An applicant or enrollee has the right to appeal any of the following:

(a) Any action or inaction related to the individual’s eligibility for or enrollment in an insurance affordability program, or for advance payment of premium tax credits and cost-sharing reductions, or the amount of the advance payment of the premium tax credit and level of cost sharing, or eligibility for affordable plan options, or eligibility for state financial assistance, or the amount of the advanced premium assistance subsidy.

Terms Used In California Government Code 100506.1

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • State: means the State of California, unless applied to the different parts of the United States. See California Government Code 18

(b) An eligibility determination for an exemption from the individual responsibility penalty pursuant to Section 1311(d)(4)(H) of the federal act or an eligibility determination for an exemption from the Minimum Essential Coverage Individual Mandate, as specified in Section 100715.

(c) A failure to provide timely or adequate notice of an eligibility determination or redetermination or an enrollment-related determination.

(Amended by Stats. 2019, Ch. 38, Sec. 5. (SB 78) Effective June 27, 2019.)

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