Crosswalk of Changes

Appendix F: Crosswalk of Changes
Annual Eligibility Redetermination, Product Discontinuation and
Renewal Notices (CMS-10527/0938-1254)
In addition to formatting corrections, we made the following changes to improve accuracy and
clarity of the notices.
Attachment #
2

2

Section
Your new
premium

•

Revision (Red indicates modified Language)
Your new monthly payment (starting in [12 Month])
is [13 estimated]: $[14 to be $[13 Dollar amount].
This reflects an [1514 estimated] monthly premium of
$[1615 Dollar amount] minus the same[16 Phrase or
dollar amount of financial help you’re getting now.].
However, your financial help may be different next
year. You’ll see your new monthly payment when you
receive your [17 Month] bill.
Important: This estimated monthly payment is based on
current information we have for [18 Year]. It doesn’t
might not account for some or all changes that could
impact your amount of financial helpmonthly payment,
like cost changes in your area for next year, or changes to
your household income or family size. To find out the
actual amount of financial help you qualify for in [19
Year] and your new premium amount, monthly payment,
update your [20 Exchange19 Exchange] application. See
below for more information.

Item numbers updated throughout

3

Entire
document
Title

4

Note Box

Important: Your plan will no longernot be offered through
the [3 Exchange][4 in your area]. Take action by [35 Date]
or you’ll be automatically enrolled in a different [46
Exchange] plan. This may change some of your costs and
coverage, so review your options carefully.

4

Your new
premium

Discontinuation notice for the individual market outside
the Exchange and the issuer is automatically enrolling
the enrollee in a different plan outside the Exchange

•

Your new monthly payment (starting in [2123
Month]) is [22 estimated]: $[23 to be: $[24 Dollar
amount].
This reflects an [2425 estimated] monthly premium of
$[2526 Dollar amount] minus the same[27 Phrase or
dollar amount of financial help you’re getting now].
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6

2&4

Entire
document
What you need
to do

Instructions

However, your financial help may be different next
year. You’ll see your new monthly payment when you
receive your [2628 Month] bill.
Important: This estimated monthly payment is based on
current information we have for [2729 Year]. It
doesn’tmight not account for some or all changes that
could impact your amount of financial helpmonthly
payment, like cost changes in your area for next year, or
changes to your household income or family size. To
find out the actual amount of financial help you qualify
for in [28 Year] and your new premium amount, monthly
payment, update your [2930 Exchange] application. See
below for more information.
Item numbers updated throughout
1. Update your [14 Exchange] application by [15 Date].
Review your [16 Exchange] application to make sure the
information is still current and correct, and to see if you
may qualify for more or less financial help [17 in Year]
than you’re getting now. This may result in a lower
monthly premium payment or lower out-of- pocket costs
(like deductibles, copayments, and coinsurance). Plus,
you can help avoid paying money back when you file
your taxes and reconcile your tax credit.
Updated throughout to reflect revised item numbers

2