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Connector Appeals Process

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  1. Connector Appeals Process Appeals Unit Individual Mandate Commonwealth Care • Member Appeals • File directly with Connector • Health plan change requests • Waivers of premiums and co-pays • Appeals of denials • Hearings by independent hearing officers Tax Appeals from DOR Schedule HC New schedule, all tax payers file demonstrating health insurance status. Appeals go through DOR to Connector Certificates of Exemption for 2008 (prospective) File directly with Connector visit: MAhealthconnector.org

  2. Mandate Appeals Process • Based on tax return, taxpayer subject to penalty may appeal by filling out appeal form contained with DOR Schedule HC • DOR will send letter to appellant requiring that he/she send documentation of appeal to DOR-appeal dismissed if no documentation sent or if sent late • Documentation will go on website built by DOR for use by DOR and Connector

  3. Mandate Appeals Process • Appeals based on Connector regulations, 956 CMR 6.08 • Factors include: • Financial hardship (e.g., homelessness, increase in essential expenses resulting from domestic violence, expense of insurance would have caused serious deprivation) • Connector may consider other issues (e.g., whether individual had access to ESI, cost to appellant of insurance and whether it met MCC, family size unusual, or other grounds showing appellant could not purchase insurance)

  4. Mandate Appeals Process • Connector personnel will review all completed appeals and make determinations • For tax year 2007, we will conduct a flexible and fair appeals process, recognizing that the primary purpose of this first year has been to get people insured and not to punish them

  5. Mandate Appeals Process • Connector personnel will allow many appeals on their face, will deny some, and will refer others to a panel of trained, independent attorneys for hearings and determinations • Connector will aim to process all appeals within 90 days of receipt

  6. Mandate Appeals Process • Connector building up its Appeals Unit to include more permanent personnel • Using a variety of assumptions, we are building a system that can handle different volumes of appeals • Through use of technology, temporary personnel, and other means, we can add capacity onto the basic organizational framework