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Reinstatement request received by: Date/Time considered received by the plan Mail Request arrives in the organization’s mailbox or mailroom Fax Request is received on the organization’s fax machine Telephone Organization’s representative receives the incoming call

Plans would need to collect any additional data that is needed to make a determination and make that determination within five business days of the date on which the individual first contacts the plan. In such cases where the plan does not have sufficient information to determine if the enrollee’s circumstances meet the requirements, it should make a good faith effort to collect it within that time frame (e.g., making multiple attempts on different days or at different times). However, if attempts are unsuccessful, the plan must use the information provided with the initial request to make its determination.

Step 1. Confirm that the request for reinstatement is being made within 60 calendar days of the disenrollment effective date. Step 2. Inform the individual that reinstatement is a possibility only if it is determined that their failure to make timely payment was due to circumstances over which they had no control OR could not reasonably have been expected to foresee. Step 3. Obtain a credible statement from the individual regarding the circumstance that prevented them from making timely payment. Step 4. Obtain affirmation from the individual indicating their willingness and ability to pay all overdue plan premiums within three months of the disenrollment date in order for reinstatement to occur. Step 5: Review the request and make a favorable or unfavorable good cause determination. • If Steps 1-4 are met, CMS expects that plans will make such determinations within five business days of initial receipt of the request, so that the individual has a reasonable amount of time to make full payment for reinstatement. • If the individual does not indicate that an unusual or unexpected circumstance caused the nonpayment of premiums, the plan should clearly communicate that the request will not be reviewed further and it does not meet the criteria for reinstatement. The individual remains disenrolled and they may not make another request for good cause during the same 60-day period following the involuntary disenrollment.