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Appeals
You have the right to file an appeal of any final eligibility determination from Get Covered Illinois. You can appeal, among other things, a decision to deny, terminate, or change:
An initial eligibility determination, including:
Eligibility to enroll in a qualified health plan (QHP) through the Exchange;
The amount of advance payments of the premium tax credit (APTC);
The level of cost-sharing reductions (CSR), or
Denial of a special enrollment period (SEP)
A redetermination of eligibility, including changes to APTC, CSR level, or SEP eligibility
Effective date of APTC or QHP coverage, if the appellant believes it was incorrectly assigned or delayed (such as due to system error or misapplication of effective date rules)
Failure by GCI to provide a timely notice of an eligibility determination
Denial of a request to vacate a dismissal issued by the GCI Marketplace Appeals Program
Termination of QHP coverage due to a marketplace eligibility determination (e.g., loss of APTC or failure to verify required information)
Please note, only final Eligibility Determinations of Get Covered Illinois are appealable.
Your appeal should be in writing. To file your appeal, please fill out and submit the following appeals form If you are unable to obtain this form online, you can always call the Get Covered Illinois Customer Assistance Center at 1- 1-866-311-1119 or TTY 711. Your appeal must include your name, address, and a detailed reason why you believe the Exchange’s eligibility determination is in error. If you are requesting an appeal for someone else (like your child), also include their name.
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1-866-311-1119 (TTY: 711)