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EXEMPTIONS CATEGORIES AND DOCUMENTATION

REFERENCE MATERIAL






EXEMPTIONS CATEGORIES AND DOCUMENTATION
Use this reference document when a consumer requests more information about individual exemptions, the exemption application process, or how to submit supporting documentation with an exemption application. If a consumer gets an exemption, he or she does not need to maintain minimum essential coverage or pay a fee for not having coverage. To apply for an exemption, consumers must either submit an application and supporting documentation to the Marketplace or claim the exemption on their federal tax return. The application process is different based on the category of exemption.
If the consumer is applying for an exemption because they are unable to afford coverage, you must direct them to the appropriate application based on where they live. Consumers in California, Colorado, the District of Columbia, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont, or Washington will use “Application for Exemption from the Shared Responsibility Payment for Individuals who are Unable to Afford Coverage and are in Certain States with a State Based Marketplace.”
Consumers in all other states will use the “Application for Exemption from the Shared Responsibility Payment for Individuals who are Unable to Afford Coverage and are in a State with a Federally Facilitated Marketplace.”
For more information and the exemption applications, please visit HealthCare.gov/exemptions.





Exemption Category

Eligibility

How to Apply

Supporting Documentation



Consumers Who are Unable to Afford Coverage in States with their own Marketplace

If the lowest-priced coverage available to you costs more than 8% of your household income.
If the applicant isn’t offered health coverage through a job, including a spouse or parent’s job, they must submit additional documentation available through their state’s Marketplace. Direct consumers to call their state Marketplace for more information.

• Claim the exemption on your federal tax return, or

• Submit a paper application to the Marketplace



• Employer and income information for everyone in your tax household, like W-

2 forms


Social Security numbers, if you have them

• Information about any job- related health insurance available to your family

• Documentation proving your yearly income for

2014, like pay stubs



Consumers Who are Unable to Afford Coverage in States using the Federally Facilitated Marketplace

If the lowest-priced coverage available to you costs more than 8% of your household income.



• Claim the exemption on your federal tax return, or

• Submit a paper application to the Marketplace



• Employer and income information for everyone in your tax household, like W-

2 forms


• Social Security numbers, if you have them

• Information about any job- related health insurance available to your family

• Documentation proving your yearly income for

2014, like pay stubs




Exemption Category

Eligibility

How to Apply

Supporting Documentation


Member of a Health Care

Sharing Ministry Exemption

If you are a member of a recognized health care sharing ministry. A health care sharing ministry is a not-for-profit organization whose members share a common set of ethical or religious beliefs and who share medical expenses.

• Claim the exemption on your federal tax return, or

• Submit a paper application to the Marketplace


• Information about people in your tax household

• Social Security numbers, if you have them

• The name and address of your health care sharing ministry




Member of Federally Recognized Indian Tribe Exemption

If you are an American Indian, Alaska Native, or Alaska Native Claims Settlement Act (ANCSA) Corporation Shareholder (regional or village). a shareholder in an Alaska Native Corporation.
Use the Members of Indian Tribes

Exemption script for more information

• Claim the exemption on your federal tax return, or

• Submit a paper application to the Marketplace



• Information about people in your tax household

• Social Security numbers, if you have them

• Documents showing tribal membership, such as a Tribal enrollment card/letter or proof of shareholder status in an ANCSA regional or village corporation.



Individual who is Eligible to Receive Services from an Indian Health Care Provider Exemption

If you are eligible to receive services through an Indian Health Service provider.


Use the Members of Indian Tribes

Exemption script for more information

• Submit a paper application to the Marketplace



• Information about people in your tax household

• Social Security numbers, if you have them

• Documents showing eligibility for services from the Indian Health Service, a tribal health care provider, or an urban Indian health care provider.
Certificate of Indian Blood (CIB) card issued by the Bureau of Indian Affairs (BIA)




Exemption Category

Eligibility

How to Apply

Supporting Documentation



Incarceration Exemption

If you are incarcerated and not awaiting the disposition of charges.


Use the Marketplace Eligibility for Incarcerated Individuals script for more information

• Claim the exemption on your federal tax return, or

• Submit a paper application to the Marketplace


• Information about people in your tax household

• Social Security numbers, if you have them

• Documents showing the name and address of the facility where you were incarcerated and the time periods of your incarceration



Religious Conscience Exemption

If you are a member of a recognized religious sect that is opposed to accepting insurance benefits.



Submit a paper application to the Marketplace

• Information about people in your tax household

• Social Security numbers, if you have them

• The name and address of your religious sect

• A copy of an approved IRS Form 4029, if you have one





Exemption Category

Eligibility

How to Apply

Supporting Documentation


Hardship Exemption

There are several circumstances that could allow you to be eligible for this exemption. These include

homelessness, eviction, bankruptcy, domestic violence, the death of a close family member, or another circumstance that negatively impacts you.


Use the Hardship Exemption script and the Hardship Exemption Reference Material for more information

Submit a paper application to the Marketplace


• Information about people in your tax household

• Social Security numbers, if you have them

• Depending on the circumstance you may also need to submit copies of supporting documents




Taxpayers with Income below the Filing Threshold Exemption

If you do not make enough money required to file a tax return -- $10,000 for individuals and $20,000 for married

couples.

Claim this exemption on your federal tax return


None



Coverage Gap Exemption

If you are uninsured for less than 3

months of the year.



Claim this exemption on

your federal tax return


None



Individuals Not Lawfully Present

Exemption

If you are not a U.S. citizen, a national,

or an alien lawfully present in the

United States.

Claim this exemption on your federal tax return


None





INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and

confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.



Unauthorized disclosure may result in prosecution to the full extent of the law.


2/27/2014 v2.0








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