On July 15, 2013, the Department of Health and Human Services (HHS) issued final rules setting forth how exchanges will verify eligibility for advance payment of premium tax credits. Exchange applicants are disqualified from receiving premium tax credits if they are enrolled in or eligible for affordable employer-provided group health coverage that provides minimum value. Because some applicants will also be eligible for advance payment of premium tax credits, exchanges will be required to verify, at the time of application, whether an applicant is enrolled in or eligible for employer coverage.
In general, the exchanges will verify an applicant's status by reviewing the applicant's attestation and verifying the applicant-provided eligibility information using available data from approved electronic sources or the Small Business Health Operations Program operating in the same state as the exchange.
If data is not available from approved sources, the exchange will generally be required to verify the submitted information by conducting a manual verification for a "statistically significant" random sample of applicants (manual verification). During manual verification, employers may be required to provide information to the exchange. Employers will have 90 days to respond to an information request. There is currently no penalty for an employer who fails to respond. However, should an employer fail to respond, the information in the applicant's attestation will be presumed to be correct.