Cal. Code Regs. Tit. 10, § 6918 - Verification Process Related to Eligibility for Exemptions Through the Exchange

(a) The Exchange shall verify or obtain information as provided in this section in order to determine that an applicant is eligible for an exemption.

(b) For any applicant who requests an exemption based on religious conscience, the Exchange shall verify that the applicant meets the standards specified in Section 6914(b) in accordance with the following process:

(1) The Exchange shall accept a copy of an approved IRS Form 4029 ("Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits") with required signatures that reflects that the applicant is exempt from Social Security and Medicare taxes under Section 1402(g)(1) of the Internal Revenue Code (26 USC § 1402(g)(1)) without further verification.

(2) Except as specified in paragraphs (3), (4) and (5) of this subdivision, the Exchange shall accept the applicant's attestation of membership in a religious sect or division if the Exchange obtains the information necessary to verify that the religious sect or division to which the applicant attests membership is recognized by the Social Security Administration as an approved religious sect or division under Section 1402(g)(1) of the Internal Revenue Code (26 USC § 1402(g)(1)).

(3) Except as specified in paragraph (4) of this subdivision:

(A) The Exchange shall accept the applicant's attestation that the applicant is a member of a religious sect or division described in Section 6914(b)(1)(B) and that the individual has not received medical health services, as specified in Section 6914(b)(1)(B), during the preceding taxable year; and

(B) The applicant shall provide documentation to the Exchange to demonstrate that such religious sect or division relies solely on a religious method of healing and that the acceptance of medical health services would be inconsistent with the religious beliefs of the applicant.

(4) If information provided by an applicant regarding the applicant's religious sect or division described in Section 6914(b)(1)(B) or the applicant's membership in such religious sect or division is not reasonably compatible with other information provided by the individual or in the Exchange's records, or if the Exchange is unable to verify the applicant's religious sect or division as specified in paragraph (2) of this subdivision, the Exchange shall follow the inconsistency procedures specified in subdivision (d) of this section.

(5) Except as specified in paragraphs (1) and (3) of this subdivision, if an applicant attests to membership in a religious sect or division that cannot be verified by the Exchange as an approved religious sect or division under Section 1402(g)(1) of the Internal Revenue Code (26 USC § 1402(g)(1)), the Exchange shall provide the applicant with information regarding how the applicant's religious sect or division can pursue recognition under Section 1402(g)(1) of the Internal Revenue Code (26 USC § 1402(g)(1)). The Exchange shall determine the applicant ineligible for this exemption until the Exchange obtains information indicating that the religious sect or division has been approved.

(c) For any applicant who requests an exemption based on a general hardship as specified in subdivision (c)(2) of Section 6914, except for the circumstances described in subdivisions (c)(2)(A) and (c)(2)(D) of Section 6914, the applicant shall provide documentation to the Exchange to demonstrate that the applicant has experienced the hardship to which the applicant is attesting. For any applicant who requests a hardship exemption based on lack of affordable coverage, the Exchange shall verify the hardship to which the applicant is attesting in accordance with the following process:

(1) The Exchange shall verify the unavailability of affordable coverage through the procedures used to determine eligibility for APTC, including the procedures described in Section 6478, and the procedures used to verify eligibility for qualifying coverage in an eligible employer-sponsored plan, as specified in Section 6490.

(2) The Exchange shall accept an application filer's attestation for an applicant regarding eligibility for minimum essential coverage other than through an eligible employer-sponsored plan, instead of following the procedures specified in Section 6480.

(3) To the extent that the Exchange is unable to verify any of the information needed to determine an applicant's eligibility for an exemption based on hardship, the Exchange shall follow the procedures specified in subdivision (d) of this section.

(d) Except as otherwise specified in this article, for an applicant for whom the Exchange cannot verify information required to determine eligibility for an exemption, including but not limited to when electronic data is required in accordance with this article but data for individuals relevant to the eligibility determination for an exemption are not included in such data sources or when electronic data is required but it is not reasonably expected that data sources will be available within one day of the initial request to the data source, the Exchange shall follow the inconsistency process specified in Section 6492, except as specified in paragraphs (1) through (3) of this subdivision.

(1) During the 95-day period described in Section 6492(a)(2)(B), the Exchange shall not grant a certificate of exemption based on the information subject to this subdivision.

(2) If, after the period described in paragraph (1) of this subdivision, the Exchange remains unable to verify the attestation, the Exchange shall:

(A) Determine the applicant's eligibility for an exemption based on any information available from the data sources used in accordance with this article, if applicable, unless such applicant qualifies for the exception provided under paragraph (3) of this subdivision; and

(B) Notify the applicant of such determination in accordance with the notice requirements specified in Section 6916(i), including notice that the Exchange is unable to verify the attestation.

(3) For an applicant who does not have documentation with which to resolve the inconsistency through the process described in this subdivision because such documentation does not exist or is not reasonably available and for whom the Exchange is unable to otherwise resolve the inconsistency, the Exchange shall provide an exception, on a case-by-case basis, to accept an applicant's attestation as to the information which cannot otherwise be verified along with an explanation of circumstances as to why the applicant does not have documentation.

(e) The Exchange shall not require an applicant to provide information beyond the minimum necessary to support the eligibility process for exemptions as described in this article.

(f) The Exchange shall validate the applicant's Social Security Number in accordance with the following process:

(1) For any individual who provides a Social Security Number to the Exchange, the Exchange shall transmit the individual's Social Security Number and other identifying information to HHS, which will submit it to the Social Security Administration.

(2) To the extent that the Exchange is unable to validate an individual's Social Security Number through the Social Security Administration or the Social Security Administration indicates that the individual is deceased, the Exchange shall follow the inconsistency procedures specified in subdivision (d) of this section.

Notes

Cal. Code Regs. Tit. 10, § 6918

1. New section filed 10-7-2019 as a deemed emergency pursuant to Government Code section 100725(c); operative 1-1-2020 (Register 2019, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-1-2025 pursuant to Government Code section 100725 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 5-11-2020 as a deemed emergency pursuant to Government Code section 100725(c), including amendment of subsections (b)(1)-(3), new subsections (b)(3)(A)-(B) and amendment of subsections (b)(4)-(c); operative 5-11-2020 (Register 2020, No. 20). A Certificate of Compliance must be transmitted to OAL by 1-1-2025 pursuant to Government Code section 100725 or emergency language will be repealed by operation of law on the following day.

Note: Authority cited: Sections 100504 and 100725, Government Code. Reference: Sections 100503 and 100715, Government Code; 26 USC Section 1402; and 45 CFR Section 155.615.

1. New section filed 10-7-2019 as a deemed emergency pursuant to Government Code section 100725(c); operative 1/1/2020 (Register 2019, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-1-2025 pursuant to Government Code section 100725 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 5-11-2020 as a deemed emergency pursuant to Government Code section 100725(c), including amendment of subsections (b)(1)-(3), new subsections (b)(3)(A)-(B) and amendment of subsections (b)(4)-(c); operative 5/11/2020 (Register 2020, No. 20). A Certificate of Compliance must be transmitted to OAL by 1-1-2025 pursuant to Government Code section 100725 or emergency language will be repealed by operation of law on the following day.