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    Health Care Eligibility Notice

    Who Gets this Notice

    Consumers who submit an application or experience a change in eligibility for health care coverage through MNsure.

    What You Need to Do

    • If the notice indicates "Approved" for qualified health plan eligibility, you need to sign in to your account to enroll in coverage through MNsure by the deadline indicated in the notice, or by the end date of your special enrollment period.
    • If the notice indicates "Approved" for Medical Assistance or MinnesotaCare, wait to hear from the Department of Human Services (DHS) for further instructions and information. Contact DHS for any questions you have about your eligibility in these programs.
    • If the notice indicates more information is needed from members of your household, you must send MNsure the required documentation by the due date in this notice.
    • If the notice indicates "Does not qualify" you may appeal this decision if you do not agree with the reason(s) for denial.

    How to Identify this Notice

    • This notice has two logos in the upper right of the first page: The DHS logo and the MNsure logo.
    • The title of the notice is “Health Care Notice.”
    • It contains information for each household member on your MNsure application
    • It may be 20 or more pages long depending on your household size.

    Your Health Care Results (Eligibility)

    The section displays information about each household member's eligibility with their name, their MNsure ID number and a table. The table shows the date the eligibility takes effect (Effective date), and the changes to the person's eligibility (Action) for each Coverage Type (you may see up to four coverage types).

    Example eligibility table
    Effective Date Action Coverage Type
    This column will show the date when the eligibility for the coverage type begins or ends. This column will show whether the individual is eligible or not for the coverage type in the next column. It will show:
    "Approved" or
    "Does not qualify"    		 This column will show some or all of these: "Qualified Health Plan without financial assistance"; "Qualified Health Plan with Advanced Premium Tax Credit/Cost-Sharing Reductions"; "MinnesotaCare"; "Medical Assistance"

    Under each eligibility table is information further explaining the eligibility for that person, and actions they may need to take.

    More Information Needed

    This section is included if you need to send supporting documentation for one or more individuals in your household.

    Example table more information needed
    Due Date Needed Information Acceptable Documents
    Date documents are due to MNsure Examples: Proof of citizenship Social Security Number Documents that are accepted as proof of the information needed. Examples: U.S. Passport State Driver’s License

    Questions

    If you have questions about this notice, call the MNsure Contact Center at 651-539-2099 (855-366-7873 outside the Twin Cities) and reference "SEN."

    For questions about Medical Assistance or MinnesotaCare, contact DHS.

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