21. How can individuals regain coverage in ConnectorCare?

A notice denying or terminating eligibility or enrollment in ConnectorCare can be appealed within 35 days of the date on the notice. A timely appeal can prevent ongoing benefits from ending while the appeal is pending. A successful appeal can also provide for the reinstatement of benefits wrongly denied. A later Q & A provides more information about resolving disputes and appealing in ConnectorCare.

The Connector has also developed policies to reinstate ConnectorCare back to the termination date for certain specific situations as described below.

Problem: A member was involuntarily terminated from ConnectorCare for failure to pay premiums, failure to supply proof of a qualifying event, or after mail was returned as addressee unknown.

Solution: The member can be reinstated into the same ConnectorCare HMO if, within 35 days of the date on the termination notice, he or she-

• Calls Customer Service and requests reinstatement,
• Supplies any missing information such as proof of the qualifying event or a new address, and
• Pays any premium balance due and the next month’s premium.

Problem: A member was enrolled in a ConnectorCare HMO. The Health Connector sends a request for information needed to determine if the individual is still eligible for subsidized coverage to which the member does not reply by the deadline. The Health Connector makes a new decision terminating coverage for subsidized coverage but leaving the member enrolled with the same HMO at full premium cost. The member cannot afford the higher premium and is terminated for non-payment.

Solution: The member can be relieved of the full premium amount owed to the HMO and reinstated into the same ConnectorCare HMO if, within 35 days of the date of the termination notice, he or she-

• Provides the missing information and it shows he or she is still eligible for ConnectorCare,
• Calls Customer Service and requests reinstatement, and
• Pays the amount of any ConnectorCare premium contribution for the balance due and the next month’s coverage. 

Health Connector Policy #NG-6B, Termination of Coverage-Non-Payments of Premium, 3/1/2019, and training materials prepared by the Connector for certified application counselors and Navigators in August 2018 and February 2019.