Difference between revisions of "General Rules"

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** NLAD STATES - ACCEPTABLE ID IS LIMITED TO: State Driver’s License, State ID, United States Passport, Voter ID (with photo ONLY), State-Issued Weapons Permit (with photo ONLY), U.S. military ID, U.S Veterans Administration ID, Native American Tribal ID, Permanent resident card
 
** NLAD STATES - ACCEPTABLE ID IS LIMITED TO: State Driver’s License, State ID, United States Passport, Voter ID (with photo ONLY), State-Issued Weapons Permit (with photo ONLY), U.S. military ID, U.S Veterans Administration ID, Native American Tribal ID, Permanent resident card
 
** CALIFORNIA - ACCEPTABLE ID IS LIMITED TO: U.S. Drivers License, Certificate of U.S. citizenship or naturalization, U.S. Passport/U.S. Territory Passport, Foreign Passport, U.S. Government, Military, State, or Tribal-issued ID which includes date-of-birth and/or Social Security number and/or Tribal ID, Common Access Card (only if designated as Active Military or Active Reserve or Active Selected Reserve), Military Discharge Documentation which includes date-of-birth and/or Social Security number and/or Tribal ID, Northern Mariana Card, Permanent Resident Card, Permanent Resident Alien Card, Permanent Resident Re-Entry Permit, Temporary Resident Identification Card, Employment Authorization Card, Mexican Consular Card (Matricula Consullar - 2006, 2014, 2015, and later versions)
 
** CALIFORNIA - ACCEPTABLE ID IS LIMITED TO: U.S. Drivers License, Certificate of U.S. citizenship or naturalization, U.S. Passport/U.S. Territory Passport, Foreign Passport, U.S. Government, Military, State, or Tribal-issued ID which includes date-of-birth and/or Social Security number and/or Tribal ID, Common Access Card (only if designated as Active Military or Active Reserve or Active Selected Reserve), Military Discharge Documentation which includes date-of-birth and/or Social Security number and/or Tribal ID, Northern Mariana Card, Permanent Resident Card, Permanent Resident Alien Card, Permanent Resident Re-Entry Permit, Temporary Resident Identification Card, Employment Authorization Card, Mexican Consular Card (Matricula Consullar - 2006, 2014, 2015, and later versions)
** CA - Must have a valid expiration date
+
** CA - Must have a valid expiration date listed (if on the reverse side of proof, photos of both sides must be submitted)
 
* PR - If ID proof has only one last name, subsidy proof with two last names can be uploaded with ID proof  
 
* PR - If ID proof has only one last name, subsidy proof with two last names can be uploaded with ID proof  
  

Revision as of 00:25, 9 May 2019

Anomalies should be left for review by compliance.

Reviewing Proofs

Accept

Photo Identification

  • Out of state identification if subsidy proof is in-state
  • Identification must be UNITED STATES government-issued (Federal or State) photo IDs.
    • NLAD STATES - ACCEPTABLE ID IS LIMITED TO: State Driver’s License, State ID, United States Passport, Voter ID (with photo ONLY), State-Issued Weapons Permit (with photo ONLY), U.S. military ID, U.S Veterans Administration ID, Native American Tribal ID, Permanent resident card
    • CALIFORNIA - ACCEPTABLE ID IS LIMITED TO: U.S. Drivers License, Certificate of U.S. citizenship or naturalization, U.S. Passport/U.S. Territory Passport, Foreign Passport, U.S. Government, Military, State, or Tribal-issued ID which includes date-of-birth and/or Social Security number and/or Tribal ID, Common Access Card (only if designated as Active Military or Active Reserve or Active Selected Reserve), Military Discharge Documentation which includes date-of-birth and/or Social Security number and/or Tribal ID, Northern Mariana Card, Permanent Resident Card, Permanent Resident Alien Card, Permanent Resident Re-Entry Permit, Temporary Resident Identification Card, Employment Authorization Card, Mexican Consular Card (Matricula Consullar - 2006, 2014, 2015, and later versions)
    • CA - Must have a valid expiration date listed (if on the reverse side of proof, photos of both sides must be submitted)
  • PR - If ID proof has only one last name, subsidy proof with two last names can be uploaded with ID proof

Subsidy Proof

  • Partial subsidy proof if necessary information to confirm name and/or subsidy account number is visible
  • A partial proof that has an expiration date but the expiration date cannot be viewed
  • A partial proof, except SNAP card, that all visible numbers match
  • All digits of a subsidy proof are required for Medicaid Cards. Only last 4 digits of account are required for any other subsidy proof.
  • Hard to read but complete document scanned; if the numbers you can read are correct.
  • The proof is addressed to the applicant and the applicant appears to be the parent/guardian of the minors covered under subsidy.
  • Has an issue date of less than one year ago

Addresses

  • unexpired driver's license
  • utility bill
  • current income statement from an employer, paycheck stub, or W-2
  • prior year's state, federal or Tribal tax return
  • current mortgage or lease statement
  • unexpired government, state, or Tribal issued ID
  • government assistance program documents
  • statement of benefits from a qualifying program which contains name and address of subscriber
  • retirement/pension statement of benefits
  • an unemployment/workers' compensation statement of benefits
  • local, state, or federal government documentation sources
  • CALIFORNIA ONLY - bank statements

Social Security Proofs

  • Social Security card or SSA-1099 (Social Security Benefit Statement)
  • W-2 from within the last 2 year
  • prior year's state, federal, or Tribal tax return
  • unexpired United States government, military, state, or Tribal issued ID, which includes Social Security Number
  • military discharge documentation which includes Social Security Number
  • unexpired weapons permit which includes Social Security Number
  • government assistance program document which includes Social Security Number
  • statement of benefits from a qualifying program which includes Social Security Number
  • unemployment/workers' compensation statement of benefits which includes Social Security Number
  • eligibility confirmation from state eligibility database or administrator which includes date of birth and/or last four digits of Social Security Number
  • PR ONLY - proof must include BOTH last names if the photo ID presented has both last names. If ID only has one last name, the SSN proof must have only one last name.

Proof of Life

To prove a consumer is living, they must first submit a copy of one of the following unexpired documents, which must include their date of birth and their SSN or Tribal ID number:

  • Government, military, state, or Tribal-issued ID
  • Military discharge documentation
  • Weapons permit
  • Government assistance program document
  • Statement of benefits from a qualifying program document
  • Unemployment or Workers’ compensation statement of benefits
  • Eligibility confirmation from state eligibility database with administrator
  • Consumers also have the option to submit two types of unexpired documentation. One document must include their date of birth and the other must have their SSN on it.
          The first document must be one of the following:
  • Driver’s license
  • Birth certificate
  • Certificate of Naturalization
  • Proof of citizenship
  • Permanent Resident or Permanent Resident Alien card
  • Passport
          The second document must be one of the following:
  • W-2 from within the last 2 years
  • Prior year’s state, federal, or Tribal tax return
  • Social security card
  • SSA-1099
          In addition to documentation with their first name, last name, date of birth, SSN (or Tribal ID), consumers must also submit documentation that proves recent life activity. 
          Consumers must submit one of the following documents to prove recent life activity:
  • Current program eligibility or government assistance documentation
  • Current utility bill (phone and internet bills cannot be used as utility bills. Consumers can use water, electricity, and waste and removal bills).
  • Current income statement such as a paystub
  • Current mortgage or lease statement
  • Current retirement/pension statement of benefits
  • Current unemployment/Workers’ compensation statement of benefits
  • A notarized letter affirming the subscriber’s identity and alive status


Reject

Identification

  • Identification does not have a photo
  • Is not UNITED STATES government-issued
  • Work, college, and bank account ID’s are not acceptable
  • Passports and IDs issued by a foreign country or a consulate of a foreign country (ACCEPTABLE IN CALIFORNIA)
  • Photo ID is missing
  • ID is expired

Subsidy Proof

  • Medicaid – entered wrong number/s (must match all numbers)
  • Selected wrong subsidy
  • Partial subsidy proof if necessary information to confirm name and/or subsidy account number is not visible
  • All three names on account, Photo ID and subsidy proof do not match
  • Subsidy proof is missing
  • Any proof with an expiration date that has expired
  • Has an issue date of more than one year ago

Reason Codes

Please make sure to select the proper reason code:

  • Name not match – use if name is misspelled or different from name on subsidy proof. If name on ID is different from customer name use the reason code Photo ID Not belongs to Customer.
  • Subsidy Proof Not Visible – use for partial subsidy proof that necessary information to confirm name and/or subsidy account number is not visible or if the subsidy proof is missing.
  • Subsidy Proof Not Acceptable – use if proof is not an acceptable eligibility program (e.g. Medicare)
  • Subsidy Proof Not Match Subsidy Selected – use if rep selected the wrong subsidy (e.g. Selected Medicaid and proof is a SNAP card)
  • Subsidy Ref Num Not Match – use if rep did not enter subsidy proof digits correctly
  • Subsidy Ref Num Already Used – use if the subsidy proof digits cannot be corrected due to already being in our system.
  • Eligibility Expired – use if the subsidy proof has a visible expired expiration date.
  • Photo ID Missing – use if the Photo ID is not included in scan.
  • Photo ID Not Visible – use if the customer name and/or picture is not visible.
  • Photo ID Not Acceptable – use if the ID does not contain a photo and/or name.
  • Photo ID Not Belongs to Customer – use if the customer name does not match the name on the ID. If the name is misspelled, use the reason code Name not Match.
  • Income on Proof Not Match Income Entered – use if income entered for order does not meet the eligibility requirements to use 135% below poverty.
  • Name Entry Error, ID Proof Verified By Reviewer - PUERTO RICO ONLY - When a name entry error is encountered, compare the entry to the ID proof to determine if the error is due to an input mistake. Such mistakes include misspellings, letter omissions, incorrect name order (first name entered as last name and vice versa), and incorrectly combined names (Delacruz for De La Cruz). Names that are totally different and do not resemble the name on the ID proof whatsoever are still unacceptable (Name Not Match).

Standard Eligibility Programs

The standard eligibility programs that may be used as proof of subsidy are listed below. Except for Medicaid, only the last four digits of the subsidy number are required.

  • Supplemental Security Income (SSI)
  • Food Stamps/SNAP
  • Medicaid (not Medicare) - all numbers must be entered correctly
  • Federal Public Housing Assistance (FPHA)
  • Veterans Pension or Survivors Pension benefit

Income Guidelines

When processing orders for individuals who are income-eligible (135% of Federal Poverty Level Guidelines), the subscriber must present documentation, such as a tax return, evidencing income from the previous full year’s time period. If the documentation relied on does not cover a full year, such as a current pay stub, the subscriber must present the same type of documentation covering three consecutive months within the previous twelve months.

Since most subscribers will not have the ability to present three months worth of pay stubs, it is imperative that field representatives inform subscribers of the other acceptable forms of documentation that cover a full year’s time period and may be more easily accessible and presentable. These forms of documentation include:

  • The prior year’s state, federal, or Tribal tax return
  • A Social Security statement of benefits
  • A Veterans Administration statement of benefits
  • A retirement/pension statement of benefits
  • An Unemployment/Workmen's Compensation statement of benefits
  • Federal or Tribal notice letter of participation in General Assistance
  • A divorce decree, child support award, or other official document containing income information for at least three months time

Income Levels - 135%

Household Size Income Level
1 $16,862
2 $22,829
3 $28,796
4 $34,763
5 $40,730
6 $46,697
7 $52,664
8 $58,631
For each additional person add $5,967


Common Situations

Social Security Benefits Income

If the proof clearly indicates that the recipient is receiving Social Security benefits income, and the name on the letter, photo ID, and account all match, the proof is acceptable. Please click on image for better resolution.

A letter from the Social Security Administration is not acceptable if it does not indicate that the letter's recipient is receiving Social Security benefits income. Please click on image for better resolution.


Medicare

Medicare is not an acceptable proof. Medicaid is an income-based subsidy; Medicare is not based on income or other financial need. Please click on image for better resolution.