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INDIVIDUALSHAREDRESPONSIBILITYEXEMPTIONSFrequentlyAskedQuestions

Q.Whatisanexemption?A. The Affordable Care Act (ACA) requires individuals to have health insurance coverage that qualifies as“minimum essential coverage” or pay a fee (also called the “individual shared responsibilitypayment”).However,underafewspecialcircumstances,anindividualmaynothavetopaythefeeeventhoughheorshedidnothavehealthinsurancecoverageforpartoralloftheyear.Thisisreferredtoasanexemptionfromtheindividualsharedresponsibility.Q.Whattypesofhealthcoveragequalifyas“MinimumEssentialCoverage”?A.Youdonotneedtoapplyforanexemptionifyouhavehealthcoveragethatqualifiesas“minimumessentialcoverage”.Ifyouarecoveredbyanyofthefollowingtypesofhealthcoverage,youhave“minimumessentialcoverage”:

• AnyHSRIplan;• MedicaidorCHIP(RIteCare);• Medicare;• Anyemployerplan(includingCOBRA),withorwithout“grandfathered”

status.Thisincludesretireeplans.Youremployerhasinformationonwhetherthehealthcoverageofferedisminimumessentialcoverage;

• TRICARE(forcurrentservicemembersandmilitaryretirees,theirfamilies,andsurvivors);

• Veteranshealthcareprograms;• PeaceCorpsVolunteerPlans;• Self-fundedhealthcoverageofferedtostudentsbyuniversitiesforplanorpolicyyearsthatbeginonorbeforeDec.31,2014;

• Otherplansmayalsoqualify.Askyourhealthcoverageproviderformoreinformation.

Q.WhatkindsofexemptionsareavailableandwheredoIapply?A. Depending on the reason you’re requesting an exemption, you can apply for an exemption throughHealthSourceRIoronyourfederaltaxreturn.Youcanlearnmoreaboutthisinthetablebelow.WestronglyencourageyoutoapplyforanexemptionwiththeIRSwhenfilingyourfederaltaxreturn,ifpossible.

If your incomewill be lowenough that youwon’t be required to file taxes, youdon’t need to apply for anexemption.Thisistrueevenifyoufileareturninordertogetarefundofmoneywithheldfromyourpaycheck.If your income isbelow the threshold for tax filing, youwon’thave topay the fee fornothavingqualifyingcoverageduringtheyear.

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Exemptionsaretypicallygoodforonecalendaryearunlessotherwisenotedbelow.

Q.HowdoIapplyforanexemptionthroughHealthSourceRI?A.Again,youareencouragedtoapplyforanexemptionthroughtheIRSwhenyoufileyourfederalincometaxes,ifpossible.Toapplyforanexemptionbasedonhardship,membershipinarecognizedreligioussectthatobjectsto insurance, membership in a federally-recognized tribe, coverage being unaffordable, incarceration, ormembershipinahealthcaresharingministry,andyoudonothavetheoptionofsubmittinganapplicationtotheIRSwhenyoufileyourfederal incometaxes,youmaycompleteandsubmittheexemptionapplicationforminyouraccount.YoucanobtainanapplicationformbyloggingintoyouraccountatHealthSourceRI.com,clickingon“Tasks”,thenclickingon“ApplyforanExemption”.

1ThefinalrulepreambleindicatesthatHHSwillcontinuetoconsiderthefeasibilityofExchangesgrantingthisexemptionafterthefirstyearofoperations.

Exemption ApplicationTimingHealthSourceRIOnly(IndividualsmustapplyforanexemptionthroughHealthSourceRI)Religiousconscience Individualmayapplyatanytime.Individualswhoexperienceahardship Individualmayapplybefore,

duringorafterthehardship,dependingonthecircumstances

Individualswholackaffordablecoveragebasedonprojectedincome

Individualmustapplyfortheexemptionbythelastdayonwhichyoucouldsignupfortheavailablecoverage

AmeriCorpscoverage IndividualmayapplyatanytimeHealthSourceRIorIRS(IndividualscanapplythroughHealthSourceRIORclaimanexemptionwhentheyfileafederalincometaxreturn)MembersofIndianTribesoreligibleforservicesthroughanIndianhealthcareprovider

Individualmayapplyatanytime

Membersofhealthcaresharingministries Individualmayonlyapplyretrospectively(i.e.,aftertheendofacalendaryearorafteryouhavelefttheministry)

Incarceratedindividuals Individualmayonlyapplyretrospectively(i.e.,afteryounolongerareincarceratedoraftertheendofacalendaryear)

OnlythroughtheIRSonFederalIncomeTaxReturnIndividualswholackaffordablecoverage Individualmayapplyonlywhen

youfileyourtaxesIndividualsnotrequiredtofiletaxesbutwhofiledanywaysandhaveincomeabovethefilingthreshold

Individualmayapplyonlywhenyoufileyourtaxes

Individualswholackaffordablecoveragewhenthecostofself-onlyplansarecombined1

Individualmayapplyonlywhenyoufileyourtaxes

Individualswithshortcoveragegaps Individualmayapplyonlywhenyoufileyourtaxes

Individualswithhouseholdincomebelowtheapplicabletaxfilingthreshold

Noapplicationisnecessary-Individualswhodonotfiletaxesareautomaticallygrantedanexemption

Citizenslivingabroadandcertainnoncitizens Individualmayapplyonlywhenyoufileyourtaxes

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Q.WherecanIfindmoreinformationonhowtoapplyforanexemptiononmytaxreturn?A. You can find more information about how to apply for an exemption on your tax return, herehttp://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Exemptions.Q.WhatmaterialsdoIneedtoapplyforanexemption?A.Youwillneedtoincludedocumentsthatsupportyourclaim,regardlessofwhetheryouareapplyingforanexemptionthroughHealthSourceRIorifyouareapplyingthroughtheIRSwhenyoufileyourtaxes.Ifyouareapplyingforahardshipexemption,youmustprovidethedocument(s)thatarefromthesametimeperiodasthehardshipyouexperienced.IfyouareapplyingforanexemptionthroughtheIRSandyoucan’tobtainthedocumentsyouneedtosupportyourapplication,calltheHealthInsuranceMarketplaceCallCenterat1-800-318-2596.IfapplyingforanexemptionthroughHealthSourceRIandyoucan’tobtainappropriatedocuments,callHealthSourceRIat1-855-840-4774.

ExemptionReason DocumentationRequired

Youareamemberofarecognizedreligioussectwithreligiousobjectionstoinsurance,includingSocialSecurityandMedicare

Thenameandaddressofthereligioussect.Ifavailable,acopyofanapprovedIRSForm4029(“ApplicationforExemptionfromSocialSecurityandMedicareTaxesandWaiverofBenefits”).

Youareamemberofarecognizedhealthcaresharingministry

Thenameandaddressofthehealthcare-sharingministry.

Youwereincarcerated

Documentsshowingthenameandaddressofthefacilitywhereyouwereincarcerated,andthetimeperiodsofincarceration.

YouareamemberofafederallyrecognizedtribeoreligibleforservicesthroughanIndianHealthServicesprovider

DocumentsshowingtribalmembershiporeligibilityforservicesfromtheIndianHealthService,atribalhealthcareprovider,oranurbanIndianhealthcareprovider.

You’veexperiencedahardshipthatpreventedyoufrompurchasinghealthinsurance Seehardshipreasonsintablebelow.

Thelowest-pricedhealthcoverageavailabletoyouin2016ismorethan8.13%ofhouseholdincome

ApplicationIDfromHealthSourceRIorinformationaboutanyjob-relatedhealthinsuranceavailabletofamily.Proofofyearlyincomefor2016.Lowestpriceplanavailable.

Thereareparticulardocumentationrequirementsforhardshipexemptions:

HardshipReason DocumentationRequiredYouwerehomeless. None.Youwereevictedinthepast6monthsorwere facingevictionorforeclosure.

Copyofevictionorforeclosurenotice.

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Youreceivedashut-offnoticefromautilitycompany.

Copyofshut-offnoticefromautilitycompanyorproofofmorethan6monthsbehindonpaymentsifutilitycan'tshutoff(forreasonsofmedicalnecessityorhardship).

Yourecentlyexperienceddomesticviolence. None

Yourecentlyexperiencedthedeathofaclose familymember.

Copyofdeathcertificate,copyofdeathnoticefromnewspaper,orcopyofofficialnoticeofdeath.

Youexperiencedafire,flood,orothernaturalorhuman-causeddisasterthatcausedsubstantialdamagetoyourproperty.

Copyofpoliceorfirereport,insuranceclaim,orotherdocumentfromgovernmentagency,privateentity,ornewssourcedocumentingevent.

Youfiledforbankruptcyinthelast6months. Copyofbankruptcyfiling.

Youhadunreimbursedmedicalexpensesinthelast24monthsthatresultedinsubstantialdebt.

Copiesofmedicalbills.

Youexperiencedunexpectedincreasesinnecessaryexpensesduetocaringforanill,disabled,oragingfamilymember.

Copiesofreceiptsrelatedtocare.

Youexpecttoclaimasataxdependentachildwho’sbeendeniedcoverageinMedicaidandtheChildren’sHealthInsuranceProgram(CHIP),andanotherpersonisrequiredbycourtordertogivemedicalsupporttothechild.

CopyofmedicalsupportorderANDcopiesofeligibilitynoticesforMedicaidandCHIPshowingthatthechildhasbeendeniedcoverage.Exemptionisonlyforthemonthsthemedicalsupportorderisineffect.

Asaresultofaneligibilityappealsdecision,you’reeligibleeitherfor:1)enrollmentinaqualifiedhealthplan(QHP)throughHealthSourceRI,2)lowercostsonyourmonthlypremiums,or3)cost-sharingreductionsforatimeperiodwhenyouweren’tenrolledinaQHPthroughHealthSourceRI.

Copyofnoticeofappealsdecision.

Youreceivedanoticesayingthatyourcurrenthealthinsuranceplanisbeingcanceled,andyouconsidertheotheravailableplansunaffordable.

Copyofnoticeofcancellation.

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Q.HowdoIdeterminewhetherinsuranceis“unaffordable”forme?A.Insuranceisunaffordableifboththecoverageofferedthroughyouremployer,andthelowestcostbronzeplanofferedthroughHealthSourceRI,wouldcostmorethanacertainpercentage(E.g.8.13%for2016)ofyourincome. Otherwise, health insurance is considered affordable to you and you do not qualify for thisexemption.

Example:Yourhouseholdincomein2016was$15,000.00.Thecostofyouremployer-sponsoredcoveragewas$1,500.00.ThelowestcostBronzeplanavailabletoyouwas$1,300.00.Becausebothoptionsexceed8.13%ofyourhouseholdincome($1,220.00),youareeligibleforapenaltyexemption.

Ifyoubelieveyourhealthinsurancewasunaffordableforyou,youneedtoapplyforthisexemptioninyourtaxreturn.Pleasenotethatthe‘percentage’valuechangeseveryyear.Pleasevisithttps://www.healthcare.gov/health-coverage-exemptions/forms-how-to-apply/forupdatedfigures.

Donottoconfusethe8.13%ExemptionTestwiththe9.5%thresholdforTaxCreditEligibility.TobeeligibleforAdvancedPremiumTaxCredits(APTCs),anindividualmustnothavetheoptionofenrolling inaffordableemployer sponsored health insurance. Employer health insurance coverage is unaffordable if the cost foremployee-onlycoverageis9.5%of“householdincome”orgreater.Underthistest,individualsmayqualifyforataxcredittopurchaseaplanthroughHealthSourceRIiftheirhouseholdincomeisbetween100-400%oftheFederal Poverty Level (FPL),the individual isnoteligible for government-offered healthcare (e.g.,Medicare,Medicaid,orRIteCare),andemployer-sponsoredcoverageisunaffordabletothem.Q.HowlongdoesittakeHealthSourceRItoprocessanexemptionapplication?A.ThetimeHealthSourceRIneedstoprocessanexemptionapplicationwillvarydependingonthecomplexityof the exemption requested, whether the application is missing any information, and whether additionalsupportingdocumentationisrequired.Ifadditionalinformationisneeded,theprocesscouldtakelonger.Onceagain,weencourageyoutoapplyforanexemptionthroughtheIRSwhenyoufileyourtaxes,ifpossible.IfyoumustapplythroughHealthSource,pleasesubmittherequireddocumentationwithyourapplication.Youwill receiveaneligibilitydeterminationnotice in themailwhen theapplicationhasbeenprocessed. If yourrequesthasbeenapproved,yournoticeswillincludeanexemptioncertificationnumber.Youshouldretainthisnumberforyourrecordsbecauseyouwillneeditwhenyoufileyourfederaltaxesfortheyear.Completedapplications caneitherbe submittedby logging into your account atHealthSourceRI.comorcanbemailedto:

HealthSourceRIAttn:ExemptionsProcessing

401WampanoagTrailEastProvidence,RI02915

Q.IfIamgrantedahardshipexemption,howlongwillitlast?A.Thedurationofanexemptiondiffersbasedonthetypeofexemptionrequested.Hardshipexemptionsmaybeclaimed for themonthsduringwhich thehardshipexisted (including themonthbefore thehardship, themonths of the hardship, and the month after the hardship), however, HealthSource RI may provide theexemption for additional months after the hardship, including up to a full calendar year, if the hardshipcontinuestoaffectthecustomer.

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Q.WhatifIthinktheresultsofmyapplicationarewrong?A.IfyouappliedforanexemptionwiththeIRSwhenyoufiledyourtaxesanddon’tagreewiththeresultsofyour application, you can appeal the decision by calling 1-800-318-2596. A request can also be made inwritingtotheHealthInsuranceMarketplace–ExemptionProcessingat455IndustrialBlvd.,London,KY40741.IfyouappliedforanexemptionthroughHealthSourceRIanddon’tagreewiththeresultsofyourapplication,youcanappealthedecisionbycallingHealthSourceRIat1-855-840-4774orvisitingHealthSourceRI.comandappealingthroughyouraccount.Requestinganappeal is time sensitive. Youmust request your appealwithin30daysof the receiptof yournotice. Please review your eligibility notice to find appeals instructions specific to each person in yourhousehold,includingthetimeframeinwhicheachpersoncanrequestanappeal. Q.WhathappensifI’mnotexempt?A.Ifyouarenotexempt,thepenaltyfornothavinginsuranceiseitherasetamountofmoneyorapercentageofyourincome—whicheverisgreater.Formoreinformationonthepenaltypleasevisit,http://www.irs.gov/Affordable-Care-Act/The-Individual-Shared-Responsibility-Payment-An-Overview