Filing an Appeal or a Complaint

Reasons for Filing an Appeal

Your eligibility notice explains what you are eligible for and the programs for which you do not qualify. Depending on your eligibility results, you may appeal any of the following:

  • You were denied enrollment into a Covered California health plan.
  • The amount of premium assistance (tax credits that help pay your monthly premium) is not correct.
  • The level of cost-sharing reduction (help paying your out-of-pocket expenses) is not correct.
  • You were denied eligibility for an exemption from the individual responsibility.
  • Covered California did not process your information in a timely manner.
  • Covered California stated that you were not a U.S. citizen or U.S. national or a lawfully present individual living in the United States.
  • Covered California stated that your application was incomplete.
  • You do not have other health coverage (such as free Medi-Cal or employer-sponsored insurance) that prevents you from qualifying for insurance through Covered California.
  • Covered California stated that you are not a California resident.
  • Covered California stated that you did not pay your premiums by your due date.
  • Covered California stated that your income is too low to qualify for Covered California coverage.
  • In the event that one of the above situations applies to you, you have the option to file an appeal. You may file an appeal by downloading and filling out the Request for a State Fair Hearing to Appeal a Covered California Eligibility Determination form.

You may also file a complaint with Covered California by downloading and filling out this Covered California complaint form.