To appeal a decision regarding a Qualified Health Plan, a Colorado Young Adult Plan, Tax Credits and/or Cost-Sharing Reductions, you can call Connect for Health Colorado at855-PLANS-4-YOU (855-752-6749)
or (TTY: 855-346-3432) or download the appeals form and send it in. Once the appeals form has been received an appeals specialist will be in contact.
Important: You have 60 days from the date of your eligibility notice to submit an appeal request for yourself or anyone in your household who applied for health insurance. To appeal means you tell someone at Connect for Health Colorado (the Marketplace) that you think the determination is wrong and ask for a fair review of the determination. You may appeal either being denied Premium Tax Credits and the amount of tax credits or Cost-Sharing Reductions you received, or your eligibility determination for a Qualified Health Plan. You may still enroll in a Qualified Health Plan and receive your Premium Tax Credit and/or your Cost-Sharing Reductions benefits while you appeal, if you are already qualified.
If someone in your household qualifies for a QHP, they may still enroll in a QHP even if they have been denied Premium Tax Credits and/or Cost-Sharing Reductions. They do not need Premium Tax Credits and/or CSR in order to enroll in a QHP and be covered. If someone in your household appeals their eligibility for Premium Tax Credits and/or CSR and does not enroll in a plan, they might not be able to enroll if they delay beyond the Open Enrollment Period. Someone who has submitted an appeal but has not enrolled in a plan will be able to enroll in a plan outside of the Open Enrollment Period only if they become newly eligible for financial assistance as the result of a successful appeal.
Once you request an appeal, the Office of Appeals, a department within the Marketplace, will first attempt to resolve your concerns through an informal resolution process, but this process is not required. During this informal resolution process, we can try to help you resolve your concerns. You can also provide new information or documents that will help us understand your situation. If you disagree with the results of the informal resolution process and would like to have your case heard at a formal hearing, the Office of Appeals will schedule a formal hearing with the Office of Administrative Courts. Or, if you do not wish to participate in the informal resolution process, the Office of Appeals will schedule a formal hearing with the Office of Administrative Courts.
You can bring someone with you to a hearing. That person can be a lawyer, a friend, or a family member.
Depending on the appeal decision, you may have to repay some or all of the financial assistance you received during the appeal process for yourself and/or your family. If you are unhappy with the decision made by the Office of Appeals, you can appeal that decision to the U. S. Department of Health and Human Services within 30 days of the Office of Appeals’ decision.
We cannot accept appeals about effective dates, termination dates of coverage, or health care services, such as the benefits your plan offers, access to doctors or specialists, or a denial of prior authorization for services.
Choose one of the following:
- Log into your online Connect for Health Colorado account and upload the appeals request form under the “My Documents” tab;
or (TTY: 855-346-3432);
- Mail your completed appeals request form to:
Office of Appeals
4600 South Ulster Street, Suite 300
Denver, CO 80237; or
- Fax your appeal to 303-322-4217.