The federal rules that govern NY State of Health limit the types of appeals that the Marketplace Appeals Unit may hear to issues concerning eligibility for health insurance coverage through the Marketplace. Below is a list of types of appeals the Marketplace Appeals Unit may hear. If the issue you are concerned about is not on this list, please call Customer Service at 1-855-355-5777 to find out the proper place to file a complaint or an appeal for your issue.
- Determination that you do not meet the rules to buy a health plan for yourself or your family in the Marketplace. Example: You do not live in New York State, or are incarcerated.
- Determination that you do not meet the rules for getting help paying for a health plan purchased in the Marketplace.
- Determination on how much you must pay for your monthly premium if you applied for financial help.
- Determination that you do not meet the rules for coverage under Medicaid, Essential Plan or Child Health Plus.
- Determination on how much money you must pay for Child Health Plus coverage if your children are eligible for this program.
- Determination on how much money you must pay for Essential Plan coverage if you or a household member are eligible for this program.
- Determination that you do not meet the rules for signing up for insurance in the Marketplace during a “special enrollment period.”
- Delayed determination by the Marketplace. Example: You did not get a notice telling you if you meet the rules for Medicaid coverage within the required 45 days.
- Denial of a request to cancel (vacate) a dismissal.