Right to Appeal
If you do not agree with our decision about whether or not you are an eligible employer, you have a right to appeal our decision and receive a hearing. Employers have the right to appeal a denial of eligibility, the failure of Health Connector to provide a timely eligibility determination, or the failure of the Health Connector to provide a timely notice of an eligibility determination.
You have 90 days from the date of the eligibility notice to request an appeal. If you do not appeal within 90 days, you may lose your appeal right.
Appeals vs. Grievances
Employers may appeal our decisions regarding whether a small business meets our employer eligibility requirements, as defined in our policy.
If an employer or employee has a grievance, the issue may not be appealable. We ask that individuals contact our customer service to further discuss any grievances they may have.
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How to File an Appeal
You may appeal by completing a Health Connector Small Group Request for Hearing Form (docx).
You may mail or fax the form.
Mail: Health Connector Appeals Unit, PO Box 960189, Boston, MA 02196
Fax: 1-617-933-3099
Appeals Process
Once we receive your appeal, it triggers both an informal and formal review process.
Informal Review
You may be contacted by a staff member within the Health Connector to review your eligibility and enrollment history with the intent of exploring whether your appeal can be resolved short of a formal hearing. Engaging in this informal review is optional for both you and the Health Connector.
Hearing
You will be scheduled for a hearing before an independent hearing officer. The hearing will take place telephonically. The Health Connector will contact you and tell you when and where your hearing will take place. The Health Connector will send you a scheduling order, including the time and date of your hearing.
At the hearing, you can testify, have others testify for you, and submit documents. At the hearing, the hearing officer will also ask questions of you and any other people who testify. After completion of the hearing, the hearing officer will make a decision in writing and sent it to you. The decision will also tell you what you can do if you do not agree with the decision.
Any decisions by a hearing officer about your eligibility as an employer might also change the eligibility of your employees and their dependents.
Withdrawing an Appeal
You may withdraw your request for a hearing at any time before the hearing officer makes a final written decision. This includes before the hearing, potentially as a result of your informal resolution with the Health Connector. To withdraw your request for a hearing, you must send a written withdrawal request, including your name and case number, to the Health Connector by mail, e-mail, or fax.
Mail: Health Connector Appeals Unit, PO Box 960189, Boston, MA 02196
Email: connector-appeals@state.ma.us
Fax: 1-617-933-3099