Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 16 - Form and Manner of Notices When Renewing a Product in the Individual Market › Rule 19-3-16.06 - Renewal Form for Individual Products

Current through June 25, 2024
RENEWAL FORM FOR INDIVIDUAL PRODUCTS OFFERED OUTSIDE OF
				  THE MARKETPLACE
Important: We are continuing to Offer Your Health
				  Coverage.
Dear (First Name of Subscriber):
Your health insurance coverage is coming up for renewal.
On (Date of Renewal), you will be automatically re-enrolled and can keep
				  your current coverage. If you do not want to be automatically re-enrolled, you
				  need to contact (Insurer's Name) by (Date).
Each year, insurance companies can make changes to the
				  plans and coverage options they offer. You can find these changes, if any, in
				  Attachment A along with your monthly premium (Note: Insurer should add changes
				  to the Insured's coverage in the attachment which includes monthly premium and
				  benefit plan changes. Insurers providing this notice electronically may refer
				  to a tab that would contain monthly premium and benefit changes).
Please note your current plan is not offered by (Insurer's
				  Name) through the Marketplace. This plan does not allow you to receive
				  financial assistance to lower your monthly premiums or lower your
				  out-of-pockets costs.
What if I want to look into other plans? You have three
				  ways to look into other plans and enroll.
* The (Plan Year) Open Enrollment period for the Marketplace
				  is from (Enrollment Period). If you want a new plan with coverage that starts
				  on January 1, 20___ in the Marketplace, the deadline to enroll is (Deadline
				  Date). Visit HealthCare.gov and look at other Marketplace plans.
* Visit HealthCare.gov and see if you qualify or your family
				  qualifies for Medicaid or the Children's Health Insurance Program
				  (CHIP).
* Look at other plans outside of the Marketplace. Just keep
				  in mind that if you qualify for financial assistance to lower your monthly or
				  out-of-pocket costs, you can only get these savings if you enroll through
				  Healthcare.gov.
What else should I look at before deciding to keep or
				  change my plan?
Call (Name of Insurer) at (Insurer's phone number) or visit
				  (Name of Insurer) website to make sure your doctor and other health care
				  providers will be in the plan network next year. Also check to make sure any
				  prescription medications you take will be covered (This provision is optional.
				  Insurer may elect to delete this provision).
Questions?
* Call (Name of Insurer) at (Insurer's phone number) or visit
				  (Insurer's website). You can also work with a licensed insurance agent or
				  broker.
* Visit HealthCare.gov or call 1-800-318-2596 (TTY:
				  1-855-889-4325) to learn more about the Health Insurance Marketplace.
Getting Help in Other Languages
English: For help in (Language) call (Phone number) and
				  an interpreter will assist you with this notice at no cost.
SPANISH (Espanol): Para obtener asistencia en Espanol,
				  llame al (Phone Number)
45 CFR §§
				  146.152, 147.106, and 148.122; Miss. Code Ann. §
										83-5-1
				  (Rev. 2011).