Sec. 14.35.07.03. Applying for Coverage Through the Individual Exchange

A. Individuals may apply to enroll in a QHP or an insurance affordability program through the Individual Exchange using the single, streamlined application form approved by the Individual Exchange.

B. An individual may submit the application:

(1) By telephone;

(2) On the Individual Exchange’s internet website;

(3) Using in-person assistance, including with the provision of reasonable accommodations; or

(4) By mail.

C. An applicant shall provide the following information on the application:

(1) The applicant’s and applicable dependents’ Social Security numbers, provided that the applicant and applicable dependents have Social Security numbers;

(2) An authorization for the Exchange to verify attested information through electronic means;

(3) An election indicating whether the applicant is seeking an eligibility determination for enrollment in a QHP or insurance affordability program;

(4) If the applicant is applying for enrollment in a QHP, sufficient information to determine eligibility for enrollment in a QHP;

(5) If the applicant is applying for enrollment in an insurance affordability program, sufficient information to determine eligibility for enrollment in such insurance affordability program;

(6) If the applicant is applying for enrollment in an insurance affordability program as defined in Regulation .02B and the applicant files for an income tax return as a married couple, the applicant shall complete an attestation that the applicant intends to file a joint income tax return for the benefit year in which the individual is seeking coverage, except:

(a) If a spouse is the victim of domestic violence or spousal abandonment, the attestation may provide that the applicant intends to file a single income tax return for the benefit year in which the individual is seeking coverage; or

(b) If the individual in a married couple qualifies to file as head of household, the attestation may provide that the applicant intends to file a single income tax return as head of household for the benefit year in which the individual is seeking coverage; and

(7) The applicant’s signature, including either an electronic or telephonic signature, under penalties of perjury.

D. Non-applicant.

(1) A non-applicant who applies for insurance affordability programs on behalf of a member in the non-applicant’s tax filing household shall provide the following information on the application:

(a) The non-applicant’s name; and

(b) The non-applicant’s Social Security number, if the applicant attests that the tax filer:

(i) Has a Social Security number; and

(ii) Filed a tax return for the year for which tax data would be used to verify the applicant’s household income and family size.

(2) A non-applicant is required to provide the following information on the application if the only members of the individual’s household seeking coverage are younger than 18 years old and are not emancipated minors:

(a) The non-applicant’s name; and

(b) The non-applicant’s address.

(3) Non-applicants are not required to provide information about the non-applicant’s citizenship, status as a national, or immigration status.

E. An individual who applies for an insurance affordability program shall receive an eligibility determination for all of the insurance affordability programs.

F. An individual may submit an application to the Individual Exchange and receive an eligibility determination at any time during the year.

G. Incomplete Applications.

(1) If an individual submits an incomplete application, the Individual Exchange shall send the individual a notice under Regulation .04D of this chapter.

(2) The individual shall have 90 days to complete the application and receive an eligibility determination from the date the notice is sent to the individual under Regulation .04D of this chapter.

(3) If an individual does not complete and submit an application within the 90 days under §G(2) of this regulation, the Individual Exchange shall close the application and the individual shall begin a new application.

H. An individual shall complete and submit an application to enroll in coverage through the Exchange.