CEC Verification and Documentation Requirements 3

Question 1

What type of income documentation is required for an applicant who receives Social Security benefits?

Accepted Answer

An SSA benefit verification letter (award letter) or SSA-1099

Answer

A recent employer pay stub

Answer

A signed letter from the applicant describing the benefit amount

Answer

IRS Form W-4 filed with the Social Security Administration

Question 2

How does the Marketplace treat verification for American Indians and Alaska Natives (AI/ANs) who are exempt from the individual shared responsibility payment?

Accepted Answer

They must submit a tribal enrollment certificate to access zero cost-sharing plans

Answer

No documentation is required; self-attestation is always sufficient

Answer

They must submit a federal tax return to verify tribal income

Answer

AI/ANs are ineligible for Marketplace plans

Question 3

When an applicant reports a change in household size (e.g., birth of a child), what documentation is typically required to verify this change?

Accepted Answer

A birth certificate or adoption decree

Answer

A hospital bill

Answer

A signed statement from the applicant

Answer

An updated Form W-4

Question 4

An applicant claims they are exempt from the employer-sponsored insurance (ESI) offer because it is unaffordable. What documentation may the Marketplace request to verify this?

Accepted Answer

An employer verification form (such as Form 14950) or documentation of the lowest-cost self-only premium offered

Answer

A recent pay stub showing the applicant's wages

Answer

A letter from the applicant's doctor confirming the plan does not meet their needs

Answer

An IRS Form 1095-C from the prior year only

Question 5

What is the Marketplace's policy for verifying residency for applicants experiencing homelessness?

Accepted Answer

Self-attestation of state residency is generally accepted; a shelter or service provider address may be used

Answer

Homeless applicants are ineligible for Marketplace coverage

Answer

They must provide a shelter address and a letter from the shelter director

Answer

They must use a P.O. Box registered with USPS

Question 6

Which verification scenario requires the Marketplace to check DHS immigration records through the Federal Data Services Hub?

Accepted Answer

A lawfully present non-citizen claiming eligibility based on immigration status

Answer

A U.S.-born citizen applying with a passport

Answer

A Medicare beneficiary applying for a supplemental plan

Answer

A child under age 18 applying with a parent who is a U.S. citizen

Question 7

If an applicant provides income documentation that conflicts with IRS data retrieved by the Marketplace, what is the CORRECT procedure?

Accepted Answer

The Marketplace notifies the applicant of the inconsistency and allows them to submit documentation explaining the difference

Answer

The Marketplace must always use the IRS data and deny the applicant's documentation

Answer

The enrollment counselor should alter the application to match IRS data without telling the applicant

Answer

The application is forwarded to the Department of Justice for review