220 R.I. Code R. 220-RICR-90-00-1.11

Current through December 26, 2024

Section 220-RICR-90-00-1.11 - Minimum Essential Coverage Exemptions

A. In General - §5000A of the Internal Revenue Code of 1986, 26 U.S.C. § 5000A, as added by the ACA, and R.I. Gen. Laws § 44-30-101 require that for each month during the taxable year, a non-exempt individual must have minimum essential coverage, as defined under the law, or pay a Federal individual responsibility penalty or State shared responsibility payment penalty, respectively.

1. The Exchange is authorized to issue exemptions from the individual responsibility penalty and the shared responsibility payment penalty.

2. With regard to exemptions from the individual responsibility penalty, the Exchange may rely on HHS for this purpose.

3. The Exchange must determine an individual's eligibility for an exemption from the shared responsibility payment penalty in accordance with the applicable standards specified in 45 C.F.R. § 155.605, incorporated above at §§ 1.3 and 1.11(B)(5) of this Part.

4. The Exchange will develop an application that applicants will be required to complete to apply for an exemption from the shared responsibility payment penalty. The application will request the minimum information necessary for the purposes of determining the applicant's eligibility for an exemption.

5. Applicants requesting an exemption from the shared responsibility payment penalty must submit the application developed by the Exchange under § 1.11(A)(4) of this Part in a manner specified by the Exchange.

6. The Exchange contact center and web site shall provide information to consumers regarding the exemption eligibility process.

B. Exchange Exemption Eligibility Determination - Any application for an exemption from either the individual responsibility penalty or shared responsibility payment penalty submitted to the Exchange will be determined by the Exchange promptly and without undue delay.

1. To the extent applicable, the Exchange will use information already available to it, so as not to request duplicate information from the applicant, except that the Exchange may require an applicant to submit a separate exemption application if the individual is requesting an exemption from the shared responsibility payment penalty. Such separate exemption application may request duplicate information from the applicant.

2. An exemption applicant who has a Social Security Number must provide such number.

3. An individual who is not seeking an exemption for himself or herself need not provide a Social Security Number, except as required by 45 C.F.R. § 155.610(e)(3), incorporated above at § 1.3 of this Part.

4. Once the applicant's eligibility for an exemption is approved pursuant to applicable exemption eligibility standards as defined in § 1.11(B)(5) of this Part and 45 C.F.R. § 155.605, incorporated above at § 1.3 of this Part, the Exchange will send the applicant a notice that will serve as the certificate of exemption. The notice will instruct the applicant to retain the certificate as proof of exemption. If the exemption is denied, the Exchange will send the applicant a notice containing instructions on how to appeal the denial.

5. In addition to the applicable eligibility standards defined in 45 C.F.R. § 155.605, incorporated above at § 1.3 of this Part, an individual may also be eligible for an exemption from the shared responsibility payment if he or she is a member of a religious sect or division thereof which is not described in 26 U.S.C. § 5000A, who relies solely on a religious method of healing, and for whom the acceptance of medical health services would be inconsistent with the religious beliefs of the individual.

a. Medical health services defined: For purposes of § 1.11(B)(5) of this Part, the term "medical health services" does not include routine dental, vision and hearing services, midwifery services, vaccinations, necessary medical services provided to children, or services required by law or by a third (3^rd) party.

b. Attestation required: § 1.11(B)(5) of this Part shall apply to an individual for months in a taxable year only if the information provided by the individual under § 1.11(A)(5) of this Part includes an attestation that the individual has not received medical health services during the preceding taxable year.

6. An individual may claim the hardship exemption described in § 1.11(B)(6)(a) of this Part on a State of Rhode Island personal income tax return without obtaining an exemption certificate number from the Exchange.

a. An individual is eligible to claim an exemption from the shared responsibility payment penalty if, due to the direct impact of the 2019 Novel Coronavirus, the individual:

(1) Lost minimum essential coverage during the 2020 calendar year; and

(2) Suffered a hardship with respect to the capability to obtain coverage under a Qualified Health Plan during subsequent months in the 2020 calendar year.

b. The exemption described in § 1.11(B)(6)(a) of this Part applies to the months of April 2020 through December 2020 only; thus, individuals will only be able to claim the exemption on a State of Rhode Island personal income tax return for the 2020 tax year.

7. If the Exchange determines the applicant eligible for an exemption from the individual responsibility penalty, the Exchange will transmit to the Internal Revenue Service, the individual's name, Social Security Number, exemption certificate number, and any other information required by the Internal Revenue Service.

8. If the Exchange determines the applicant eligible for an exemption from the shared responsibility payment penalty, the Exchange may transmit to the Rhode Island Division of Taxation the individual's name, Social Security Number, exemption certificate number, and any other information required by the Rhode Island Division of Taxation.

9. The Exchange will attempt to verify information provided by the applicant in compliance with the requirements of 45 C.F.R. § 155.615, incorporated above at § 1.3 of this Part.

10. In accordance with R.I. Gen. Laws § 44-30-101(h), for purposes of determining eligibility for an exemption from the shared responsibility payment penalty, references to Federal laws and regulations shall be construed as references to Federal laws and regulations as in effect on December 15, 2017, including applicable administrative guidance that was in effect as of that date.

11. Appeals - An individual has the right to an appeal of an eligibility determination based on this section pursuant to the appeals process described in these Regulations and 210-RICR- 10-05-2, Appeals Process and Procedures for EOHHS Agencies and Programs, if applicable.

220 R.I. Code R. 220-RICR-90-00-1.11

Amended effective 12/22/2019
Amended effective 12/31/2020
Amended effective 4/2/2023