Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(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.
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.
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.
