Letter Of Explanation To Confirm Life Events Template
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2Letter of Explanation to Confirm Life Events
If you get a notice from the Marketplace saying that you need to submit documents to confirm a life
event, you can upload or mail the Marketplace certain documents. If you don’t have any of these
documents, you can submit a “letter of explanation.”
To do this, save this file to your computer, fill out the section that’s related to your life event, and
upload it to your Marketplace account on HealthCare.gov. If you need more room, you can continue
on a blank sheet of paper.
On HealthCare.gov, select “Letter of explanation” from the drop-down menu of document types. Or,
you can mail it to the Marketplace with your printed bar code page from your eligibility notice. Here’s the
mailing address: Health Insurance Marketplace, Attn: Supporting Documentation, 465 Industrial Blvd.,
London, KY 40750-0001. Visit
HealthCare.gov/help/how-to-upload-documents
for more information.
Your Name
Your Application ID
(You only need to write your application ID if you’re mailing this document. To find your application
ID, look at your notice. It’s at the top near your mailing address.)
Loss of Coverage
When did you/will you lose your coverage?
What kind of coverage did you/do you have?
____ / ____ / ______
MM
DD
YYYY
Why are you losing your coverage?
Why can’t you submit the requested documents?
Move
What’s your old address?
When did you move?
____ / ____ / ______
MM
DD
YYYY
What’s your new address?
Why can’t you submit the requested documents?
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Parent category: Letters