Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: May 16, 2017

Program Area: Enrollment and Eligibility (ENR)

Question: What is the proper CMS protocol for the resolution of an unjustified cancellation request sent via a Health Insurance Casework System (HICS) case? Are issuers to reroute the case back to the Exchange or submit the case as an Enrollment Resolution and Reconciliation (ER&R) Dispute?

Answer: If the issuer receives a valid HICS Case instructing the issuer that a canceled policy should be reinstated, the issuer should reinstate the enrollment by submitting a dispute through the ER&R Dispute process. Issuers should not redirect the enrollee to contact the Exchange for reinstatement. The HICS Exchange Issuer Best Practices 2018 can be found on REGTAP here: https://www.regtap.info/reg_librarye.php?i=2344

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