ONLINE FORM INSTRUCTIONS - APPEAL OF MARYLAND HEALTH CONNECTION DECISION

1. Print the Authorized Representative Form.  Please fill out Sections I,  IV and V, and everything below Section V, and return the form to us.​
   
               We need this release form in order to proceed on your behalf.
   
   
2. Fill out the Complaint Form HERE.   When your information is complete; click the "Submit" button.
   
   
3. You will receive a notice that your complaint has been submitted for processing and you will be provided with a Complaint Submission number. You will be able to print your complaint from this screen. You will receive an email within 2-3 business days with your HEAU Complaint number.
   
   
4. Send the following documents to our office via mail, email or fax:
   
   
   • The first page of your Complaint with the Complaint Submission Number.
     
     
   • A signed and dated Authorized Representative Form.
     
     
   • Copies of any documents relevant to your complaint.
     
     
   • If your complaint is about Advanced Premium Tax Credits or Cost-Sharing Reductions, we will need copies of financial records that show your household income (paystubs, W-2 forms, wage and tax statements). Please do not send original documents.

Office of the Attorney General, Health Education and Advocacy Unit
200 St. Paul Place, 16th Floor
Baltimore, MD 21202

(410) 528-1840
FAX (410) 576-6571
Toll-free in Maryland
1-877-261-8807
Email: heau@oag.state.md.us
Receipt of the Authorized Representative Form and copies of other documents relevant to your complaint are necessary to begin the mediation process.

IMPORTANT: You only have 90 days from the date of the Maryland Health Connection notice to ask for a hearing. It is very important to provide us your documents as soon as possible.