representative can be an attorney, relative, or friend.
The quickest way to ask for a hearing is to fill out an Appeal Request Form:
- Cambodian – អក្សរខ្មែរ
- Chinese (simplified) – 简体中文
- Korean – 한국의
- Laotian – ລາວ
- Russian – русский
- Somali – Af-soomalli
- Spanish – Español
- Vietnamese – việt
You may contact us by:
Mail: Washington Health Benefit Exchange
ATTN: Legal Division
PO Box 1757
Olympia, WA 98507
Please provide your full name, date of birth, Washington Healthplanfinder application ID, and a daytime phone number where you can be reached.
Interpreter and Translation Services
The Appeals Program has access to comprehensive language translation services. We’re committed to eliminating language barriers for Limited English Proficient (LEP) and deaf individuals. If you want a language interpreter, we’ll provide one at no cost to you. We’ll send notices and the final decision in a language that you understand. Let us know in the Appeal Request Form and we will provide telephonic interpreting and document translation, including support for American Sign Language.
Washington Relay Service
At your request, the Appeals Program can use Washington Relay Service. This is a free service provided by the Washington State Office of the Deaf and Hard of Hearing. It ensures equal communication access to the telephone service for people who are deaf, deaf-blind, hard of hearing, and speech disabled.
This service allows the Appeals Program staff to communicate with text-telephone (TTY) users. If you’re deaf or hard of hearing and need to contact the Appeals Program, simply dial 711 to connect with a relay operator through the Washington Relay Service. The relay operator will dial the requested number and relay the conversation between the two callers.
For more information about your rights regarding interpreter or translation services, visit lep.gov.
Anyone with a disability who needs assistance to participate in an appeal can ask the Appeals Program for assistance. Please email or call the Appeals Program to explain why you need an accommodation and what accommodation you would like. Any medical records and medical information you give us to support your request will be sealed and held confidentially.
You may request any assistance that will help you fully and meaningfully participate in the appeals process, so please request the accommodation that will best allow you to do that.
Some possible accommodations could be:
- A sign language interpreter
- Large print or high contrast documents and forms
- Extended time for hearings and recesses
- Assistive listening and seeing devices
The Exchange is also committed to providing services that embrace diversity, respect the rights of all individuals, are open and accessible, and are free of bias or discrimination based on, but not limited to, ethnicity, race, creed, color, religion, age, disability, sex, marital status, national origin, political opinions or affiliations, veteran status, and genetic information.
Anyone with questions about compliance or a complaint regarding bias, harassment, or discrimination should contact the Exchange Legal Department at:
Washington Health Benefit Exchange Legal Department
ATTN: Legal Division Equal Access/Equal Opportunity Coordinator
PO Box 1757
Olympia, WA 98507-1757
U.S. Department of Health and Human Services Appeals Process
The U.S. Department of Health and Human Services appeals entity serves as the second-level review once the Exchange appeals process has been exhausted. If you wish to appeal the Exchange’s decision you may file an appeal with the U.S. Department of Health and Human Services by completing and submitting the Marketplace Eligibility Appeal Request Form. Learn more about how to appeal a decision at healthcare.gov.