CEC Verification and Documentation Requirements 2

Question 1

Which IRS form does the Marketplace primarily use when conducting electronic income verification against prior-year tax data?

Accepted Answer

Form 1040 transcript data via the IRS

Answer

Form W-2

Answer

Form 1095-A

Answer

Form 4506-T

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?

Accepted Answer

A letter from the prior insurer or employer confirming loss of coverage with the date

Answer

A signed self-attestation form from the applicant

Answer

A copy of the applicant's most recent Explanation of Benefits

Answer

An IRS Form 1095-B from the current year

Question 3

For a self-employed applicant, which combination of documents BEST verifies annual income for Marketplace purposes?

Accepted Answer

Most recent federal tax return and a current profit/loss statement

Answer

Recent pay stubs and a W-2 from the current year

Answer

A bank statement and a letter from an accountant

Answer

Form 1095-A and prior-year W-2

Question 4

Which document is used to verify lawful immigration status for a non-citizen applying for Marketplace coverage?

Accepted Answer

Permanent Resident Card (Form I-551/Green Card) or Employment Authorization Document (I-766)

Answer

State driver's license

Answer

Social Security card

Answer

Voter registration card

Question 5

Under federal regulations, how long must certified enrollment counselors (Navigators/Assisters) retain applicant records and documentation?

Accepted Answer

5 years

Answer

1 year

Answer

3 years

Answer

10 years

Question 6

What is the Marketplace's process when it cannot electronically verify an applicant's identity through the Federal Data Services Hub?

Accepted Answer

The applicant is given the opportunity to submit paper documentation to verify identity

Answer

The application is automatically denied

Answer

The applicant must appear in person at a Social Security office

Answer

Coverage begins but a penalty is applied to the first premium

Question 7

Which of the following is NOT an acceptable document to verify state residency during a Marketplace application?

Accepted Answer

An applicant's self-attestation alone

Answer

Utility bill showing the applicant's name and address

Answer

Lease or rental agreement

Answer

School enrollment records