19 Miss. Code. R. 3-16.06 - Renewal Form for Individual Products

RENEWAL FORM FOR INDIVIDUAL PRODUCTS OFFERED OUTSIDE OF THE MARKETPLACE

Important: We are continuing to Offer Your Health Coverage.

Dear (First Name of Subscriber):

Your health insurance coverage is coming up for renewal. On (Date of Renewal), you will be automatically re-enrolled and can keep your current coverage. If you do not want to be automatically re-enrolled, you need to contact (Insurer's Name) by (Date).

Each year, insurance companies can make changes to the plans and coverage options they offer. You can find these changes, if any, in Attachment A along with your monthly premium (Note: Insurer should add changes to the Insured's coverage in the attachment which includes monthly premium and benefit plan changes. Insurers providing this notice electronically may refer to a tab that would contain monthly premium and benefit changes).

Please note your current plan is not offered by (Insurer's Name) through the Marketplace. This plan does not allow you to receive financial assistance to lower your monthly premiums or lower your out-of-pockets costs.

What if I want to look into other plans? You have three ways to look into other plans and enroll.

* The (Plan Year) Open Enrollment period for the Marketplace is from (Enrollment Period). If you want a new plan with coverage that starts on January 1, 20___ in the Marketplace, the deadline to enroll is (Deadline Date). Visit HealthCare.gov and look at other Marketplace plans.

* Visit HealthCare.gov and see if you qualify or your family qualifies for Medicaid or the Children's Health Insurance Program (CHIP).

* Look at other plans outside of the Marketplace. Just keep in mind that if you qualify for financial assistance to lower your monthly or out-of-pocket costs, you can only get these savings if you enroll through Healthcare.gov.

What else should I look at before deciding to keep or change my plan?

Call (Name of Insurer) at (Insurer's phone number) or visit (Name of Insurer) website to make sure your doctor and other health care providers will be in the plan network next year. Also check to make sure any prescription medications you take will be covered (This provision is optional. Insurer may elect to delete this provision).

Questions?

* Call (Name of Insurer) at (Insurer's phone number) or visit (Insurer's website). You can also work with a licensed insurance agent or broker.

* Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to learn more about the Health Insurance Marketplace.

Getting Help in Other Languages

English: For help in (Language) call (Phone number) and an interpreter will assist you with this notice at no cost.

SPANISH (Espanol): Para obtener asistencia en Espanol, llame al (Phone Number)

Notes

19 Miss. Code. R. 3-16.06

45 CFR §§ 146.152, 147.106, and 148.122; Miss. Code Ann. § 83-5-1 (Rev. 2011).

Adopted 4/22/2015