Filing a Health Connector appeal

You have the right to file an appeal if you disagree with the action taken by the Massachusetts Health Connector. Filing an appeal is a way to ask us for a “hearing” (a formal legal review) about a decision or action we took that affected your Health Connector insurance. If you are scheduled for a hearing, you will have a chance to share information about what happened with an impartial hearing officer. The hearing officer can decide whether the Health Connector needs to change the original action or take a new action.

• If you need help with a decision that was made by MassHealth, you will need file an appeal with MassHealth, not the Health Connector. To get help with a MassHeath issue, call 1-888-665-9993 (TTY: 1-888-665-9997).

What kinds of decisions can you appeal?

You can appeal decisions we made about:

• The Health Connector program you qualified for
• The amount of financial help you qualified for
• The timing of when you were able to enroll in a Health Connector plan

You don't need to file an appeal if you only need to change your application information. You can get help with updating your account information by calling Health Connector Customer Service at 1-877-MA-ENROLL (1-877-623-6765), or TTY: 711.

When to appeal

If you got a notice (letter) about the action or decision that you want to appeal, you will need to send us your Appeal Request form within 60 days of the date you received that notice.

If you want to appeal an action that we did not take, you will need send us a Hearing Request form within 120 days of the date when you believe we should have acted. An example of not acting could be: failing to send you a letter about what program you qualified for, or failing to act on your application.

• Let us know right away if you have urgent health care needs. If you need your appeal to be decided faster because you have serious health needs and your ability to get care depends on your appeal decision, please call the Health Connector Appeals Unit at 617-933-3096 (TTY: 711).

What happens next

You may be able to keep your Health Connector plan while your appeal is being decided. If you qualify for this, we will let you know after we get your form. Please note that an appeal decision for one household member may change eligibility for other household members.

At least 15 days before the hearing, we will send you a notice telling you the date and time of the hearing. Your hearing will be held over the phone unless we’ve approved your request for an in-person hearing.

Your rights

• You have a right to be helped at the hearing. You may have a lawyer or other person represent you. However, the Health Connector will not pay for a representative. If you can’t afford legal help, you may want to contact a local legal aid service or community agency to see if you can receive help or representation at no cost.
• You have a right to have an interpreter, assistive device, or other needed accommodation at your hearing. Tell us about the type of help or accommodation you will need for your hearing in the “Other Information” section of your Hearing Request form.
• You have a right to review your case file. If you or your representative want to review your case file before the hearing, please call the Health Connector Appeals Unit at 617-933-3096 (TTY: 711).
• You have a right to ask to subpoena witnesses and ask questions of witnesses. You or your representative may write to ask that witnesses or documents be subpoenaed (ordered to appear) to the hearing. You or your representative may share evidence and ask witnesses questions at the hearing. The hearing officer will then make a decision based on all evidence presented.

Hearing Request Form

Tell us about the person who is asking for a hearing

If you are appealing a decision that affects more than one person in your household, please choose one adult to be the contact person for the hearing.

Fields with this symbol (*) next to them must be filled out.

Tell us who is appealing

List the names of the people who should be included in your appeal.

Tell us why you are appealing

Fields with this symbol (*) next to them must be filled out.

Tell us if you need help during your hearing

Please check the box next to any accommodations that you need for help during your hearing.

Tell us if someone will be representing you during your hearing

If another person, such as a lawyer or Authorized Representative, will speak on your behalf during your hearing, please select Yes.

Tell us how to get in contact with you

We will be able to more quickly get in touch with you about your appeal if we are able to contact you by phone or email. Please check the box below to tell us if it’s ok to contact you by phone, email, or both. Please note that If we contact you by phone and can’t reach you, we may leave a voicemail that could include personal information about your household. If we send you email, it might include personal information and it may be unsecure, meaning that there is some risk that someone who is not part of your household could read or access the email.

If you change your mind at any point about receiving messages by email or voicemail, please call the Health Connector Appeals Unit at 617-933-3096 (TTY: 1-877-623-7773) to let us know.

Please sign below if you agree with the following statement:

The information on this form is true and accurate to my knowledge. For this appeal, I give the Health Connector permission to give me and my representative or translator my personal information, including federal and state tax information used to determine my eligibility.