CEC Verification and Documentation Requirements

Question 1

When the Marketplace finds a data inconsistency related to an applicant's income, what is the FIRST action taken?

Accepted Answer

The applicant is notified and given an opportunity to resolve the inconsistency

Answer

Federal regulations require that applicants be notified of any inconsistency and given a reasonable period to provide documentation to resolve it before any adverse action is taken.

Question 2

How long does a Marketplace applicant typically have to submit documentation to resolve a data inconsistency after receiving notice?

Accepted Answer

90 days

Answer

Applicants are generally given 90 days to provide documentation resolving a data inconsistency before the Marketplace changes their eligibility determination.

Question 3

Which federal agency's records does the Marketplace primarily use to verify Social Security numbers?

Accepted Answer

Social Security Administration (SSA)

Answer

The Marketplace uses the Social Security Administration's data hub to electronically verify Social Security numbers provided on applications.

Question 4

Which document is MOST commonly used to verify current wages from an employer during a Marketplace application?

Accepted Answer

Recent pay stubs from the past 30 days

Answer

Recent pay stubs (generally from the past 30 days) are the primary documentation used to verify current employment income for Marketplace eligibility purposes.

Question 5

What happens to an enrollee's Marketplace coverage if they fail to resolve an income inconsistency within the required timeframe?

Accepted Answer

Their eligibility is redetermined based on the data sources the Marketplace has on file

Answer

If the inconsistency is not resolved, the Marketplace redetermines eligibility using available federal data sources, which may result in a change to the tax credit amount or other eligibility findings.

(CEC) Certified Enrollment Counselor Practice Test

(CEC) Certified Enrollment Counselor Practice Test

CEC Verification and Documentation Requirements