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Covered CA Appeals Process
Individuals can file an appeal to the county's fair hearings unit or through Covered CA when they disagree with the:
- Eligibility determination.
- Amount of premium assistance or cost sharing reduction.
- Annual redetermination of eligibility.
- Denied eligibility for an exemption from the individual responsibility.
- Denied enrollment into a Covered CA health plan.
- Covered CA did not process your information in a timely manner.
- Covered CA stated that you were not a U.S. citizen or U.S. national or a lawfully present individual living in the United States.
- Covered CA stated that your application was incomplete.
- An individual does not have other health coverage (such as free MC or employer-sponsored insurance) that prevents you from qualifying for insurance through Covered CA.
- Covered CA stated that you are not a California resident.
- Covered CA stated that you did not pay your premiums by your due date.
An individual can file an appeal by completing the Request for a State Fair Hearing to Appeal a Covered CA Eligibility Determination form.
Individuals have 90 calendar days to submit an appeal to the county or Covered CA. Individuals can also file an appeal directly to the U.S. Department of Health and Human Services. Counties and Covered CA have 90 to 120 calendar days to review and resolve the appeal.
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