TN 22 (11-01)
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, will ordinarily be 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 his/her eligibility and the
necessary premium payment, the PSC may reinstate him/her, 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 will 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 his/her enrollment termination has been reconsidered in accordance
with his/her request, and the initial decision terminating his/her enrollment has
been found to be correct. Further, if he/she believes that the reconsideration determination
is not correct, he/she may request a hearing with an Administrative Law Judge. If
he/she wishes a hearing, he/she must request it no later than 60 days from the date
he/she receives the notice. 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 he/she failed
to request relief by the end of the month following the month in which he/she 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.