Marketplace FTR Recheck Warning Notice: The FFM will be performing a recheck of IRS data to confirm that consumers who attested on their 2016
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1 Marketplace FTR Recheck Warning Notice: The FFM will be performing a recheck of IRS data to confirm that consumers who attested on their 2016 applications to filing a 2014 federal tax return and reconciling their 2014 APTC have filed and reconciled APTC. This warning notice will be sent to 2016 enrollees who are currently receiving APTC and checked the FTR attestation question. This notice warns the tax filer that he/she may wish to confirm that he/she has filed a 2014 tax return and if not, that he/she must file a 2014 tax return with IRS Form 8962 immediately or the household risks losing its financial assistance for 2016.
2 DEPARTMENT OF HEALTH AND HUMAN SERVICES 465 INDUSTRIAL BOULEVARD LONDON, KENTUCKY [hh_contact_first_name] [hh_contact_last_name] [todays_date] [hh_contact_street_name_1] [special_address_2_line] [hh_contact_city_name], [hh_contact_state_code] [hh_contact_zip_plus_4_code] Application date: [application_submission_date] Application ID: [application_identifier] Dear [hh_contact_first_name]: WARNING: People in your household may be at risk of losing financial help for their Marketplace coverage. You re getting this notice because you re currently enrolled in 2016 Marketplace health coverage with financial help, such as advance payments of the premium tax credit (APTC) and cost-sharing reductions. The Marketplace must make sure you filed a 2014 federal income tax return and reconciled APTC you received in 2014 for all members of your household. URGENT: If you haven t filed your 2014 tax return yet, you should do so immediately, even if you don t usually have to file taxes. If you have filed your 2014 tax return, you don t need to do anything else. It s extremely important for you to file your 2014 income tax return and reconcile APTC for all members of your household who received APTC in The Marketplace will compare records with the Internal Revenue Service (IRS) soon. If we can t confirm the tax filer or tax filers in your household filed a 2014 tax return for your family with IRS Form 8962, Premium Tax Credit, everyone in your household may lose all help with costs they re currently getting for Marketplace coverage, including APTC or cost-sharing reductions. This means you may be responsible for the full cost of your monthly health insurance premiums and the full amount of any deductibles, copayments, or other coinsurance. If we confirm that you have filed your 2014 federal income tax return and reconciled your 2014 APTC when we check IRS records and you otherwise remain eligible to receive financial help, your 2016 Marketplace coverage with financial help will continue. What you need to do Make sure you filed your 2014 tax return and attached Form 8962 reporting the APTC received by all members of your household in If you haven t, you should do so immediately. You should have 1
3 received your 2014 Form 1095-A Health Insurance Marketplace Statement to help fill out IRS Form If you have filed your 2014 tax return, you don t need to do anything else. If you don't have a copy of your 2014 Form 1095-A, visit HealthCare.gov and log into your Marketplace account, or call the Marketplace Call Center at If you have questions about your household's tax filing status for 2014 or if you have filed and want to confirm your tax filing status, use the Interactive Tax Assistant ( or call IRS Telephone Assistance for Individuals at For more information on filing a 2014 federal tax return using Form 8962, visit HealthCare.gov/taxes or IRS.gov/aca. The Marketplace will NOT send another notice to warn you to file your 2014 tax return and reconcile APTC. If we cannot confirm you filed and reconciled, the Marketplace will send you a new eligibility determination notice stating that you aren t eligible for APTC and the Marketplace will stop paying APTC and cost-sharing reductions to your health insurer. You will remain enrolled in your Marketplace plan and your health insurer will start billing you for the full cost of your monthly premiums. Your eligibility determination notice will include instructions on how to appeal the discontinuation of your APTC if you believe your APTC was removed in error. For more help Visit HealthCare.gov, or call the Marketplace Call Center at TTY users should call You can also make an appointment with an assister who can help you. Information is available at LocalHelp.HealthCare.gov. Get language assistance services. If you need language assistance in a language other than English, you have the right to get help and information in your language at no cost. Information about how to access these language assistance services is included with this notice, as a separate page. You can also call the Marketplace Call Center to get information on these services. Call the Marketplace Call Center to request a reasonable accommodation if you have a disability. These accommodations are available and provided at no cost to you. Sincerely, Health Insurance Marketplace Department of Health and Human Services 465 Industrial Boulevard London, Kentucky Privacy Disclosure: The Health Insurance Marketplace protects the privacy and security of the personally identifiable information (PII) that you have provided (see Healthcare.gov/privacy/). This notice was generated by the Marketplace based on 45 CFR and 45 CFR part 155, subpart D. The PII used to create this notice was collected from information you provided to the Health Insurance Marketplace. The Marketplace may have used data from other federal or state agencies or a consumer reporting agency to determine eligibility for the individuals on your application. If you have questions about this data, contact the Marketplace at (TTY: ). 2
4 According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is Nondiscrimination: The Health Insurance Marketplace doesn t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age. If you think you ve been discriminated against or treated unfairly for any of these reasons, you can file a complaint with the Department of Health and Human Services, Office for Civil Rights by calling (TTY: ), visiting hhs.gov/ocr/civilrights/complaints, or writing to the Office for Civil Rights/ U.S. Department of Health and Human Services/200 Independence Avenue, SW/ Room 509F, HHH Building/ Washington, D.C
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PUB Name: GSB0012 2018 Prescription Drug Schedule Humana Medicare Employer Plan Rx 269 University of Richmond Y0040_GHHK48XEN18 (Pending CMS Approval) Rx 269 Let's talk about Humana Medicare Employer
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Standard Member Appeal and Grievance Process Carefully read the information in this packet and keep it for future reference. It has important information about how to appeal/grieve decisions Blue Cross
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at Highmarkbcbs.com or by calling 1-800-472-1506. Important