How do I file a Covered CA Appeal?
We are not attorneys and can just point out the law, rules, relevant sections in the EOC Evidence of Coverage.
We also need you to write out your story and including all the proofs – evidence & exhibits.
We might be able to help you file and process your appeal (click for form) , IF you appoint us (Steve Shorr) as your Certified Insurance Agent, by following these instructions as we are paid a measly monthly sum by Covered CA to help you.
Your eligibility notice explains what you are eligible for and the programs for which you do not qualify. Depending on your eligibility results, you may appeal any of the following (check as many boxes as you would like):
I was denied enrollment into a Covered California health plan
The amount of Premium Assistance (tax credits that help pay my monthly premium) is not correct – Get Calculation
The level of Cost Sharing Reduction (help paying my out of pocket expenses) is not correct
I was denied eligibility for an exemption from the individual responsibility CA Mandate Penalty
Covered California did not process my information in a timely manner
Covered California stated that I am not a US Citizen or US National or a lawfully present individual living in the United States
Covered California stated that my application was incomplete
I do not have other health coverage (such as free Medi-Cal or employer sponsored insurance) that prevents me from qualifying for insurance through Covered California
Covered California stated that I am not a California Resident
Covered California stated that I did not pay my premiums by my due date
Covered California stated that my MAGI income is too low chart to qualify for Covered California coverage Get Calculation
Other Tell us more about why you disagree with Covered California’s decision. You may attach additional sheets of paper if you need more space to write. We STRONGLY suggest you do. Be sure to read all the helpful aids we have on this page. You are going up against well versed opponents!
For other appeals check our Site Map, Child & Related Pages below.
Resources, Child Pages & Links
- Covered CA Appeals
- How we can help you with your grievance
- Independent Medical Review
- Last Minute Application? When does coverage start?
- Technical Links – Appeals & Grievances
Their service is the worst I have seen since earning my Degree in Insurance at San Diego State University in 1975. I learned the word SNAFU from a guy I knew in the Dorm. This is the first time, I’ve been able to use the word in “real” life. Please note how many of the 8,000 certified agents are now refusing to deal with Covered CA. See screen shots below from Ehealth Insurance and another agent. It’s twice the work, for less than 1/2 of what we were paid last year and “criminal” support and customer service!
Hurry, we may well soon be FORCED to charge a fee for appeals and consultation for Covered CA.
1.29.2015 Update – Through the Covered CA Agent Portal & Email, I’m now getting pretty good service & response.
July 23, 2010 OCIIO-9993-IFC: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act – Opens in a new window (PDF – 257 KB)
- June 22, 2011 CMS-9993-IFC2: Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External Review Processes – Opens in a new window
- July 26, 2011 CMS-9993-CN: Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External Review Processes; Correction – Opens in a new window (PDF – 184 KB)
Article 7. Appeals Process for the Individual Exchange
- § 6602. General Eligibility Appeals Requirements.
- § 6604. Notice of Appeal Procedures.
- § 6606. Appeal Requests.
- § 6608. Eligibility Pending Appeal.
- § 6610. Dismissals.
- § 6612. Informal Resolution.
- § 6614. Hearing Requirements.
- § 6616. Expedited Appeals.
- § 6618. Appeal Decisions.
- § 6620. Appeal Record.
- § 6622. Employer Appeals Process.