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Draft Individual Exchange Application and Employer Coverage Form

Thursday, April 4, 2013

The Affordable Care Act (ACA) calls for the creation of state-based competitive marketplaces, known as Affordable Health Insurance Exchanges (Exchanges), for individuals and small businesses to purchase private health insurance. ACA requires the Exchanges to become operational in 2014. According to the Department of Health and Human Services (HHS), the Exchanges will allow for direct comparisons of private health insurance options based on price, quality and other factors, and will coordinate eligibility for premium tax credits and other affordability programs.On Jan. 25, 2013, HHS released draft versions of applications that will be used by individuals seeking to enroll in health insurance coverage through an Exchange in 2014. HHS has also included an Employer Coverage Form that Exchanges will use to verify employer-sponsored coverage.These applications are in draft form, and are not final. HHS has solicited comments, critiques and suggestions for a second draft. Enrollment in the Exchanges for eligible individuals and small businesses is expected to begin on Oct. 1, 2013.

Draft Individual Exchange Application

HHS released draft versions of both online and paper applications that individuals will fill out to buy policies in the Exchanges. These applications will collect demographic and financial information about the applicant, which will be used to determine whether he or she:

  • Is eligible to purchase a qualified health plan (QHP) through the Exchange; and
  • Qualifies for any affordability programs, such as advance payment of premium tax credits, cost-sharing reductions and Medicaid.

Individuals will be able to submit applications online, through the mail, over the phone or in person. HHS has stated that they are designing a single online “smart” application that will tailor the amount of data required from an individual based on circumstances and responses.

Paper Application

HHS released two separate paper applications—one for those applying for affordability programs (Appendix C) and one for those who are not (Appendix D).The application for those applying for the affordability programs is 21 pages long, and HHS estimates that it will take 45 minutes to complete. The application for those who are not applying for any affordability programs is eight pages long, and HHS estimates that it will take 20 minutes to complete.

Online Application

HHS also released drafts of a list of all potential questions that can be asked in an online application (Appendix A). Two videos explaining the online application were also released, and are located on the HHS Centers for Medicare & Medicaid Services YouTube Channel.The two videos depict the health insurance application process for an individual and for a family of three. A description of the videos and a URL link are included in Appendix B.

Draft Employer Coverage Form

The Appendix C paper application also contains an Employer Coverage Form to assist employees in gathering information about health coverage offered by an employer. HHS anticipates that individuals who are applying for tax credits will ask their employers to complete this one-page form to help the Exchange verify whether the individual is:

  • Enrolled in employer-sponsored coverage; or
  • Eligible for employer-sponsored coverage that meets the affordability and minimum value standards.

This is important for employers because ACA’s shared responsibility penalty for large employers is triggered when a full-time employee receives a premium tax credit for coverage under an Exchange.Employers may want to familiarize themselves with the information requested on the Employer Coverage Form. Additionally, employers may want to download the final template from an Exchange website and pre-populate it with information about their health coverage.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.

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