U.S. Relaxes Individual Income Verification Duties of HealthCare Exchanges

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On Friday, the final regulations regarding the running of insurance marketplaces in states under the new HealthCare law were handed out to the 16 states and the District of Columbia who are setting up their own exchanges. The final regulations issued by the Department of Health and Human Services show changes relaxing a number of requirements at present.

While the White House has said the health insurance marketplaces are on target and would open from October 1, the current relaxation of income verification of applicants by state exchanges indicates technical and other problems still existing in full implementation of the HealthCare mandates.

  

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From October 1, in order to receive tax subsidies for buying insurance, applicants must prove income ranging between one hundred percent and four hundred percent of the federal poverty line. They must also show that they do not have access to alternate affordable insurance through an employer.

Before Friday, the stance of the administration was that health insurance exchanges should verify facts about new applicants, and verification of the income status of each applicant. Random checks were proposed to ascertain whether new applicants are receiving employer-sponsored insurance benefits.

However, Friday’s regulations mention that health insurance exchanges have until 2015 to start their random checks on employer-insurance status of employees. At the same time, checks of individual income eligibility have been made random and not compulsory in each case, at least for 2014.

In lieu of compulsory checks the state-run exchanges would be able to accept an “attestation regarding enrollment in an eligible employer-sponsored plan” to determine employer-insurance status. The 34 marketplaces to be operated by the federal government would rely on random checks in 2014.

The new regulations also made clear, “For income verification, for the first year of operations, we are providing (state and federal) exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification.”