Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Definitions. For purposes of this section, the
following terms shall have the following meanings:
(1) RIDP: Remote Identity Proofing
service;
(2) FDSH: Federal Data Service
Hub;
(3) Certified Representative:
(A) Service Center Representative: an Exchange
employee operating in a call center as set forth in
45 C.F.R. section
155.205(a);
(B) Certified Enrollment Counselor as defined in
section 6650;
(C) Certified Application Counselor as defined in
45 C.F.R. section
155.225;
(D) Certified Insurance Agent as defined in
section 6800;
(E) Certified Plan-Based Enroller as defined in
section 6410.
(b) Paper Applications
(1) The Exchange shall accept only paper
applications for health insurance coverage that are accompanied by a signature in
ink, under penalty of perjury in the declaration and signature section of the
Exchange's paper application as defined in section
6470.
(2) The Exchange shall not accept or process any
paper application lacking an attestation of identity signed by the applicant in ink
under penalty of perjury.
(c)
Non-paper applications
(1) Prior to initiating an
application as set forth in section
6470, an applicant must consent to
having his or her identity verified in one of the following ways:
(A) If the applicant applies through CalHEERS
without the assistance of a Certified Representative, the applicant shall consent by
clicking the "Yes" button on the CalHEERS Screen in response to being asked, "Do you
give your permission to Covered California to confirm your identity?"
(B) If the applicant applies through CalHEERS with
the assistance of a Certified Representative, he or she shall provide this consent
to the Certified Representative orally. The Certified Representative shall attest to
having received this consent from the applicant in one of the following ways:
1. Clicking the "Yes" button next to the statement
"I attest that I have visually verified this person's identity";
2. Clicking the "Yes" button next to the statement
"I have the consumer's consent to access their identity information through the
Federal Data Services Hub Remote Identity Proofing
service."
(2) Prior
to initiating an application as set forth in section
6470, an applicant shall submit his or
her identity for verification using one of the following methods:
(A) Visual Verification
1. An applicant shall mail, present in person, or
electronically transmit through CalHEERS to the Exchange or to a Certified
Representative acceptable proof of identity as follows:
(i) A copy of a valid identification card issued
by a federal, state, or local governmental entity that bears a recognizable
photograph of the applicant or other identifying information of the individual such
as name, age, sex, race, height, weight, eye color, or address, including school
identification card, voter registration card, Military Dependent's identification
card, Native American Tribal document, U.S. Coast Guard Merchant Mariner card, a
Certificate of Naturalization (Form N-550 or N-570), Certificate of U.S. Citizenship
(Form N-560 or N-561), Permanent Resident Card or Alien Registration Receipt Card
(Form I-551), employment authorization document that includes a photograph (Form
I-766), Foreign Passport or identification card issued by a foreign embassy or
consulate that contains a photograph, or
(ii) Two of the following: a birth certificate,
Social Security card, marriage certificate, divorce decree, employer identification
card, high school or college diploma (including high school equivalency diplomas),
property deed or title, an adoption decree for the adoptee, foreign school record
that includes a photograph, notice from a public benefits agency, or a union or
worker center identification card.
2. If submitted in person or by mail, a Certified
Representative shall upload a copy of the identity documents to
CalHEERS.
(B) Federal Data
Service Hub Remote Identity Proofing service
1. If
the applicant does not elect to have his or her identity verified pursuant to
subdivision (c)(2)(A), he or she shall consent to allowing the Exchange or Certified
Representative to use the FDSH RIDP service to access his or her identity
information.
2. The applicant shall
answer a number of questions generated by the FDSH RIDP service. Examples of these
questions include, but are not limited to:
(i)
Please select the number of bedrooms in your home from the following choices. If the
number of bedrooms in your home is not one of the choices please select 'NONE OF THE
ABOVE.'
(ii) Please select the county
for the address you provided.
(iii)
Please select the range that includes the year the home was built for the address
that you provided.
3. Based on
the accuracy of the applicant's answers to the questions referenced in (c)(2)(B)2.
of this section the FDSH RIDP service will either verify the applicant's identity or
provide information on how to complete an alternative identity verification
process.
(3) If the
Exchange is unable to verify the identity of an applicant in accordance with
subdivision (c)(2) of this section, neither the Exchange nor a Certified
Representative shall accept an application for health insurance from that same
applicant until one of the following is satisfied:
(A) The applicant successfully completes the
alternative identity verification process by calling the Help Desk number listed in
CalHEERS and successfully answers additional personalized questions, and the FDSH
RIDP service informs the Exchange or Certified Representative of such;
(B) The applicant completes the visual
verification process as set forth in (c)(2)(A) of this section; or
(C) The applicant submits a paper application in
accordance with subdivision (b) of this section.
(d) An applicant who successfully completes the
identity verification requirements set forth in this section may, if otherwise
permitted, apply for health insurance for himself or herself and for members of his
or her household, without those household members also satisfying the requirements
set forth in this section.
(e) Consumers
who submitted an application prior to the effective date of this section are subject
to the requirements of this section if they make a change to the Primary Contact
screen.
(f) This section shall not apply
to individuals applying through CCSB (as defined in section
6410).
1. New section
filed 9-17-2014 as an emergency pursuant to Government Code section
100504(a)(6),
as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-17-2014 (Register
2014, No. 38). A Certificate of Compliance must be transmitted to OAL by 9-19-2016
or emergency language will be repealed by operation of law on the following
day.
2. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code
section
100504(a)(6)
to change the date upon which a Certificate of Compliance must be transmitted to
OAL. Pursuant to Government Code section
100504(a)(6),
as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance
must be transmitted to OAL by 9-19-2017 or the language in the emergency order of
9-17-2014 will be repealed by operation of law on the following day (Register 2015,
No. 38).
3. Refiling of 9-17-2016 order, including further amendment of
subsections (c)(2)(A)1.(i)-(ii), (c)(3)(A) and (f), on 11-28-2016 as a deemed
emergency pursuant to Government Code section
100504(a)(6),
as modified by Senate Bill 833 (Stats. 2016, c. 30); operative 11-28-2016 (Register
2016, No. 49). A Certificate of Compliance must be transmitted to OAL by 9-18-2019
pursuant to Government Code section
100504 or
emergency language will be repealed by operation of law on the following
day.
Note: Authority cited: Section
100504(a)(6),
Government Code. Reference: Sections
100503(a),
100503(h)
and
100503(s),
Government Code.
