TN 48 (11-22)

HI 01001.305 Program Service Center (PSC) Action on Request for Relief

When the enrollee writes directly to the PSC requesting reinstatement, the request, if made timely, is ordinarily referred to the field office (FO) for action in accordance with HI 01001.300. The PSC prepares and forwards the request to the FO via the online system. The FO utilizes the Health Insurance Query Response (HIQR) screens to determine when the termination of enrollment was effective, and the amount of premiums owed.

If the enrollee's letter includes an explanation showing eligibility and the necessary premium payment, the PSC may reinstate, assuming that the PSC records do not contain information indicating that the relief should not be given. When there is doubt, or any indication that a FO contact should be made to prevent further delay, refer the matter to the FO for appropriate action.

In some cases, as explained in HI 01001.300, the PSC may receive the enrollee's explanation from a FO which requires additional information. The PSC must provide a brief explanation of any information the PSC may have pertinent to the enrollee's eligibility for reinstatement relief.

In those cases where the enrollee is found ineligible for reinstatement, the PSC advises the enrollee that enrollment termination has been reconsidered in accordance with the request, and the initial decision terminating enrollment has been found to be correct. Further, if the enrollee believes that the reconsideration determination is not correct, then request a hearing with an Administrative Law Judge. If the enrollee wishes a hearing, the enrollee must request it no later than 60 days from the date the notice was received. Advise the enrollee to make any such request through the FO, see GN 03102.000.

Where the enrollee is found ineligible for reinstatement by reason of failure to pay the requested premiums within the prescribed 30-day period or where enrollee failed to request relief by the end of the month following the month in which enrollee received the termination notice, label (Reinstatement denied--Premiums not paid within 30 days or request for relief not filed timely.) No further action is necessary.

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HI 01001.305 - Program Service Center (PSC) Action on Request for Relief - 11/23/2022
Batch run: 11/23/2022