Reform Alert - News from the Blues' Office of National Health Reform

Marketplace eligibility provisions amended in new proposed rule

July 1, 2013

The Program Integrity: Marketplace, SHOP, Premium Stabilization Programs and Market Standards proposed rule released on June 14 amends two provisions regarding Individual Marketplace eligibility.

  • Incomplete Applications. The proposed rule recognizes there will be applicants who submit incomplete applications. The Marketplace will notify the applicant of missing information needed to make an eligibility determination. The Marketplace will determine a time period, at least 15 days but no more than 90 days, for applicants to provide that missing information.
  • Verification of Minimum Essential Coverage. The proposed rule makes largely technical corrections, and also adds a new paragraph enabling HHS to provide a response to the Marketplace in order to verify information about eligibility and verify enrollment in minimum essential coverage public programs other than Medicaid, Children’s Medicaid (CHIP) and the Basic Health Programs — such as the Veterans Health Administration, TRICARE and Medicare.

Where can I find more information?
More information can be found in the proposed rule (PDF).


The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.