An applicant or enrollee has the right to appeal any of the following: (a) Any action or inaction related to the individualâs eligibility for or enrollment in an insurance affordability program, or for advance payment of premium tax credits and cost-sharing reductions, or the amount of the advance payment of the premium tax credit and level of cost sharing, or eligibility for affordable plan options, or eligibility for state financial assistance, or the amount of the advanced premium assistance subsidy. (b) An eligibility determination for an exemption from the individual responsibility penalty pursuant to Section 1311(d)(4)(H) of the federal act or an eligibility determination for an exemption from the Minimum Essential Coverage Individual Mandate, as specified in Section 100715. (c) A failure to provide timely or adequate notice of an eligibility determination or redetermination or an enrollment-related determination.
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