Get Marketplace Appeal Request Form 2021-2025

Navigating the Marketplace Appeal Request Form can seem complex, but this guide provides clear, step-by-step instructions to help you complete it online effectively and efficiently. Whether you're appealing a decision or seeking assistance, you'll find supportive guidance tailored to your needs.

Follow the steps to successfully complete your Marketplace Appeal Request Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your first and last name in the designated fields to identify the person filling out the form.
3. Specify whose eligibility you are appealing. For each individual listed on your Marketplace application whose eligibility is under appeal, provide their first name, last name, date of birth, email, and daytime phone number. Repeat this for each person.
4. Indicate the reason for your appeal by providing your Application ID number and the notice date. Select all applicable Marketplace decisions you are contesting and explain why you believe the decision is incorrect.
5. If necessary, indicate if you need to fast-track your appeal due to health concerns. Choose 'yes' and provide an explanation if you do request an expedited appeal.
6. Optionally, fill in your contact information if you wish to receive electronic updates about your appeal.
7. If you want to appoint an authorized representative to assist with your appeal, provide their details, including their name, date of birth, and contact information.
8. (Optional) Include any supporting documents that bolster your case, ensuring you submit copies and not original documents.
9. Have the tax filer listed on your Marketplace application sign and date the form, granting consent for the Marketplace to share required information during the appeal process.
10. Once the form is complete, save your changes and choose to download, print, or share the form as needed. Follow the instructions provided to submit your appeal.

Start filling out your Marketplace Appeal Request Form online today for prompt assistance.