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DOL (US Department of Labor) Appeal Application - COBRA Subsidy Denials

If you believe you are entitled to the premium assistance, you may request that either CMS or the DOL review your case. Each is accepting a separate review form.

The DOL has an appeal process for individuals if they are denied a premium subsidy for their group health plan continuation coverage. The DOL application form should be used if you were employed by a private sector employer with twenty or more employees.

The appeal process allows applicants who are denied the subsidy to request a review by the DOL's Employee Benefits Security Administration. Individuals seeking a review must complete the department's appeal form in order to begin the review process. Applicants seeking a review of their denial should follow the instructions below.

Go to http://www.dol.gov/ebsa/COBRA/main.html for information about the appeal process. An application is available here on Discovery's site or the application may be downloaded or completed online from the DOL site.

Answer eligibility questions on the application to the best of your knowledge and ability.

Attach any documents relevant to the department?s review of the application.

Include complete contact information (e.g., daytime phone number, an alternate phone number, and an email address, if available).

Separate application(s) must be completed for any family member whose plan information is not identical to the information you provide.

Keep for your records a copy of the application(s) and original supporting documentation.

Submit your application to the DOL as instructed on the form or DOL web site.

Individuals requiring assistance may also contact EBSA at 1.866.444.3272 or visit its dedicated Web page at www.dol.gov/cobra. The Web page also contains additional frequently asked questions to help dislocated workers, their families and their employers understand the requirements.

Form Type: Enrollment
Categories: COBRA

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