General Rules

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.
  • ACCEPTABLE ID IS LIMITED TO: State Driver’s License, State ID, United States Passport, Voter ID (with photo ONLY), State Department of Corrections ID (with photo ONLY), State-Issued Weapons Permit (with photo ONLY), U.S. military ID, U.S Veterans Administration ID, Native American Tribal ID

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 Food Stamps/SNAP Card and Medicaid Card. 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.

Addresses

• Photo ID with address and name
• Current insurance policies and current mortgages/leases with the applicant's name
• Utility bills with the applicant's name
• Benefits award letters with the applicant's name
• Medicaid card with address and name

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
• Photo ID is missing

Subsidy Proof

• Medicaid – entered wrong number/s (must match all numbers)
• Food stamps/Snap Card - 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.

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.

Standard Eligibility Programs

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

• Temporary Assistance to needy Families (TANF)
• Supplemental Security Income (SSI)
• Food Stamps - all numbers must be entered correctly
• Medicaid (not Medicare) - all numbers must be entered correctly
• National Free School Lunch Program
• Federal Public Housing Assistance (FPHA)
• Low-Income Home Energy Assistance Program (LIHEAP)

Income Guidelines

When processing orders for individuals who are income-eligible (135% of Federal Poverty Level), 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

Household Size	Income Level
1	$15,080
2	$20,426
3	$25,772
4	$31,118
5	$36,464
6	$41,810
7	$47,156
8	$52,502
For each additional person add $5,346

Common Situations

Social Security Income

If the proof clearly indicates that the recipient is receiving SSI, and the name on the letter, photo ID, and account all match, the proof is acceptable. File:SSI - acceptable.tif

A letter from the Social Security Administration is not acceptable if it does not indicate that the letter's recipient is receiving SSI. File:SSI - unacceptable.tif

Medicare

Medicare is not an acceptable proof. Medicaid is an income-based subsidy; Medicare is not based on income or other financial need. File:Medicare.tif