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.