CEC Verification and Documentation Requirements 2 — Questions and Answers
Question 1: Which IRS form does the Marketplace primarily use when conducting electronic income verification against prior-year tax data?
- Form W-2
- Form 1095-A
- Form 4506-T
- Form 1040 transcript data via the IRS (Correct answer)
Correct answer: Form 1040 transcript data via the IRS
The Marketplace queries IRS records (equivalent to 1040 transcript data) through the Federal Data Services Hub to verify prior-year household income during the electronic verification process.
Question 2: What documentation is typically required to verify a qualifying life event (QLE) for a Special Enrollment Period (SEP) due to loss of minimum essential coverage?
- A signed self-attestation form from the applicant
- A letter from the prior insurer or employer confirming loss of coverage with the date (Correct answer)
- A copy of the applicant's most recent Explanation of Benefits
- An IRS Form 1095-B from the current year
Correct answer: A letter from the prior insurer or employer confirming loss of coverage with the date
A letter from the prior insurer or employer confirming the loss of minimum essential coverage, including the termination date, is the standard document used to verify eligibility for an SEP based on loss of coverage.
Question 3: For a self-employed applicant, which combination of documents BEST verifies annual income for Marketplace purposes?
- Recent pay stubs and a W-2 from the current year
- Most recent federal tax return and a current profit/loss statement (Correct answer)
- A bank statement and a letter from an accountant
- Form 1095-A and prior-year W-2
Correct answer: Most recent federal tax return and a current profit/loss statement
A self-employed applicant's most recent federal tax return combined with a current profit/loss statement provides both a historical baseline and a current-year income estimate for Marketplace verification.
Question 4: Which document is used to verify lawful immigration status for a non-citizen applying for Marketplace coverage?
- State driver's license
- Social Security card
- Permanent Resident Card (Form I-551/Green Card) or Employment Authorization Document (I-766) (Correct answer)
- Voter registration card
Correct answer: Permanent Resident Card (Form I-551/Green Card) or Employment Authorization Document (I-766)
Documents issued by the Department of Homeland Security, such as a Permanent Resident Card (I-551) or Employment Authorization Document (I-766), are the accepted proofs of lawful immigration status for Marketplace enrollment.
Question 5: Under federal regulations, how long must certified enrollment counselors (Navigators/Assisters) retain applicant records and documentation?
- 1 year
- 3 years
- 5 years (Correct answer)
- 10 years
Correct answer: 5 years
Federal Navigator regulations generally require that records related to enrollment assistance be retained for a minimum of 5 years to support oversight and auditing requirements.
Question 6: What is the Marketplace's process when it cannot electronically verify an applicant's identity through the Federal Data Services Hub?
- The application is automatically denied
- The applicant is given the opportunity to submit paper documentation to verify identity (Correct answer)
- The applicant must appear in person at a Social Security office
- Coverage begins but a penalty is applied to the first premium
Correct answer: The applicant is given the opportunity to submit paper documentation to verify identity
If electronic identity verification fails, applicants are given the opportunity to resolve the inconsistency by submitting acceptable identity documents through an offline process.
Question 7: Which of the following is NOT an acceptable document to verify state residency during a Marketplace application?
- Utility bill showing the applicant's name and address
- Lease or rental agreement
- School enrollment records
- An applicant's self-attestation alone (Correct answer)
Correct answer: An applicant's self-attestation alone
While self-attestation is accepted for some eligibility elements, state residency typically requires a supporting document (utility bill, lease, etc.) rather than self-attestation alone under Marketplace verification rules.
CEC Verification and Documentation Requirements 2
Which IRS form does the Marketplace primarily use when conducting electronic income verification against prior-year tax data?