3.11.29 Health Coverage Tax Credit (HCTC) Enrollment Processing

Manual Transmittal

December 03, 2019

Purpose

(1) This transmits revised IRM 3.11.29, Health Coverage Tax Credit (HCTC) Enrollment Processing.

(2) This IRM is used by employees of Document Perfection’s HCTC Enrollment Team in Entity at the Austin Submission Processing Center. The Enrollment Team evaluates eligibility for the HCTC Advance Monthly Payment program, enters information from Form 13441-A into a database, and authorizes payment of the credit.

Material Changes

(1) 3.11.29.4(17) Added instructions for field restrictions. IPU 19U0833 issued 06-28-2019 IRM

(2) 3.11.29.7(4) and (6) Clarified that documents should be batched by date received in Entity unit, for consistency with aging criteria in IRM 3.11.29.4(14). IPU 19U0833 issued 06-28-2019 IRM

(3) 3.11.29.8(7) Added a missing link. (9) Added missing space. IPU 19U0833 issued 06-28-2019 IRM

(4) 3.11.29.9(2) Removed extra space. Changed statuses to Cancelled-Ineligible for consistency. (4) Corrected correspondence instructions when Part 4 information is not provided for all policies. (5) Added editing instructions for situations where the database record is created under an individual other than the eligible recipient. IPU 19U0833 issued 06-28-2019 IRM

(5) 3.11.29.9.1(5) Removed text "or lined through." . IPU 19U0833 issued 06-28-2019 IRM

(6) 3.11.29.9.2(4) Clarified when certification checkbox is required on an updated enrollment. IPU 19U0833 issued 06-28-2019 IRM

(7) 3.11.29.9.3(7) Removed text "or lined through" . (4) Added reminder not to edit the participant in Part 3. (5) & (6) Added instructions for processing family members with ATINs/ITINs. IPU 19U0833 issued 06-28-2019 IRM

(8) 3.11.29.9.4(6) Updated language for consistency. (7) Created list with special processing rules for fields. Added processing instructions for blank effective date. Moved Note on Member ID, Policy ID, Group ID to list. (12) Removed text "or lined through." IPU 19U0833 issued 06-28-2019 IRM

(9) 3.11.29.9.6 Consolidated instructions for missing signature correspondence. Added instructions for missing signature when no change requested. Editorial changes. IPU 19U0833 issued 06-28-2019 IRM

(10) 3.11.29.10(2) Removed status "Ineligible" and "Cancelled-Permanent Ineligibility" from use. IPU 19U0833 issued 06-28-2019 IRM

(11) 3.11.29.10(3) Created new paragraph defining database statuses not currently in use. IPU 19U0833 issued 06-28-2019 IRM

(12) 3.11.29.13 Added instruction to remove editing marks prior to returning document to participant. Clarified PIN is not required on new enrollments when corresponding for required missing signature. Typographical errors. IPU 19U0833 issued 06-28-2019 IRM

(13) 3.11.29.13.1 Added instructions for letter fields. IPU 19U0833 issued 06-28-2019 IRM

(14) 3.11.29.13.4(3) & (4) Clarified when Letter 4541 should be used instead of Letter 4540. (5) Updated status to "Cancelled-Ineligible" for consistency. IPU 19U0833 issued 06-28-2019 IRM

(15) 3.11.29.13.5(9) updated status to "Cancelled-Ineligible" for consistency. IPU 19U0833 issued 06-28-2019 IRM

(16) 3.11.29.15(8) Added editing instructions for consistency with IRM 3.11.29.9(5). IPU 19U0833 issued 06-28-2019 IRM

(17) 3.11.29.16 Reorganized and updated to clarify responsible areas. Consolidated Enrollment Team instructions for Form 14095. IPU 19U0833 issued 06-28-2019 IRM

(18) 3.11.29.16.1 Clarified that participants may be eligible for reimbursement after enrollment in certain circumstances. IPU 19U0833 issued 06-28-2019 IRM

(19) 3.11.29.16.2 Revised to indicate that substantially similar documentation may be acceptable support for Form 14095. Moved instructions for rejection and comments to IRM 3.11.29.16, as Enrollment Team actions. IPU 19U0833 issued 06-28-2019 IRM

(20) 3.11.29.17 Added text defining correspondence to be referred to P&A for determination. IPU 19U0833 issued 06-28-2019 IRM

(21) 3.11.29.1.4(2) clarified areas of responsibility for program reviews. IPU 19U0688 issued 05-24-2019 IRM

(22) 3.11.29.1.7(1) clarified that QFM and QFMP are separate acronyms. IPU 19U0688 issued 05-24-2019 IRM

(23) 3.11.29.4 removed form-specific information. Removed general editing guidelines due to specific instruction provided where applicable. Clarified what constitutes a change to the database. Added instructions for suspending to P&A. Reorganized and clarified instructions throughout. IPU 19U0688 issued 05-24-2019 IRM

(24) 3.11.29.8 clarified required supporting documentation. Provided specific instruction for when certification check-box is required. Clarified language throughout. IPU 19U0688 issued 05-24-2019 IRM

(25) 3.11.29.9 consolidated instructions for determining where the database record should be established. IPU 19U0688 issued 05-24-2019 IRM

(26) 3.11.29.9.1 reorganized page to group information for clarity. Changed Zip Code to a required field. Specified editing requirements. Clarified certain items which only apply on new enrollments. IPU 19U0688 issued 05-24-2019 IRM

(27) 3.11.29.9.1.1 added instruction to perfect eligibility type based on proof of eligibility provided. IPU 19U0688 issued 05-24-2019 IRM

(28) 3.11.29.9.2 added missing option to table in (3). Clarified differences between new enrollments and updates. Added caution regarding difference between QFM and QFMP. Minor organizational/clarity changes throughout. IPU 19U0688 issued 05-24-2019 IRM

(29) 3.11.29.9.3 moved table to 3.11.29.9. Clarified editing instructions. IPU 19U0688 issued 05-24-2019 IRM

(30) 3.11.29.9.4 replaced table in (2) with link to consolidated instructions. Added Cobra End date instructions previously in 3.11.29.4. Consolidated various instructions for perfecting Part 4 into an if/and/then table. Clarified editing instructions. Clarified HCTC Coordinator’s role in vendor verification. Reorganized page to follow processing order. IPU 19U0688 issued 05-24-2019 IRM

(31) 3.11.29.9.5 clarified instruction to remove any existing information when participant answers "No" to question "Do you want to allow another person to talk with the HCTC Program about your account?" IPU 19U0688 issued 05-24-2019 IRM

(32) 3.11.29.9.6 simplified language. IPU 19U0688 issued 05-24-2019 IRM

(33) 3.11.29.12 In paragraph 7, changed schedule for shipping to FRC from three years to five years. IPU 19U0688 issued 05-24-2019 IRM

(34) 3.11.29.13 Updated letter descriptions in table. Moved contents of note into letter description. Clarified that pre-filled letters are available on SharePoint. Moved signature rule into Exception for ease of view. Added instructions for undeliverable correspondence. Simplified language throughout. IPU 19U0688 issued 05-24-2019 IRM

(35) 3.11.29.13.1 added secondary use of 3772 letter and applicable instructions. IPU 19U0688 issued 05-24-2019 IRM

(36) 3.11.29.13.2 clarified that letter use is determined by P&A. IPU 19U0688 issued 05-24-2019 IRM

(37) 3.11.29.13.3 clarified that letter use is determined by P&A. IPU 19U0688 issued 05-24-2019 IRM

(38) 3.11.29.13.4(8) Clarified and organized correspondence reply/no reply instructions. IPU 19U0688 issued 05-24-2019 IRM

(39) 3.11.29.13.5(8) Clarified and organized correspondence reply/no reply instructions. IPU 19U0688 issued 05-24-2019 IRM

(40) 3.11.29.13.6(2) clarified that currently enrolled participants should not be moved to "Complete" status. IPU 19U0688 issued 05-24-2019 IRM

(41) 3.11.29.13.7 removed duplicated instruction not to send without management instructions. IPU 19U0688 issued 05-24-2019 IRM

(42) 3.11.29.13.8 clarified that letter use is determined by P&A. IPU 19U0688 issued 05-24-2019 IRM

(43) 3.11.29.13.10 clarified that letter use is determined by P&A. IPU 19U0688 issued 05-24-2019 IRM

(44) 3.11.29.14 Updated title to include relevant keywords. Clarified instructions for what should be processed as a 4442 inquiry, and how to process. Added instructions for processing substitute Forms 4442 issued by P&A. Added instructions for expedite requests. IPU 19U0688 issued 05-24-2019 IRM

(45) Added definition of QFMP in (1). Added guidelines for identifying QFMP enrollments. Clarified eligibility instructions throughout. Added instructions for entering a QFMP into the database. IRM 3.11.29.15 Updated title. .IPU 19U0688 issued 05-24-2019

(46) 3.11.29.18 Fixed formatting error. IPU 19U0688 issued 05-24-2019 IRM

(47) 3.11.29.25 In paragraph 1, changed schedule for shipping to FRC from three years to five years. IPU 19U0688 issued 05-24-2019 IRM

(48) 3.11.29.4 added paragraph 17 with instructions for corresponding on items with a future date. IPU 19U0688 issued 05-24-2019 IRM

(49) 3.11.29.10(2) added note with instructions for performing status changes. IPU 19U0688 issued 05-24-2019 IRM

(50) Reviewed and updated the IRM where necessary for the following types of editorial changes: legal citations, published forms, documents, and web addresses. Updating IRM references; correcting spelling or grammatical errors; updating information that changes annually; adding or correcting IRM references; formatting; and rearranging the flow of the IRM to mimic the processes.

Effect on Other Documents

IRM 3.11.29, dated December 11, 2018 (effective date January 1, 2019), is superseded. This IRM also incorporates the following IRM Procedural Updates (IPUs) - 19U0688 dated 05-24-2019 and 19U0833 dated 06-28-2019.

Audience

Employees in the Austin Submission Processing Center and Customer Service Representatives in Accounts Management.

Effective Date

(01-01-2020)


Linda J. Brown
Director, Submission Processing
Wage and Investment Division

Program Scope and Objectives

  1. Purpose: This IRM provides guidance on the Health Coverage Tax Credit (HCTC).The Enrollment Team evaluates eligibility for the monthly advance payment, enters information from Form 13441-A into a database, authorizes payment of the credit, and sets up approved HCTC vendors for ACH payments.

  2. Audience: The HCTC Enrollment Team, in Austin, is the primary user of this IRM.

  3. Policy Owner: The Director of Submission Processing

  4. Program Owner: Wage and Investment (W&I) Submission Processing

  5. Primary Stakeholders: The HCTC Enrollment Team in Austin

  6. Program Goals: The information contained in this IRM provides the HCTC Enrollment Team instructions to evaluate eligibility for the advance monthly payments of the HCTC.

Background

  1. The Health Coverage Tax Credit (HCTC), authorized in the Trade Adjustment Assistance Reform Act of 2002, first became effective for coverage months beginning after August 6, 2002. The HCTC later expired for coverage months after 2013. But the Trade Adjustment Assistance Reauthorization Act of 2015 restored the HCTC retroactively for 2014 coverage, erasing the hiatus in its duration, and extended it for coverage through the end of 2019, when it expires again. Therefore, the last eligible coverage month for the HCTC is December 2019. The HCTC is not available for months starting with January 2020. Individuals are responsible for paying their full health insurance premiums for coverage months beginning in 2020.

  2. The HCTC subsidizes most of the cost of qualified health insurance for eligible individuals and their eligible family members. The credit pays 72.5% of the insurance premiums while the participant enrolled in the program pays 27.5% of the premiums.

  3. Eligibility for the HCTC is restricted to two groups of individuals:

    1. Individuals who are eligible for benefits under the program Trade Adjustment Assistance (TAA) because of a qualifying job loss and receive benefits through the Trade Readjustment Allowance (TRA), Reemployment Trade Adjustment Assistance (RTAA), or Alternative Trade Adjustment Assistance (ATAA)

    2. Individuals who are between 55 and 64 years old, whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation (PBGC), and are not enrolled in Medicare

  4. Individuals eligible for the HCTC are allowed the tax credit only if:

    1. they aren’t enrolled in certain government-or employer-subsidized health coverage (Medicaid, for instance).

    2. they aren’t eligible for other specified coverage (Medicare Part A or TRICARE) and

    3. they cannot be claimed as a dependent on another person’s federal income tax return.

  5. To apply for the HCTC, applicants submit Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, and the required supporting documents to IRS, Mail Stop 6098 AUSC, Austin, TX 78741.

Authority

  1. Authority for these procedures is found in Internal Revenue Code (IRC) Section 7527.

  2. All Policy Statements for Submission Processing are contained in IRM 1.2.1.4, Policy Statements for Submission Processing Activities.

Roles and Responsibilities

  1. The Director of Submission Processing is the executive responsible for overseeing policy and guidance for employees of the Austin Submission Processing Center and ensuring consistent application of policies and procedures to effect tax administration while protecting taxpayers’ rights.

  2. The Submission Processing Field Director, reports to the Director Submission Processing, and is responsible for the delivery of policy and guidance that impacts the HCTC Advance Monthly Payment process.

  3. The Operation Manager is responsible for implementing policy and guidance that impacts the HCTC Advance Monthly Payment process.

  4. All employees must perform their professional responsibilities in a way that supports the IRS Mission in order to provide top quality service and to apply the law with integrity and fairness to all.

Program Reviews

  1. The HCTC program is an unmeasured program for production. However, due to the nature of the program, all applications, changes, reimbursement requests, and correspondence are 100% quality reviewed.

  2. Instructions issued by the P&A Staff are reviewed by P&A and/or HQ. The Quality Review team should ensure that the instructions are correctly followed but are not responsible for reviewing the content of those instructions.

    Note:

    If the Quality Review team is concerned about the potential impact of an instruction issued, they may elevate through the HCTC Coordinator for verification.

Program Controls

  1. IRS will implement access control measures that will provide protection from unauthorized alteration, loss, unavailability, or disclosure of information. Access controls will follow the principle of access enforcement, least privilege, separation of duties, system-use notifications, session locks, and session lock-control enhancements as defined in IRM 10.8.1, Information Technology (IT) Security, Policy and Guidance.

IDRS Notice Issuance

  1. While working assigned cases, Submission Processing employees may come across some accounts that are blocked on IDRS and can be identified by an IDRS security violation message, "Unauthorized Access to this Account" . Forward the case to your manager. Managers will notify the local Planning & Analysis Staff who will scan the case and send encrypted information to the ? ? ? ? ? mailbox to request access to the account. Managers will retain the case in a file awaiting access (can take up to 5 business days). Once notified access has been granted, the documents can be worked following applicable procedures.

Acronyms

  1. Following are commonly used acronyms:

    Acronym Meaning
    ATAA Alternative Trade Adjustment Assistance
    COBRA Consolidated Omnibus Budget Reconciliation Act
    DOL Department of Labor
    DPO Document Perfection Operation
    DSRA-BT Delphi Salaried Retirees Association Benefit Trust
    HCTC Health Coverage Tax Credit
    HPA Health Plan Administrator
    IDRS Integrated Data Retrieval System
    P&A Planning and Analysis
    PBGC Pension Benefit Guaranty Corporation
    PIN Participant Identification Number
    QFM Qualified Family Member
    QFMP Qualified Family Member Participant
    RCO Receipt Control Operation
    RTAA Reemployment Trade Adjustment Assistance
    SWA State Workforce Agency
    TAA Trade Adjustment Assistance
    TPA Third Party Administrator
    TRA Trade Readjustment Allowance

Deviations from the IRM

  1. Service Center Directors, Headquarter Branch Chiefs, and Headquarter Analysts do not have the authority to approve deviations from IRM procedures. Any request for an exception or deviation to an IRM procedure must be elevated through appropriate channels for executive approval. This will ensure that other functional areas are not adversely affected by the changes and that it does not result in disparate treatment of taxpayers.

  2. See guidelines in IRM 1.11.2, Internal Revenue Manual (IRM) Process. Request for an IRM deviation must be submitted in writing and signed by the Field Director, following instructions from IRM 1.11.2.2.4. Any disclosure issues will be coordinated by the Program Owner. No deviations can begin until they are reviewed by the Program Owner and approved at the Executive Level. All requests must be submitted to the Submission Processing Headquarters IRM Coordinator.

Reporting Time - Organization Function Program (OFP)

  1. Report all time spent in processing or handling HCTC forms with the organization, program, and function codes (OFP) below.

    Function/Program WP&C Title Application Type
    390-84310 F14095 Original Form 14095
    390-84311 14095COR F14095 correspondence
    390-84312 14095RPL F14095 reply to correspondence
    390-84313 14095NOR F14095 without a reply to correspondence
    390-84330 HCTC New Form 13441-A applications
    390-84331 HCTCUPDT Updated F13441-A applications
    390-84332 HCTC4442 Inquiries with Form 4442 or from US Bank
    390-84333 HCTCCORR Forms with correspondence (suspense)
    390-84334 HCTCRPLY Forms with a reply to correspondence
    390-84335 HCTCNORP Forms without a reply to correspondence
    770-84310 F14095 Clerical - Form 14095
    770-84330 HCTC Clerical - Form 13441-A

HCTC Program General Information

  1. All forms, correspondence, or other participant documentation must be processed following the general guidelines below.

  2. Any necessary editing should be done in erasable red ink.

    Note:

    Remove all editing marks prior to returning any document to an applicant.

  3. TE stamp each document processed.

  4. Verify the received date is present and legible. If not, edit the first available date from the list below in the "Rcvd MMDDYY" format.

    • Latest postmark on the envelope, the latest date from a designated private delivery service, or electronic transmission date (date of fax or e-mail)

    • Service Center Automated Processing System (SCAMPS) digital date

    • Participant’s latest signature date

    • Today’s date

  5. All forms, correspondence, and documentation should be stapled to the back of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, in Received Date order with the oldest (Original) Form 13441-A stapled to the top. If an updated Form 13441-A is submitted, then any prior Form 13441-A should be "X’d."

  6. If any information on HCTC forms is "X’d," crossed out, or lined through, either pre-printed or manually, it should be considered invalid.

  7. If a record is entered in error, refer the application to the HCTC Coordinator.

  8. Never obliterate, alter or erase the original entry on a document when deleting or correcting an entry. Circle out invalid information, making sure the original entry remains legible.

  9. When detaching documentation, edit an action trail:

    1. On the application, which includes:
      - Item detached
      - Current Date (MMDDYY)
      - Participant Identification Number

      Example:

      Detached F13441-A, pg. 3 030819 10000XXXXX

    2. On the detached document, which includes:
      - Form the document was detached from
      - Current Date (MMDDYY)
      - Participant’s Name
      - Participant Identification Number

      Example:

      Detached F13441-A 030819 [Name] 10000XXXXX

  10. Comments must be entered into the HCTC database for any correspondence, inquiry, or action to participants account. Comments must be specific and include the nature of the action taken.

  11. If a change to the participant’s database entry changes the "Last Modified" date, all entries in the database must be verified for accuracy. Ensure all information in the database is supported by documentation in the applicant’s file.

    Note:

    Not all database actions affect the "Last Modified" date. If the requested change results only in changes to the comments, it is not required to verify the entire database record.

  12. Anytime a record is updated in the database, see IRM 3.11.29.12, Setting the Status of the Application.

  13. The participant’s file should be present when processing updates which affect the Last Modified date, to allow the required research to be performed.

    Exception:

    End-of-year attestation spreadsheets are received from the vendor and allow for rate changes only; TE’s are not required to review all entries. The participant's file is not required to be present if submitted per this exception, however the Forms 4442 will need to be added to each participant's file no later than one week following the update.

  14. Forms and correspondence received by the HCTC Enrollment Team are to be processed or routed within 5 business days from the date received by the Enrollment Team.

    Exception:

    Some forms and correspondence received for processing by the HCTC Enrollment Team are not effective until a future date. Review any item effective on a future date for correspondence conditions and correspond if necessary. Once the file is processable, suspend until the 20th day of the month prior to the effective date.

  15. If the participant’s Participant Identification Number begins with 100006, they are an interim participant who was added to the program before the current database was available. When processing a change to an interim participant’s database entry, review all blank fields (both required and non-required).

  16. In some cases, it is necessary to elevate a question or issue to P&A and/or HQ for resolution. Once elevated, suspend the document until a response is received but not longer than 10 business days. Once a response is received, the document should be rebatched and processed following normal timeliness guidelines.

  17. Some database fields have character restrictions which prevent information from being entered as provided/perfected. If one or more characters are invalid for the field, enter the information while omitting the special character.

    Example:

    Policy or plan ID is an alpha-numeric field. 00-XXXXX will be entered as 00XXXXX, since this field cannot accept special characters, including hyphens (-)

Access to the HCTC Database

  1. For Tax Examiners to process, edit, and review HCTC forms, they must request access to the HCTC Database through the Online 5081 system.

  2. Roles are granted based on job duties as follows:

    Role OL5081 Application Name and Group
    Clerk PROD USER HCTC CLERK DR USER HCTC CLERK
    Examiner PROD USER HCTC TAX EXAMINER
    Reviewer PROD USER HCTC QUALITY REVIEWER DR USER HCTC QUALITY REVIEWER
    Customer Service PROD USER HCTC READ ONLY DR USER HCTC READ ONLY
    Admin PROD USER HCTC ADMIN (HEALTH COVERAGE TAX CREDIT-HCTC)
    Reports PROD USER HCTC REPORTS (HEALTH COVERAGE TAX CREDIT-HCTC)
  3. A warning that the database is for authorized use only appears when accessing the database. Users must accept the terms of use to open the database.

Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update

  1. Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, is processed in two operations in Austin Submission Processing: Receipt & Control (RCO) and Document Perfection (DPO).

    1. In RCO, clerks receive, extract, and Receive Date stamp Form 13441-A. RCO then routes Form 13441-A to DPO’s Entity Enrollment Team at AUSC Stop 6098 at the Austin Service Center.

    2. In DPO, clerks in the Entity Enrollment Team batch Form 13441-A. Tax Examiners screen enrollment Forms 13441-A for completeness and to determine any need for correspondence. They will accept or correspond for the correction of defects.

Batching Form 13441-A

  1. Batching Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, occurs in the Entity Enrollment Team.

  2. Separate new Forms 13441-A from updated Forms 13441-A. Batch new and old separately.

    Note:

    Applicants who update their registration may check box 6 on page 1 of Form 13441-A.

  3. Follow instructions in IRM 3.10.5.6.4, Image Control Team (ICT) Batch Creation Screen, for creating batches in the BBTS system.

  4. Batch Forms 13441-A by the date the form was received in Entity, in groups of 25. Each form in the batch must have been received on the same date.

  5. Print batch transmittals and associate the transmittals with their batches.

  6. Stage batches by the date received in the designated work area.

Initial Review of Form 13441-A

  1. Verify the applicant signed the form in Part 6 prior to updating the database. See IRM 3.11.29.9.6, Inputting Form 13441-A Part 6: Form Completion.

  2. Edit a Received Date on the first page of Form 13441-A, if missing. See IRM 3.11.29.4, HCTC Program General Information.

  3. Stamp your Tax Examiner number in the upper left of the ?rst page of Form 13441-A.

  4. Verify Form 13441-A is batched correctly. If the form is in the wrong batch, remove the form and have the clerk re-batch.

  5. New enrollments should be reviewed for QFMP status, see IRM 3.11.29.15, Qualified Family Member Participant (QFMP).

  6. A health insurance bill (or other document(s) which meet the criteria below) dated within the last sixty days must be present when enrolling or if updating their vendor and/or premium information. If information below is not available, see IRM 3.11.29.13, Correspondence:

    1. Name of applicant (may be the policy holder or a covered individual on policy. See IRM 3.11.29.9, Inputting Form 13441-A.)

    2. Dates of coverage

    3. Amount of monthly premium

      Note:

      Due to other benefits and/or family members not enrolled in the HCTC, the premium on the bill may differ from Form 13441-A. Do not perfect entries on Form 13441-A based on the supporting documents unless verified by the HCTC Coordinator.

    4. Name of Health Plan Administrator (HPA)

    Note:

    Forms submitted by the participant to their administrator in order to elect coverage are not acceptable in lieu of a bill.

  7. Updated Forms 13441-A require a signature in order to be processed. New enrollments and certain updates require the certification checkbox in Part 2 to be checked (see IRM 3.11.29.9.2).

    Note:

    Other than the signature and certification checkbox, participants are only required to enter the fields being modified when submitting an updated Form 13441-A. Requirements for perfecting Form 13441-A are provided in the relevant IRM subsections for each part.

  8. If the signature is not present, do not update the database until a response is received. See IRM 3.11.29.9.6.

  9. If a remittance is discovered in any HCTC documentation:

    If ... Then ...
    a) Payable to "US Treasury - HCTC" Send correspondence, remittance, and a copy of Form 13441-A (if available) to:
    US Treasury - HCTC
    PO Box 970023
    St. Louis, MO 63197-0023
    b) Payable to another entity:

    Example:

    IRS, Federal Reserve, or a HPA/TPA vendor

    Determine the intent of the payment from the documents in the application packet or correspondence.
    1. If it is determined remittance is for HCTC, see (9) box a (Payable to "US Treasury-HCTC" ).

    2. If it is determined remittance is not for the HCTC, see IRM 3.8.46.1 Discovered Remittances.

Inputting Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, Into the Database

  1. Before entering Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the database, search for an existing application from the participant already in the database.

  2. If the applicant is already in the database:

    And... Then...
    1) The documents are a response to correspondence and the status of the applications is "Waiting for supporting documentation"
    • Enter the requested items into the database

    • Change any information in the database the applicant changed in the response

    2) The documents are a response to correspondence and the status of the application is "Cancelled-Ineligible" Refer to HCTC Coordinator
    3) The document is not a response to correspondence and doesn’t change the information in the database Consider the Form 13441-A a duplicate and associate it with the original Form 13441-A. See IRM 3.11.29.13, Correspondence.
    4) The document is not a response to correspondence; however, it changes information in the database and the status of the application isn’t "Declined," "Cancelled-Ineligible," or "Enrolled"
    • Revise the affected information in the database and modify the applicant’s status, if needed

    • Associate the response with the original application

    • Consider the submission a superseding or supplementary Form 13441-A

  3. If the applicant is not yet in the database, determine which name should be listed as the applicant in the database:

    If And Then
    The eligible recipient is the policy holder   Enter the record under the eligible recipient
    The eligible recipient is not the policy holder The eligible recipient is covered on the policy Enter the record under the policy holder’s name from Part 4 and enter the eligible recipient as a family member in part 3.
    The eligible recipient is not the policy holder The eligible recipient:
    1. Is not covered on the policy

    2. Is currently eligible for HCTC. See IRM 3.11.29.9.1.1, Determining Eligibility.

    Enter the record under the policy holder’s name indicated in Part 4 and see information on separate coverage below.
    The eligible recipient is not the policy holder The eligible recipient:
    1. Is not covered on the policy

    2. Is divorced from the applicant or is not currently eligible for HCTC. See IRM 3.11.29.9.1.1, Determining Eligibility.

    See IRM 3.11.29.15, Qualifying Family Member Participant, for information on determining QFMP eligibility and database entry.
  4. If the eligible recipient and the QFM(s) have separate coverage and Participant Identification Numbers are not already established for each:

    If ... Then ...
    A separate Part 4 is provided for each individual with separate coverage
    1. Detach family member’s Page 3 (Part 4) from the original application. The family member needs to submit a separate Part 4 only. They do not need to submit a separate Form 13441-A.

    2. Enter information as a separate record to establish a new PIN for the family member who has a separate health plan.

    3. Edit new family member’s PIN, above Part 4: Health Plan Information, in right corner and process the application.

    4. Edit action trail per IRM 3.11.29.4, HCTC Program General Information.

    A separate Part 4 is not provided
    • Enroll any participants with complete information provided

    • Correspond with Letter 4541. See IRM 3.11.29.13.5, Letter 4541, HCTC Candidate Insufficient Documentation

    Note:

    If each PIN is already established, process the update(s) to the applicable database records.

  5. If the record is being established under someone other than the eligible recipient, edit the file as follows:

    1. Edit the eligible recipient in Part 1, if not already present.

    2. Edit the policy holder in Part 4, if not already present.

    3. Include the name entered into the database beside the PIN in the top right corner of Form 13441-A.

    4. Part 3 will be completed normally if there is more than one person on the policy.

Inputting Form 13441-A, Part 1: Your General Information

  1. Enter the received date and participant provided information from Part 1: Your General Information of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the relevant fields of the database.

    Figure 3.11.29-1

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    Please click here for the text description of the image.

  2. The fields for the HCTC Database, Part 1, General Information, are as follows; see (3) below for exceptions and requirements:

    Field Items Format Length Required
    IRS Received Date Stamp Numeric 8 Yes
    First Name Alphanumeric 25 Yes
    Middle Name Alpha 25 No
    Last Name Alphanumeric 35 Yes
    Suffix Alphanumeric 10 No
    Social Security Number Numeric 9 Yes
    Date of Birth Numeric 8 Yes
    Primary Phone Number Numeric 10 No
    Alternative Phone Number Numeric 10 No
    Mailing Address Line 1 Alphanumeric 55 Yes
    Mailing Address Line 2 Alphanumeric 55 No
    City Alpha 30 Yes
    State Alpha 2 Yes
    Zip Code Numeric 15 Yes
  3. Certain fields have additional requirements and/or restrictions:

    1. Received Date (New enrollments only): If the received date is missing, invalid, or illegible, see IRM 3.11.29.4. Do not change this field if updates are received.

    2. First Name/Middle Name/Last Name: Do not abbreviate. Type as written until you reach the end of the field.

    3. Social Security Number (SSN): If the SSN on Form 13441-A is invalid and cannot be located, research CC INOLES. If still unable to confirm, then elevate to HCTC Coordinator. Do not enter the record into the database until a valid SSN has been identified.

    4. Mailing Address Line 1 / Mailing Address Line 2:
      - If mailing address is missing/incomplete, perfect Form 13441-A from the database. For a new enrollment, or if no current address appears in the database, see IRM 3.11.29.13, Correspondence.
      - If mailing address is invalid or illegible, perfect the defective elements (house number, street name, apartment number, etc.) using the envelope or attachments. If the address on the envelope or attachments does not appear to be the same address as Form 13441-A, do not perfect based on this information.
      - If both a PO Box and a street address are present, enter the street address in the Mailing Address Line 1 field, and the PO Box in the Mailing Address Line 2 field.

    5. Zip Code: Do not correspond for a missing zip code, but review the attached documents, envelopes, and/or https://www.usps.com/ to determine the correct zip code.

  4. Except as specified by (3) above, if any required information is missing, invalid, or illegible, perfect it with information from the file. Circle out any incorrect information, edit the perfected information onto Form 13441-A, and enter into the database. Correspond per IRM 3.11.29.13, Correspondence if information cannot be perfected.

  5. If any non-required information is missing, invalid, or illegible, it is not required to perfect. Invalid or illegible information must be circled out. Do not correspond for non-required information.

    Note:

    TEs may perfect any non-required information that they identify during processing. When perfecting non-required information, edit the information on Form 13441-A and enter into the database.

  6. When processing new enrollments, an eligibility indicator appears after the SSN is entered. See IRM 3.11.29.9.1.1, Determining Eligibility.

  7. After the SSN has been entered, the database will use the TIN-V process to validate and auto-fill the date of birth and address information into the database.

    Note:

    It is not necessary to correct or review the date of birth, but the address must be corrected to reflect the information provided on Form 13441-A.

  8. If the SSN fails TIN-V, the status will change to either" Ineligible: Could Not Validate TIN at This Time" or "Cancelled - Ineligible: TIN Validation Failure," and the application must be elevated to P&A. When elevating to P&A, include the complete file and an IDRS screen shot of the CC INOLES screen.

Determining Eligibility
  1. Eligibility for the HCTC is restricted to two groups of individuals.

    1. Individuals who are eligible for bene?ts under the program Trade Adjustment Assistance (TAA) because of a qualifying job loss and receive bene?ts through the Trade Readjustment Allowance (TRA), Reemployment Trade Adjustment Assistance (RTAA), or Alternative Trade Adjustment Assistance (ATAA).
      - TRA is a weekly cash payment for workers no longer eligible for unemployment benefits
      - RTAA is a wage supplement for workers who are 50 or older and certified eligible under the terms of the TAA and ?nd employment at a lower wage
      - ATAA is a wage insurance like RTAA

    2. Individuals who are between 55 and 64 years old, whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation (PBGC) and are not enrolled in Medicare.

  2. An individual is eligible for the HCTC on the first day of a month if the individual received a TAA bene?t for any day in that month or the month before.

  3. Only individuals who receive cash bene?ts through the TRA, RTAA, or ATAA may be certi?ed eligible for bene?ts under TAA. Individuals who receive non-cash bene?ts, such as assistance with looking for a job, aren’t eligible for the HCTC.

  4. To determine the applicant’s eligibility for the HCTC, the database checks the record created from Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, against information from the Department of Labor (DoL) and PBGC. The Enrollment Team receives eligibility files from the DoL daily and the PBGC monthly.

  5. Enter the applicant’s SSN into the database. If the eligibility indicator "Individual is Eligible (Code 00)" appears, proceed with creating the record.

  6. If after entering the applicant’s SSN into the database, the eligibility indicator does not appear:

    1. Verify the SSN with CC INOLES in IDRS.
      - If the SSN on Form 13441-A doesn’t belong to the applicant, search IDRS for the valid SSN with CC NAMES or within the supporting documentation.
      - If the applicant entered the wrong SSN on Form 13441-A, replace the incorrect SSN in the database with the valid SSN retrieved from CC NAMES or from the supporting documents. Write the correct SSN in the margin to the left of the box for the SSN.
      - Proceed with creating the record in the database.

    2. Verify a letter of eligibility from the DoL, PBGC, or relevant Form 1099-R, Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., is present. See Exhibit 3.11.29-1, Exhibit 3.11.29-2, Exhibit 3.11.29-3, Exhibit 3.11.29-4.
      - If present, consider the applicant eligible and proceed with processing Form 13441-A. Perfect the eligibility type (TAA/PBGC) in Part 2 of Form 13441-A to match the supporting documentation provided.
      - If not present, see IRM 3.11.29.13, Correspondence.

  7. An applicant with an IRSN or ITIN is ineligible for the HCTC. If the applicant’s TIN is an ITIN or IRSN:

    1. Do not enter the Form 13441-A into the database.

    2. Send correspondence Letter 4540 to the participant. See IRM 3.11.29.13.4, Correspondence, Letter 4540.

    3. Choose Paragraph 8 – Unqualified health insurance coverage.

    4. Return Form 13441-A and all supporting documentation to the applicant.

  8. An applicant is not eligible after becoming eligible for Medicare at age 65. Correspond using letter 4540 and include the following open paragraph: "You or a family member is eligible to enroll in Medicare." See IRM 3.11.29.13.4, Correspondence, Letter 4540.

Inputting Form 13441-A, Part 2: Confirm Your Eligibility

  1. Enter the information from Part 2: Confirm Your Eligibility of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the relevant ?elds of the database and update the QFMP information, if applicable.

    Figure 3.11.29-2

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    Please click here for the text description of the image.

  2. There are three steps to confirm participant eligibility:

    1. Confirming the participant is eligible through either PBGC or TAA

    2. Confirming the participant meets general requirements

    3. Confirming if the participant is a Qualifying Family Member Participant. See IRM 3.11.29.15, Qualifying Family Member Participant (QFMP).

  3. For statement one, "Check the box that applies to you to certify that the statement is true" , if neither or both boxes are checked:

    And Then
    1. Either are present:
    • An official letter from the Pension Bene?t Guaranty Corporation (PBGC) stating that the applicant received a bene?t

    • Form 1099-R showing a benefit paid by the PBGC

    Select the PBGC button on the screen
    2. Either are present:
    • An official letter from the Department of Labor (DoL) states that the applicant is eligible for the trade adjustment bene?ts

    • A letter from a state workforce agency (SWA) or employment office states that the applicant is eligible for trade adjustments bene?t

    Select the TAA, ATAA, or RTAA button on the screen
    3. Neither box 1 nor box 2 above applies. See IRM 3.11.29.13, Correspondence
    4. Both box 1 and box 2 above applies. Select the PBGC button on the screen
  4. If the certification checkbox "I certify that all of the following statements are true for me and my qualified family member" is not checked:

    1. On a new enrollment, see IRM 3.11.29.13, Correspondence.

    2. On an updated Form 13441-A, review the nature of the changes requested. The certification checkbox must be marked if either are true:
      - Changes to the covered individuals on the policy (adds, subtracts, or replaces). See IRM 3.11.29.9.3, Inputting Form 13441-A, Part 3: Family Member Information.
      - Changes to the health plan vendor in Part 4. See IRM 3.11.29.9.4, Inputting Form 13441-A, Part 4: Health Plan Information.

      Reminder:

      The certification checkbox allows the participant to self-certify they meet the requirements for enrollment. As a result, it is not necessary to end participation in the program.

  5. Select the third box when the participant is enrolling as a QFMP. See IRM 3.11.29.15, Qualified Family Member Participant (QFMP).

    Caution:

    Do not confuse a QFM (see IRM 3.11.29.9.3) for a QFMP.

  6. The database was updated on October 16, 2018, to include the QFMP fields. When updating records entered in the database prior to the update, the QFMP fields can be perfected, but it is not required. Correspondence should not be issued to perfect these fields.

Inputting Form 13441-A, Part 3: Family Member Information

  1. In Part 3: Family Member Information of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, the applicant reports family members (other than themselves) registering for the HCTC.

    Figure 3.11.29-3

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    Please click here for the text description of the image.

  2. For special circumstances regarding family members:

    1. If the applicant is requesting enrollment as a Qualifying Family Member Participant (QFMP) who is eligible due to the Medicare enrollment, death, or divorce of the eligible recipient, see IRM 3.11.29.15, Qualifying Family Member Participants.

    2. If the applicant is requesting enrollment as a Qualified Family Member (QFM) of the eligible recipient, but the eligible recipient is not the policy holder or has a separate policy, see IRM 3.11.29.9 to determine which individual the record should be created under.

  3. If there is no family member information in Part 3, select "No" on the Family Member Information screen of the database for "Does the applicant have qualified dependents?"

  4. If family member’s information appears in Part 3, select "Yes" on the Family Member Information screen of the database for "Does the applicant have qualified dependents?"

    Exception:

    Do not enter an individual as both participant and as a family member in Part 3. See IRM 3.11.29.9.

  5. Enter available information from Part 3: Family Member Information of Form 13441-A, into the relevant ?elds of the HCTC database. The database prompts are as follows:

    Family Member Item Required
    a. First Name Yes
    b. Middle Initial No
    c. Last Name Yes
    d. Suffix No
    e. Family member’s relationship to applicant No
    f. Social Security Number

    Note:

    If TIN displays as invalid, then verify the validity of the family member’s SSN with IDRS CC INOLES. ATINs and ITINs are acceptable for family members (see below).

    Yes
    g. Date of Birth No
    h. Is this person on the applicant’s health plan? Yes
  6. The HCTC Database does not currently accept ATINs/ITINs for family members. If the TIN can be verified with IDRS, leave the Social Security Number field of the database blank but enter all other information.

  7. If any required information is missing, invalid, or illegible, correct with relevant information found in the supporting documentation. Circle out any incorrect information, edit the perfected information onto Form 13441-A, and enter into the database. If the required information can’t be perfected, see IRM 3.11.29.13, Correspondence.

  8. If any non-required information is missing, invalid, or illegible, it is not required to perfect. Invalid or illegible information must be circled out. Do not correspond for non-required information.

    Note:

    TEs may perfect any non-required information that they identify during processing. When perfecting non-required information, edit the information on Form 13441-A and enter into the database.

  9. If the applicant responds "No" to "Is this person on the applicant’s health plan?" a separate Part 4 with family member’s Health Plan Information must be provided. See IRM 3.11.29.9.

  10. If the applicant indicates more than five family members, an additional copy of Form 13441-A, Part 3 must be attached. If not attached, see IRM 3.11.29.13, Correspondence.

Inputting Form 13441-A, Part 4: Health Plan Information

  1. In Part 4: Health Plan Information, the applicant reports information about the health plan provider and information which affects their monthly payment. Enter provided information from Part 4 of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the relevant ?elds of the HCTC database.

    Figure 3.11.29-4

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    Please click here for the text description of the image.

  2. Each policy holder for each Part 4 must have their own record. If Form 13441-A indicates that family members have separate coverage, see IRM 3.11.29.9 for details.

  3. The HCTC Coordinator will review the HPA Vendor Number, Member ID, Group ID, and Policy or Plan ID on all new enrollments or if the participant indicates a change to their vendor information.

    1. The HCTC Coordinator will attach a Vendor Verification Form to the bottom right of Part 4 if providing missing/corrected information.

    2. If the HCTC Coordinator is unable to determine the vendor number and at least one of the other fields, elevate to P&A.

  4. Where present, the entries on the Vendor Verification Form will take precedence over the entries on Form 13441-A.

  5. If the participant submits an update to change the Vendor, Member ID, Group ID, and/or Policy or Plan ID and no updated Vendor Verification is present, refer to the HCTC Coordinator for determination. If the HCTC Coordinator determines the vendor is not enrolled, correspond per IRM 3.11.29.13.4, using paragraph 13.

  6. The fields for the HCTC Database, Part 4, Health Plan Information, are as follows; see (7) below for exceptions and requirements:

    Health Plan Item Required
    a. Vendor Name Yes
    b. Vendor Number Auto populated
    c. Effective Date of Coverage (MMDDYYYY) Yes
    d. Health Plan ID Number No
    e. Member ID* See Note
    f. Group ID* See Note
    g. Policy or Plan ID* See Note
    h. Policy Holder’s First Name Yes
    i. Policy Holder’s Middle Initial No
    j. Policy Holder’s Last Name Yes
    k. Policy Holder’s Suffix No
    l. Social Security Number Yes
    m. Total Monthly Premium (line 1) Yes
    n. Total number of people on policy (line 2) No
    o. Number of family members on policy who are not qualified for the HCTC (line 3) No
    p. Monthly premium amount for family members not qualified for the HCTC (line 4) No
    q. Other Health Benefits Amount (line 6) No
    r. Total HCTC (line 5) Auto populated
    s. Monthly HCTC Payment (line 7) Auto populated
    t. Total Government Payment Auto populated
  7. Certain fields have additional requirements and/or restrictions:

    1. If the effective date is blank, research the packet for an indication of when HCTC Eligibility begins. If none is found enter the current date.

    2. At least one of the following is required: Member ID, Group ID, or Policy ID. Elevate to the HCTC Coordinator if none are present. If any of these fields exceed the field length, refer to HCTC Coordinator for determination. Coordinator will reorder entries between these fields if possible; otherwise, TE will be instructed to enter as much of the entry as possible in each field.

  8. Use the table below to correct common participant errors:

    On Form 13441-A, if... And... Then...
    a. The vendor is changing There is an End Date for COBRA coverage in the database which is not being updated Refer to the HCTC Coordinator for determination.
    b. The policy holder is the applicant The policy holder’s SSN in Part 4 differs from the SSN in Part 1 Replace the SSN in Part 4 with the valid SSN from Part 1 of Form 13441-A
    c. Line 2, "Total number of people on this policy" is blank No family members appear in Part 3 Enter "1" onto line 2, "Total number of people on policy"
    d. Line 2, "Total number of people on this policy" is greater than "1" No family members appear in Part 3 See IRM 3.11.29.13, Correspondence
    e. Line 2, "Total number of people on this policy" is blank Family members appear in Part 3 Enter the sum of the applicant plus the family members from Form 13441-A, Part 3 onto line 2, "Total number of people on this policy"
    f. Line 3, "Number of family members on this policy who are not qualified for HCTC" is greater than zero Line 4 "Monthly premium amount for family members who are not qualified for HCTC" is blank No correction is required. Enter lines 3 and 4 into the database as given.
    g. Line 4 "Monthly premium amount for family members not qualified for the HCTC" is greater than zero Line 3 "Number of family members who are not qualified for the HCTC" is blank or zero Add the amount on line 4 to any existing amount on Line 6, "Other health benefits amount" .
  9. Other Benefits (or Other health benefits) refer to premiums for insurance which is not eligible for the HCTC (dental, vision, etc.). This amount will be automatically added to the participant’s Total HCTC (27.5% medical premium payment) to determine the participant’s monthly payment amount.

  10. Do not enter Consolidated Omnibus Budget Reconciliation Act (COBRA) ?elds into the HCTC database if the participant is PBGC eligible.

    Note:

    This includes cases when the participant indicated that they were eligible as both TAA and PBGC recipients.


    The database prompts are as follows:

    COBRA Information Required
    a. Former Employer No
    b. Former Employer’s HR Phone Number No
    c. Start Date for COBRA Coverage (mm/dd/yyyy) No
    d. End Date for COBRA Coverage (mm/dd/yyyy) No
    e. Lifetime Benefit checkbox No

    Exception:

    If the “Check here only if the Health Plan Information in Part 4 is for COBRA Coverage” box is checked and the COBRA Start and End dates are not present, refer to the HCTC Coordinator.

  11. If the Lifetime Benefit checkbox is selected:

    1. If the TAA box in Part 2: Confirm Your Eligibility of Form 13441-A is not checked, refer to the HCTC Coordinator.

    2. Circle out any End Date for COBRA Coverage. Delete the COBRA End Date from the database, if present.

    3. Change the participant’s birth year to 2000 in the database. Add the actual birth year in a comment stating "Lifetime Benefits: Actual birth year 19xx"

      Note:

      If the birth year is not changed to 2000, the database will automatically unenroll participants over 65 years old during its daily update.

  12. If any required information is missing, invalid, or illegible, correct with relevant information found in the supporting documentation. Circle out any incorrect information, edit the perfected information onto Form 13441-A, and enter into the database. If the required information can’t be perfected, see IRM 3.11.29.13, Correspondence.

  13. If any non-required information is missing, invalid, or illegible, it is not required to perfect. Invalid or illegible information must be circled out. Do not correspond for non-required information.

    Note:

    TEs may perfect any non-required information that they identify during processing. When perfecting non-required information, edit the information on Form 13441-A and enter into the database.

Inputting Form 13441-A, Part 5: Account Accessibility

  1. In Part 5: Account Accessibility of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, the applicant can designate a Third-Party to have access to their account information.

    Figure 3.11.29-5

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    Please click here for the text description of the image.

  2. Enter information from Part 5: Account Accessibility of Form 13441-A, if a five digit numerical Personal Identification Number (PIN) is provided.

    Exception:

    If the applicant has indicated "No" to the question "Do you want to allow another person to talk with the HCTC Program about your account?" do not enter Part 5 into the database. Remove if present.

  3. No correspondence is necessary if any of the information is missing or incomplete.

Inputting Form 13441-A, Part 6: Form Completion

  1. In Part 6 of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, the applicant signs the form. Do not process changes to Form 13441-A without a signature.

    Figure 3.11.29-6

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    Please click here for the text description of the image.

  2. If Form 13441-A is unsigned and changes are requested:

    1. Do not update the database.

    2. Correspond per IRM 3.11.29.13.5, Correspondence, Letter 4541, HCTC Candidate Insufficient Documentation

    3. Return the unsigned Form 13441-A and all related documents to the applicant.

    4. Include a blank Form 13441-A signature page with the correspondence if Part 6 is missing from the application, if the signature is "X’d," or if the signature is lined through.

  3. If the signature is missing and there are no requested changes, comment the file and do not correspond for missing signature. See IRM 3.11.29.13 , Correspondence, if the account is currently in a non-enrolled status due to missing information.

  4. The signature must appear under the jurat — "Under penalty of perjury…" —and above the phrase "Privacy Act and Paperwork Reduction Act Notice." If Form 13441-A is signed outside this area, treat as unsigned.

  5. Faxed, digital, or photocopied signatures are acceptable.

  6. Accept a signature by a third party only with a power of attorney (POA):

    1. Form 2848, Power of Attorney and Declaration of Representative, names the third party and may be present in the packet.

    2. If Form 2848 is not part of the packet, look for the POA with CC CFINK.

    3. If the applicant hasn’t granted power of attorney to the person who signed the Form 13441-A, treat as unsigned.

  7. If the signature section is "X’d" or lined through, either pre-printed or manually, treat as unsigned.

  8. If you enter Form 13441-A with a missing signature in error into the database:

    1. Set the eligibility status to "Processing— Waiting for Supporting Docs."

    2. Add a comment into the database stating the application was entered in error without a signature.

Setting the Status of the Application

  1. There are several statuses available in the HCTC database for participants depending upon their application. If you are unable to change a status on an application, then refer to HCTC Coordinator for elevation to P&A.

  2. Anytime a record is updated, use the following chart to determine the status for the application.

    Note:

    Any status change which causes an enrolled participant to become unenrolled should not be performed until the effective date of the change.

    If ... Then ... Applicable Letter
    The application packet is complete and acceptable and the applicant is eligible Move to Complete

    Note:

    If the participant is already in enrolled status, then no status change needed.

    IRM 3.11.29.13.6, Letter 4545, HCTC Enrollment Letter
    You are reviewing an application Move to Quality Review  
    Quality Review has been performed and the participant is able to be enrolled Move to Enrolled  
    Participant’s health plan is not qualified for the HCTC. This status will always take priority if we are corresponding for a HPA Vendor in addition to anything else. Processing—HPA Vendor Num Not Avail IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility
    Information on Form 13441-A or supporting documentation is defective, missing, incomplete, invalid, or illegible and the applicant is eligible. Processing—Waiting for Supporting Docs. IRM 3.11.29.13.5, Letter 4541, HCTC Candidate Insufficient Documentation - System Letter
    The application packet is incomplete or unacceptable, and the applicant is eligible but didn’t reply or inadequately replied to correspondence use paragraph 5 and/or paragraph 6 for Letter 4540. See IRM 3.11.9.13.4, Letter 4540, HCTC Notice of Ineligibility. Cancelled -Ineligible IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility
    The participant has been enrolled and is now requesting removal from the program Cancelled—Ineligible IRM 3.11.29.13.1, Letter 3772, End of Program Letter
    COBRA insurance has expired Cancelled—Ineligible IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility
    The participant had been enrolled and is no longer eligible Cancelled—Ineligible IRM 3.11.29.13.1, Letter 3772, End of Program Letter
    None of the above scenarios are applicable Refer to the HCTC coordinator  

    Note:

    If both Letters 4540 and 4541 are needed, use Letter 4540 utilizing the open paragraph format. An applicant’s eligibility takes priority over defective items in an application. IRM 3.11.29.13.4.

  3. When removing an applicant from an enrolled status, do not delete existing information from the database unless specifically instructed. The most recent information is retained.

  4. The following statuses are no longer in use:

    • Processing-HPA Vendor Num Avail: Should not appear in database.

    • Ineligible: May appear in database, replace with Cancelled-Ineligible if updating the record.

    • Cancelled-Permanent Ineligibility: May appear in database, replace with Cancelled-Ineligible if updating the record.

Systemically Generated Statuses of the Application

  1. Following are several statuses that are systemically generated by the HCTC database. If you believe a systemically generated status is incorrect, elevate to P&A.

    1. Form received

    2. Inactive

    3. Cancelled: Permanent Ineligibility - Over 65

    4. Ineligible - Over 65

    5. Cancelled: Ineligible - COBRA End Date Expired

    6. Ineligible - COBRA End Date Expired

    7. Cancelled: Ineligible - Prison File Match

    8. Ineligible: Could Not Validate TIN at This Time

    9. Cancelled - Ineligible: TIN Validation Failure

    10. Ineligible - QFM End Date Expired

    11. Cancelled: Ineligible QFM End Date Expired

  2. For the statuses in the table below, the database will automatically unenroll the participant. The participant must be notified 45 days prior to the loss of eligibility based on date entries in the fields listed in the table. See IRM 3.11.29.13.1, Letter 3772, End of Program Letter.

    Status Expiration Determined By
    Cancelled: Permanent Ineligibility - Over 65 Date of Birth
    Ineligibility - Over 65 Date of Birth
    Cancelled: Ineligible - COBRA End Date Expired End Date for COBRA coverage
    Ineligible - COBRA End Date Expired End Date for COBRA coverage
    Cancelled: Ineligible - QFM End Date Expired End Date for QFM
    Ineligible - QFM End Date Expired End Date for QFM
  3. When the database moves a previously enrolled participant into the status "Cancelled: Ineligible - Prison File Match" , elevate to P&A for review.

Releasing / Filing Forms 13441-A, Batches

  1. Clerks review each Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, before releasing to Files and/or the storage area. They verify that all pages of Form 13441-A are present and supporting documents are attached.

  2. Each packet with Form 13441-A may contain one or more of the following:

    1. The original Form 13441-A

    2. An updated Form 13441-A

    3. Required supporting documentation: a copy of the participant’s health insurance bill dated within the last 60 days

    4. A copy of any correspondence sent to the applicant

    5. Any correspondence sent by or on behalf of the applicant

  3. Clerks verify that the PIN (Participant Identi?cation Number) on the Enrollment letter matches the PIN on the first page of Form 13441-A.

  4. In the Batch Block Tracking System (BBTS), Clerks release Forms 13441-A and associated documents to Files and/or the storage area.

  5. Place each batch of Forms 13441-A, along with the Form 9856, Attachment Alert, and two copies of Form 3210, Document Transmittal, for the batch, into a gusset folder. On the tab of the gusset folder, write the range of PINs, the program name "HCTC," and the tax year of the applications.

  6. Route Forms 13441-A numbered with a PIN to Files or a designated storage area at the Austin Submission Processing campus to be held until retirement.

  7. Retain Forms 13441-A at the Austin processing center for five (5) years. After the end of the fifth year, retire Form 13441-A to the Federal Record Center (FRC) for an inde?nite period. See IRM 3.11.29.25, Record Retention Requirements.

  8. Include an Application Identi?cation Sheet (AIS) and highlight the correct PIN. The AIS is used to attach documents to the applicant’s packet.

Correspondence

  1. The Enrollment Team is responsible for sending the following letters.

    Letter Title Purpose
    3772 End of Program Letter To cancel participant’s HCTC registration or notify the participant of upcoming systemic unenrollment.
    4510 HCTC Reimbursement Request – Denial To deny request for reimbursement (Form 14095)
    4511 HCTC Reimbursement Request - Insufficient Documentation Participant provided insufficient documentation (Form 14095)
    4540 HCTC Notice of Ineligibility To notify participant of ineligibility, or when there is no reply to Form 4541.
    4541 HCTC Candidate Insufficient Documentation
    • Form 13441-A missing signature

    • Form 13441-A is incomplete

    • Supporting documents are missing or incomplete

    • Policy holder SSN is invalid

    4545 HCTC Enrollment Letter To notify participant of confirmed enrollment
    5758 Health Coverage Tax Credit Enrollment in Process To acknowledge receipt of application. For use only with explicit management approval.
    5945 HCTC Reimbursement Approval Notifies participant request was approved (Form 14095)
    5974 Annual HCTC Vendor Renewal Notification To remind HPA/TPA to annually certify to receive ACH payments
    6009 Refund of HCTC Payments To notify participant of refund of HCTC payments
    6011 Return of HCTC Funds To request funds from a participant (HQ Only)
  2. Do not save any correspondence containing participant’s Personal Identifiable Information (PII) to your desktop or personal storage drive.

  3. Remove all editing marks prior to returning any document to an applicant.

  4. When it is necessary to correspond with taxpayers, correspondence should be professional (i.e., correct spelling, punctuation, and grammar).

  5. Correspondence letters are available through the HCTC SharePoint.

  6. Correspond only after you have entered the entire Form 13441-A into the HCTC database.

    Exception:

    If correspondence is for a missing signature, do not update the database until a response is received.

  7. Enter comments into the HCTC database, including what letter was sent and why the letter was sent (correspondence conditions).

  8. All correspondence must include the participant’s Participant Identification Number.

    Exception:

    When corresponding for a missing signature on a new enrollment, a PIN is not required.

  9. Address all decedent correspondence to "Estate of" and the decedent’s name. (e.g., Estate of John Smith)

  10. One copy of all correspondence is attached to the applicable applicant package in Received Date order with the oldest stapled to the top. See IRM 3.11.29.4, HCTC Program General Information.

  11. All letters are subject to review by the Improvement Team.

  12. Retrieve E-faxes daily. Check the E-fax folder daily for replies/missing information. Print the reply and associate it with the original submission on the suspense wall.

    Note:

    Faxes received from US Bank should be elevated to the HCTC Coordinator for research. Faxes received by 10:00 am must receive a response by noon the same day. If the HCTC Coordinator is not available, elevate to P&A.

  13. Each correspondence letter may trigger a change in the status of the application. See IRM 3.11.29.10, Setting the Status of the Application.

  14. Allow applicant 45 days for responding to correspondence. A reply is late on the 46th day after correspondence.

  15. Duplicate Form 13441-A: If a Form 13441-A is received which appears to be a duplicate of the current 13441-A:

    1. Review the Form 13441-A thoroughly for any changes.

    2. Review any supporting documentation or correspondence for indications that a change was intended or that this is a reply to prior correspondence.

    3. Verify that the signature date, if any, is the same.

  16. If, after review, the Form 13441-A still appears to be a duplicate, process the Form 13441-A normally, but do not re-issue any correspondence. Comment the database to indicate that a duplicate 13441-A was received, and no correspondence was issued.

    Exception:

    If the received date of the duplicate is greater than 30 days from the received date of the current form and the account is in a non-enrolled status due to missing information, process and correspond as normal to ensure the participant is aware of any unresolved issues related to their account.

  17. Undeliverable Correspondence: When undeliverable correspondence is received, research the database, the file, and/or IDRS for an alternative address.

    1. If an alternative address is found, reissue the correspondence. Comment the database with the address used and date resent. Do not change the address in the database without Form 13441-A or a 4442 instruction (see IRM 3.11.29.14).

      Note:

      https://www.usps.com should be used to perfect missing/invalid elements of the address, if applicable.

    2. If a better address is not found, comment the database to indicate which letter was returned undeliverable and that no alternative address was found. Do not reissue letter.

Letter 3772, End of Program Letter

  1. Letter 3772, End of Program Letter, informs participants they have been cancelled from the HCTC program, or notifies them that they will be systemically unenrolled at a future date. See Exhibit 3.11.29-5. See also IRM 3.11.29.10, Setting the Status of the Application.

  2. Monthly, the HCTC Coordinator will create a list of applicants who will be systemically unenrolled within the next 60 days due to Medicare eligibility, COBRA expiration, or QFMP end date. Issue Letter 3772 to notify identified participants that they will be unenrolled/ineligible.

    Note:

    Correspondence will only be issued to those participants in enrolled status, or who are currently suspended pending correspondence, to advise them of the change in their enrollment/eligibility status.

  3. If the change is effective immediately, change the status of the application to "Cancelled—Permanent Ineligibility." . Do not change the status if participant will be unenrolled systemically at a future date.

  4. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following:

    1. Participant Identification Number (PIN) beside Dear HCTC Program participant

    2. Open paragraph with HQ pre-approved text, if provided.

Letter 4510, HCTC Reimbursement Request - Denial

  1. Letter 4510, HCTC Reimbursement Request – Denial, is a denial letter for the reimbursement request for the HCTC Advance Monthly Program. See Exhibit 3.11.29-6. Letter 4510 will be sent only when instructions are received from P&A.

  2. There will be no status change when sending Letter 4510.

  3. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following (provided by P&A):

    1. Participant Identification Number (PIN) beside "Dear HCTC Program participant"

    2. Month(s) the reimbursement is requested in the first paragraph

    3. Amount of the reimbursement request in the first paragraph

    4. Reason for denial (check box entry)

    5. Open paragraph with HQ pre-approved text, if needed

Letter 4511, HCTC Reimbursement Request - Insufficient Documentation

  1. Letter 4511, HCTC Reimbursement Request - Insufficient Documentation, is sent to request documentation for the reimbursement request Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form. See Exhibit 3.11.29-7. Letter 4511 will be sent only when instructions are received from P&A.

  2. There will be no status change when sending Letter 4511.

  3. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following (provided by P&A):

    1. Participant Identification Number (PIN) beside "Dear HCTC Program Participant"

    2. Open paragraph with HQ pre-approved text, if needed

Letter 4540, HCTC Notice of Ineligibility

  1. Letter 4540, HCTC Notice of Ineligibility, notifies participants their HCTC eligibility has not been processed. See Exhibit 3.11.29-8. See IRM 3.11.29.10, Setting the Status of the Application.

  2. If the participant is currently enrolled, refer to HCTC Coordinator prior to corresponding for missing information as some information can be obtained through vendor outreach.

  3. When corresponding for missing/incomplete information, use Form 4541, HCTC Candidate Insufficient Documentation, unless one of the following applies:

    • No appropriate fill-in exists on Letter 4541.

    • You are issuing correspondence due to no reply/incomplete reply on Letter 4541.

    • Fill-ins from both Letter 4540 and Letter 4541 are required.

  4. If both Letters 4540 and Letter 4541 are needed, use Letter 4540 and include any necessary information from Letter 4541 in the open paragraph. An applicant’s eligibility takes priority over defective items in an application.

  5. Change the status in the database to one of the following, depending on the circumstances.

    • Processing—Waiting for Supporting Documentation

    • Processing—HPA Vendor Not Avail

    • Cancelled-Ineligible

  6. Letter 4540 is customizable with 14 selectable paragraphs on the following topics. Multiple paragraphs may be selected to appear in the same letter.

    1. Paragraph 1 - Dependent status

    2. Paragraph 2 – Disqualifying health insurance coverage

    3. Paragraph 3 – Age requirement (PBGC only)

    4. Paragraph 4 – Imprisonment

    5. Paragraph 5 – Incomplete registration form

      Reminder:

      Use only when Letter 4541 cannot be used. See (3) above.

    6. Paragraph 6 – Missing supporting documents

      Reminder:

      Use only when Letter 4541 cannot be used. See (3) above.

    7. Paragraph 7 – Spousal coverage

    8. Paragraph 8 – Unqualified health insurance coverage

    9. Paragraph 9 – Participant eligibility

    10. Paragraph 10 – Family member eligibility – Insufficient documentation

    11. Paragraph 11 – Family member eligibility – Unable to confirm eligibility

    12. Paragraph 12 – Family member eligibility – You are not eligible

    13. Paragraph 13 – Unable to verify Health Plan Administrator (HPA) set up

    14. Paragraph 14 – Miscellaneous missing information

  7. If signature is missing, return the unsigned Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, and all related documents to the applicant. See IRM 3.11.29.9.6, Inputting Form 13441-A, Part 6: Form Completion.

  8. If the signature is" X’d," crossed out, or lined through, either pre-printed or manually, return the original Form 13441-A and all related documents to the applicant with a blank Form 13441-A signature page.

  9. If you are not returning Form 13441-A to the applicant, remove the words "Enclosure: Your HCTC registration form" from page 2 of Letter 4540 prior to printing.

  10. When a response is received, or if the 45-day suspense period passes without a response:

    1. For an adequate response in which all required information is present and acceptable, update the information in the database to reflect the applicant’s response. See IRM 3.11.29.10, Setting the Status of the Application.

    2. For no response or an inadequate response in which required information is missing or unacceptable:

    • Send Letter 4540 with the relevant paragraph "Incomplete registration form" or "Missing supporting document," per the reason for the correspondence. If both reasons apply, send both explanations.

    • Utilize the open paragraph with HQ pre-approved text.

    • Set the status of the application to Cancelled-Ineligible.

Letter 4541, HCTC Candidate Insufficient Documentation

  1. Letter 4541, HCTC Candidate Insufficient Documentation, notifies participants they are missing the required documentation to successfully establish eligibility. See Exhibit 3.11.29-9. See also IRM 3.11.29.10, Setting the Status of the Application.

  2. If the participant is currently enrolled, refer to HCTC Coordinator prior to corresponding for missing information as some information can be obtained through vendor outreach.

  3. Change the status in the database to "Processing—Waiting for Supporting Documentation."

  4. The enrollment team sends an applicant Letter 4541 if Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, isn’t signed or is incomplete, the policyholder’s SSN is invalid, or supporting documents are missing or incomplete.

  5. If both Letters 4540, HCTC Notice of Ineligibility, and 4541 are needed, use Letter 4540 utilizing the open paragraph format. An applicant’s eligibility takes priority over defective items in an application.

  6. If signature is missing, return the unsigned Form 13441-A and all related documents to the applicant. See IRM 3.11.29.9.6, Inputting Form 13441-A Part 6: From Completion.

  7. If the signature is "X’d," crossed out, or lined through, either pre-printed or manually, return the original Form 13441-A and all related documents to the applicant with a blank Form 13441-A signature page.

  8. If you are not returning Form 13441-A to the applicant, remove the words "Enclosure: Your HCTC registration form" from page 2 of Letter 4541 prior to printing.

  9. When a response is received, or if the 45-day suspense period passes without a response:

    1. For an adequate response in which all required information is present and acceptable, update the information in the database to reflect the applicant’s response. See IRM 3.11.29.10, Setting the Status of the Application.

    2. For no response or an inadequate response in which required information is missing or unacceptable:

    • Send Letter 4540, HCTC Notice of Ineligibility, with the relevant paragraph "Incomplete registration form" or "Missing supporting documents," per the reason for the correspondence. If both reasons apply, send both explanations. See IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility.

    • Utilize the open paragraph with HQ pre-approved text.

    • Set the status of the application to Cancelled-Ineligible.

Letter 4545, HCTC Enrollment Letter

  1. Letter 4545, HCTC Enrollment Letter, notifies participants that their HCTC eligibility has been successfully processed. See Exhibit 3.11.29-10. Along with the standard address, date, and last four digits of the participant’s SSN:

    1. Enter the Participant ID number

    2. Enter the Monthly HCTC Payment in the field "Amount due" in the second paragraph

  2. If the participant is not currently enrolled, change the status in the database to "Complete" .

Letter 5758, Health Coverage Tax Credit Enrollment in Process

  1. Letter 5758, Health Coverage Tax Credit Enrollment in Process, is used to acknowledge receipt of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update and supporting documents. See Exhibit 3.11.29-11.

  2. Do not send this letter without explicit instructions from management.

Letter 5945, HCTC Reimbursement Approval

  1. Letter 5945, HCTC Reimbursement Approval, notifies participants that their request for reimbursement on Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form, has been approved and they should expect a payment within three weeks. Letter 5945 will be sent only when instructions are received from P&A. See Exhibit 3.11.29-12.

  2. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following (provided by P&A):

    1. Enter the Participant ID number

    2. Enter the reimbursement payment amount in the "$0.00" field in the second paragraph

Letter 5974, Annual HCTC Vendor Renewal Notification

  1. Letter 5974, Annual HCTC Vendor Renewal Notification, notifies Health Plan Administrator (HPA) or the Third-Party Administrator (TPA) that they must annually complete a Form 3881-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, to continue to receive Automatic Clearing House (ACH) payments from the HCTC program. See Exhibit 3.11.29-13. Along with the standard address, date, and last four digits of the vendor’s EIN (in the Taxpayer ID Number box) enter the following:

    1. Enter the HPA/TPA name

    2. Enter a due date in the "[insert date]" prompt in the third paragraph

Letter 6009, Refund of HCTC Payments

  1. Letter 6009, Refund of HCTC Payments, notifies participants that they will be receiving a refund of payments for applicable months. Letter 6009 will be sent only when instructions are received from P&A. See Exhibit 3.11.29-14.

  2. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following (provided by P&A):

    1. Enter the Participant Identification number (PIN).

    2. Enter the HCTC Program participant name following "Dear HCTC Program participant:"

    3. Use the drop-down box to make the appropriate selection of "month" or "months."

    4. Enter the name of the appropriate month(s) in the "[enter months]" prompt. Enter exactly as it will appear in the body of the letter.

    5. Enter the amount of payment being returned to the participant in the "[123,456.00]" prompt. Include comma separators for thousands (if needed) and cents. Enter exactly as it will appear in the body of the letter.

    6. If needed, utilize the open paragraph with HQ pre-approved text.

Letter 6011, Return of HCTC Funds

  1. Letter 6011, Return of HCTC Funds, is sent by HQ analysts to a participant to request the return of HCTC monies for any of the following reasons:

    1. Administrative Error

    2. Repayment of Other Benefits

    3. Participant Identification Number Mismatch

    4. Other

  2. The HCTC participant is requested to send a check to the HCTC CFO Beckley Finance Center.

  3. Documentation may be sent to the Enrollment Team, by the participant, and should be elevated to P&A.

  4. HQ will review the documentation and will send it back to the Enrollment Team to be attached to the participant’s file.

Form 4442, Participant Correspondence, and US Bank Correspondence

  1. Participant correspondence may be received by e-mail, fax, or forwarded from another department for processing. Forms 4442 are received from Accounts Management (AM). Participant correspondence and items received from Lockbox (US Bank) should be processed as Forms 4442.

    Note:

    If it is unclear if an item received should be processed as Form 4442, or if it is unclear what action is requested, refer to the HCTC Coordinator for determination.

  2. When participant correspondence or a Form 4442 is received, review the inquiry.

    • If the request is processable following normal procedures, process and respond as needed. Comment the database, describing any action taken.

      Note:

      Do not update the database based on unclear or ambiguous participant correspondence. If participant intent cannot be clearly determined, elevate to P&A or correspond.

    • If a copy of a US Bank rejection letter is received which begins "We have received your HCTC payment; however, we are unable to process your payment for the following reason(s):" , comment the database with the reason for rejection and add to the participant’s file.

    • If the request involves a payment question, Form 1099-H, or is not allowable following normal procedures, elevate to P&A.

    • If a remittance is discovered with participant correspondence, see IRM 3.11.29.8.

  3. When forwarding Form 4442 to AM, include a copy of any correspondence (member, third party, etc.) to assist customer service representatives (CSRs) when responding back to HCTC participants.

  4. Return Form 4442 to the originator if:

    1. The person named in Form 4442 isn’t in the database

      Exception:

      If the information attached is related to a Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, returned because an earlier submission wasn’t signed, or the SSN was invalid; the Form 4442 should be processed.

    2. Form 4442 doesn’t provide enough information to determine relevance, intention, or identify the applicant

    3. Form 4442 was sent to the Enrollment Team in error

  5. When P&A issues a substitute Form 4442 with instructions to the Enrollment Team:

    1. Process the item(s) as requested.

    2. Review the change for any additional actions generated, particularly correspondence criteria. See IRM 3.11.29.13

      Example:

      A premium change may require a letter to be issued.

    3. Review the database record for accuracy, if the “Last Modified” date will be affected. See IRM 3.11.29.4

    4. Comment the database with the action(s) taken.

    Note:

    If you see indications that the change may be incorrect due to an more recent update of the account or other supporting documentation, refer to the HCTC Coordinator.

  6. Due to the potential for specific harm to participants - up to and including lapses of health insurance - it is necessary to expedite some cases through the enrollment/update process. If an expedite request is issued, the document should be hand-walked through the enrollment/QR process before the end of the business day (unless otherwise specified).

    1. If correspondence is required on an expedited document, contact P&A and/or HQ to find out if the correspondence issue can be resolved by contacting the participant and/or vendor.

    2. If conflicting priorities make expediting the document impossible, P&A and/or HQ must be notified as soon as possible.

    3. Most expedite requests will be issued from HQ based on contact from the participant/vendor, but P&A and/or the HCTC Coordinator may make the determination if a potential for specific harm is identified. TEs may refer cases to the HCTC Coordinator for review if they believe it is necessary to expedite.

  7. Form 4442 must be attached to the back of Form 13441-A. See IRM 3.11.29.4, HCTC Program General Information.

Qualified Family Member Participant (QFMP)

  1. A Qualifying Family Member Participant (QFMP) is a family member (spouse or dependent) who may maintain their HCTC enrollment for 24 months after one of the following qualifying events:

    1. Eligible recipient is eligible for Medicare.

    2. Eligible recipient is deceased.

    3. If the QFM is divorced from the eligible recipient.

    Note:

    An "eligible recipient" is the PBGC payee or TAA recipient.

  2. A QFMP relies on the eligibility information of the eligible recipient but must meet all other requirements for enrollment.

    Caution:

    Do not confuse a family member who has a separate policy, or is the policy holder on the eligible recipient’s policy, for a QFMP. See IRM 3.11.29.9.

  3. New enrollments should be reviewed for QFMP status. Possible indications that Form 13441-A is related to a QFMP include (but are not limited to):

    1. Form 13441-A, General Instructions, box 5 is checked

    2. Form 13441-A is filled out for a name other than the eligible recipient

    3. Participant correspondence is attached

    4. Supporting documentation for QFMP status is present (see below)

    Note:

    If unable to determine if documentation indicates QFMP enrollment, refer to HCTC Coordinator.

  4. QFMP due to Medicare Eligibility – In most cases, an individual becomes eligible for Medicare the first day of their birth month the year they turn 65. An individual will remain HCTC eligible their entire birth month in which they turn 65.

    1. Form 13441-A for enrollment must be completed and signed by either the eligible recipient or the QFMP.

    2. One or more of the following must be true:
      - Eligible recipient is 65 or older.
      - Eligible recipient was previously enrolled and was unenrolled from HCTC AMP due to Medicare eligibility.
      - A Medicare enrollment letter, Medicare card, or other documentation of Medicare eligibility is present.

  5. QFMP due to Divorce – The spouse of the eligible recipient is eligible for enrollment following a divorce. Eligible dependents may be included on either policy.

    1. Form 13441-A must be completed and signed by the QFMP.

    2. A divorce certi?cate identifying the eligible recipient (or similar legal documentation) is required and must include the date of divorce

  6. QFMP due to Death – The spouse and/or dependents of a deceased eligible recipient are eligible for enrollment.

    1. Any spouse of the participant (determined at the time of death) is treated as an eligible individual

    2. Any individual who was a QFM immediately before such death is treated as an eligible individual

    3. The enrollment form must be completed and signed by the QFMP.

    4. A death certi?cate for the eligible recipient, (or similar documentation which includes the date of death) must be present.

  7. Determine the QFM Start Date field using qualifying event date:

    If Then
    QFMP is eligible due to Medicare In the QFM Start Date field, enter the first day of the qualifying event month.

    Example:

    Qualifying Event Date: 05/XX/2019; QFM Start Date: 05/01/2019

    QFMP is eligible due to divorce or death and was on eligible recipient’s medical policy on the date of the qualifying event In the QFM Start Date field, enter the first day of the following month.

    Example:

    Qualifying Event Date: 05/XX/2019; QFM Start Date: 06/01/2019

    QFMP is eligible due to divorce or death and was on a separate medical policy on the date of the qualifying event In the QFM Start Date field, enter the first day of the qualifying event month.

    Example:

    Qualifying Event Date: 05/XX/2019; QFM Start Date: 05/01/2019

    You cannot determine the date of the qualifying event Correspond per IRM 3.11.29.13.4 , Correspondence Letter 4540.
    The date of the qualifying event does not match the effective date on the form. Refer to the HCTC Coordinator for determination.
  8. If an individual is identified as a QFMP:

    1. Create the database record under the name of the QFMP.

    2. Edit the eligible recipient in Part 1, if not already present.

    3. Edit the policy holder in Part 4, if not already present.

    4. Include the QFMP name beside the Participant Identification Number in the top right corner of Form 13441-A.

    5. If a QFMP was previously enrolled under an eligible recipient, edit an action trail on both forms. Reference the QFMP PIN on the eligible recipient’s form and reference the eligible recipient’s PIN on the new QFMP form in the top left margin.

    6. Comment the database with “QFMP of [eligible recipient’s name.]” Include eligible recipient’s PIN, if established.

    7. Part 3, Family Member Information, will be completed normally if there is more than one person on the policy. Do not include the eligible recipient in Part 3.

    8. Complete the QFM information in Part 2: Eligibility in the HCTC database using the information above.

    9. The database will calculate an end date of 24 months after the start date.

Processing Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form

  1. Taxpayers can request 72.5% reimbursement for premiums they paid directly to their administrator while waiting to be accepted into the Advance Monthly Program by using Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form.

  2. General: When a Form 14095 is received in the Enrollment Team:

    1. The Enrollment Team will pull the original Form 13441-A and attach to the Form 14095.

      Note:

      If an unprocessed Form 14095 is attached to Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, refer to the HCTC Coordinator.

    2. The HCTC Coordinator will notify P&A as Forms 14095 are received in the unit

  3. P&A: When a Form 14095 is received, P&A will research eligibility for reimbursement.

    1. P&A will identify and elevate to HQ any discrepancies between information recording in the database and information supplied with Form 14095.

    2. HQ will determine the cause of the variance. If the cause can be determined, the amount should be corrected to reflect the database amounts when possible.

    3. Where HQ cannot determine the cause, the participant is reimbursed based on the attached proof of payment in conjunction with what is on the Form, ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?.

    4. If the participant paid less than their total premium amount for any month, the participant is reimbursed the substantiated amount. This includes pro-rated payments and partial payments required due to an unprocessed premium change.

    5. If the variance is greater than the tolerance correspondence is needed. See IRM 3.11.29.13, Correspondence.

    6. If P&A determines that supporting documentation does not support Form 14095 claim, they will prepare a Substitute Form 4442, Inquiry Referral, instructing the Enrollment Team to send Letter 4510 or Letter 4511, as appropriate.

    7. If P&A determines that supporting documentation does support Form 14095, they will submit the claim to HQ for final approval.

    8. On the 15th and 30th of each month, after HQ approval, either the P&A Analyst or HQ will forward the spreadsheet to the public mailbox ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? to be processed. If either the 15th or 30th fall on a non-business day, spreadsheet submission takes place on the business day immediately prior.

  4. Submit the spreadsheet to CFO with the following information:

    "The attached spreadsheet represents payment to participants who submitted Forms 14095. The (Month) (15th or 30th), 201X submission to CFO represents a total of $(Amount) for reimbursements of the 72.5% portion of the health insurance."

    "Retroactive Refunds, the government portion, Fund R0923HTC"

  5. Due to program constraints, Forms 14095 have an annual cutoff of October 1st and will resume after the beginning of the new year. Any reimbursement requests with a Received Date stamp after October 1 will need to be claimed on the participant’s federal tax return using Form 8885, Health Coverage Tax Credit. Forms 14095 with a Received Date stamp after October 1 for the current processing year will be returned to the participant with Letter 4510, using the open paragraph for the October cutoff date. See IRM 3.11.29.13.2, Letter 4510, HCTC Reimbursement Request - Denial.

  6. Enrollment Team: After processing is complete, P&A will return forms to the Enrollment Team for batching, correspondence, and comments.

  7. The Enrollment Team will prepare the required correspondence indicated by P&A on the substitute Form 4442 and add comments to the HCTC database. See IRM 3.11.29.13, Correspondence and IRM 3.11.29.4, HCTC Program General Information.

    1. Letter 5945, HCTC Reimbursement letter, will be used to approve reimbursed amounts. See IRM 3.11.29.13.8.

    2. Letter 4511, HCTC Reimbursement Request - Insufficient Documentation, will be used to request missing information. See IRM 3.11.29.13.3 .

    3. Letter 4510, HCTC Reimbursement Request - Denial, will be used to deny ineligible claims. See IRM 3.11.29.13.2

    Caution:

    Claims may be for multiple months; therefore P&A may indicate that more than one letter should be issued for the same claim.

  8. Attach Forms 14095, supporting documentation, and letters to the back of the participant’s original Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, as instructed in IRM 3.11.29.4, HCTC Program General Information

Form 14095, Part 2: Determine Eligibility and Request Reimbursement

  1. P&A will verify the following from Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form, with information in the HCTC database.

    1. The participant is eligible for the requested reimbursement month(s) while they were enrolling in the Advance Monthly Program (AMP) or chose not to be in the AMP program. Reimbursement can only be for January through September of the current calendar year.

      Note:

      Credit for October through December will need to be claimed on the participant’s Federal tax return using Form 8885, Health Coverage Tax Credit.

    2. Participant may be eligible for the requested reimbursement month(s) after they were enrolled in the program, in limited circumstances. If participant is requesting reimbursement for month(s) after enrollment in the HCTC AMP, refer to HQ for determination.

    3. The requested reimbursement months were for months the participant did not receive monthly program payments through their Health Plan Administrator (HPA) or Third Party Administrator (TPA).

Form 14095, Part 3: Gathering Supporting Documents

  1. P&A will verify that a health insurance bill, payment coupon, or similar documentation from the Health Plan Administrator (HPA) or Third Party Administrator (TPA) is present for the months identi?ed in Part 2 of Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form. These documents must contain the following information:

    1. Name of the participant

    2. Social Security Number (SSN) of the policy holder if different from requestor

    3. Name of health plan

    4. Monthly premium amount

    5. Dates of coverage

    6. Health plan ID number including one of the following:
      - Member ID
      - Group ID
      - Policy ID
      - Plan ID

  2. Proof of payment must indicate the amount paid and to whom it was paid. Proof of payment includes evidence of full payment of premiums, such as bank statement, copies of checks, credit card statements, or receipts for money orders.

  3. If it is unclear the available documentation is sufficient to support the claim, refer the claim to HQ for determination. Include a scan of all supporting documents.

Form 14095, Part 4: Sign and Date This Form

  1. Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form, must be signed. If form 14095 is not signed:

    1. Correspond with Letter 4511, HCTC Reimbursement Request - Insufficient Documentation. See IRM 3.11.29.13.3.

    2. Leave comments in the HCTC database specifically stating what is missing.

    3. File on suspense wall or designated area.

Replies to Form 14095, The Heath Coverage Tax Credit (HCTC) Reimbursement Request Form

  1. Replies to correspondence for Form 14095, The Heath Coverage Tax Credit (HCTC) Reimbursement Request Form, should be elevated to P&A. This includes participants appealing the decision or requesting additional information on the determination.

  2. P&A will review replies and return forms to the Enrollment Team for batching and correspondence.

SF-1034, Public Voucher for Purchases and Services other than Personal, Monthly Payment Reconciliation

  1. Each month the Department of Treasury transmits 100% of the insurance premium payments to the Health Plan Administrator (HPA) or Third-Party Administrator (TPA) through a payment file for all enrolled participants associated with the HPA/TPA’s vendor number. This payment ?le is used to reconcile payments for each participant.

  2. If after reconciliation it is discovered participants had an unapproved vendor, duplicate payments, misapplied payments, were using an incorrect Participant Identification Numbers (PIN), among other instances, then HPA/TPA/Individuals may be refunded their 27.5% portion of the insurance premium. This reimbursement is processed with a Standard Form 1034, Public Voucher for Purchases and Services other than Personal.

  3. Payment reconciliation is handled on a case-by-case basis by P&A and HQ with two different processes: individuals and vendors.

  4. For individuals, the reimbursement process is completed by P&A on a spreadsheet and goes through HQ for approval. After approval, the spreadsheet is submitted to CFO by P&A.

    1. When submitting the spreadsheet to CFO, use the following information:

      "The 1034 spreadsheet represents HCTC payments to participants based on reconciliation. The spreadsheet submission for (month day), 201(X) is a total of $(amount) in payments of the 27.5% portion of their health insurance. Fund R6163HTC."

    2. For individuals, the spreadsheet is submitted using:
      Vendor number 02020069
      Fund R6163HTC

  5. Once the SF-1034 reimbursement spreadsheet for individuals has been submitted to CFO, it will be provided to the Enrollment team for batching so that comments can be added to the database notating the issuance of the 1034 payments.

  6. For vendors, the reimbursement process is completed by the Enrollment Team Work Leader with direction from HQ and goes through a routing path for approval. After approval, Standard Forms 1034 are submitted to CFO by the Enrollment Team Work Leader.

  7. The Austin Submission Processing designated authorized certifying officers for vendor’s SF-1034 are as follows:

    1. Primary
      Denise Bradley, Operations Manager, DPO

    2. Back-ups
      Maureen Varnado, P&A Chief, SP
      Steve Harmon, P&A Manager, SP

  8. The 1034 reimbursements will be added to the payment file within the HCTC database by P&A.

  9. If the Enrollment Team is contacted regarding a reconciliation issue, elevate to P&A.

    Figure 3.11.29-7

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Completing SF-1034

  1. Use the following information, to complete SF-1034 for vendor reimbursement. See Figure 3.11.29-7.

    • Input the voucher number in the format of HPA/TPA MM-YYYY (M=month Y= year). For example, BCBSM 01-2017.

    • U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION – HCTC Program – Austin Enrollment Team

    • DATE VOUCHER PREPARED – Enter date voucher is prepared

    • CONTRACT NUMBER AND DATE, REQUISITION NUMBER AND DATE, SCHEDULE NO, and PAID BY– Leave Blank

    • DATE INVOICE RECEIVED – Enter date voucher is prepared

    • DISCOUNT TERMS – Leave Blank

    • PAYEE’S ACCOUNT NUMBER – Enter the vendor’s employer identification number (EIN)/taxpayer identification number (TIN)

    • PAYEE’S NAME AND ADDRESS – Enter the vendor identification number followed by vendor’s name and address. For example:
      Vendor Number 00012345
      John Doe Insurance
      123 Main Street.
      Anytown, TX 78704

    • SHIPPED FROM, TO, WEIGHT, GOVERNMENT B/L/ NUMBER, NUMBER AND DATE OF ORDER (column), and DATE OF DELIVERY OR SERVICE (column) – Leave Blank

    • ARTICLES OR SERVICES (column) – Enter a description for the reimbursement, the date of the return of funds (if available), the program name (HCTC AMP (Advance Monthly Payment)), and a breakdown of the government’s percentages and the participant’s percentage. For example:
      Payment to (vendor) to reconcile (month(s)).
      Return of Funds from (vendor) on (date)
      HCTC AMP
      27.5% portion = (calculate 27.5% of total)
      72.5% portion = (calculate 72.5% of total)

    • QUANTITY (column) and UNIT PRICE (column) – Leave Blank

    • AMOUNT – Enter amount of reimbursement

    • TOTAL – Enter total amount of reimbursement. This amount must match the APPROVED FOR amount.

    • PAYMENT (check boxes) – Leave Blank

    • APPROVED FOR – Enter the amount of reimbursement. This amount must match the TOTAL amount.

    • EXCHANGE RATE, DIFFERENCES, BY(2), and TITLE– Leave Blank

  2. ACCOUNTING CLASSIFICATION Section

    1. Enter the appropriate Accounting Classi?cation Codes provided by CFO for the 72.5% appropriation account.

      Example:

      For the 72.5% appropriation account use the following:


      Fund: R0923HTC
      Commitment: 41
      Funds Center RA04
      Functional Area - RMAD
      Order - CHTC
      Business Area – 0002

    2. Enter the appropriate Accounting Classi?cation Codes provided by CFO for the 27.5% appropriation account.

      Example:

      For the 27.5% appropriation account use the following:


      Fund: R6163HTC
      Commitment: 2400
      Funds Center RA04
      Functional Area - RMAD
      Order - CHTC
      Business Area – 0002

Form 8885, Health Coverage Tax Credit

  1. Any documentation related to Form 8885, Health Coverage Tax Credit, received in the Entity unit should first be reviewed to determine if it is related to the Advanced Monthly Program or Form 1040.

    1. If the documentation was sent in support of the Advanced Monthly Program, it should be processed following standard HCTC procedures.

    2. If the documentation was sent in support of Form 1040, route to CIS/AM.
      - Edit "(HCTC)" in the left margin
      - Place in your route-out folder

Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC

  1. Health Plan Administrators (HPA) and Third Party Administrators (TPA) must be able to receive payments via Electronic Funds Transfer (EFT) processed through the Direct Deposit Program as an Automated Clearing House (ACH) payment.

  2. HPAs/TPAs must be enrolled in the EFT program to receive insurance premium payments for their customers who are participants in the HCTC program. Receiving electronic payments ensures timely, accurate payments and reduces the risk of payments being misdirected within the HPA/TPA’s organization.

  3. HPAs and TPAs must complete Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC, to enroll and begin receiving HCTC payments. If a vendor is not set-up as an approved HCTC vendor, correspond with Letter 4540 using selectable paragraph 9. See IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility.

  4. Once a HPA/TPA has sent Form 3881-A and is established to receive payments, they do NOT need to submit another Form 3881-A if additional individuals enroll after the HPA/TPA is established.

  5. However, a HPA/TPA must recertify each year by submitting a new Form 3881-A. See IRM 3.11.29.20.2, Recertifying with Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC.

Submitting and Updating Form 3881-A

  1. Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC, is processed by the HCTC Coordinator. If attached to an application, elevate to the Coordinator.

  2. Form 3881-A may be received through the Stakeholder mailbox, submitted with an application, or sent through the mail. If a physical form is sent in, scan the form and e-mail it to yourself.

  3. Once there is an electronic version of Form 3881-A, verify the following information is included:

    • Agency Information Federal program agency

    • Agency Information Agency Identifier

    • Agency Information Agency Location Code (ALC)

    • Agency Information ACH format (checkbox)

    • Agency Information Address

    • Payee Name

    • Payee SSN or Taxpayer ID number

    • Payee Address

    • Payee Contact person name

    • Payee Contact e-mail address

    • Payee Telephone number

    • Financial Institution Name

    • Financial Institution’s Telephone number

    • Financial Institution Nine-digit routing transit number

    • Financial Institution Depositor account number

    • Financial Institution Type of account

    • Financial Institution Signature of authorized official

    • Financial Institution Title of authorized official

    • Financial Institution Telephone number of authorized official

  4. If any of the above information is missing, elevate to P&A. P&A will work with HQ to obtain the required fields.

  5. Once the form is complete, forward, via secure e-mail using IRS IT-approved encryption technology, to the following contacts FROM THE STAKEHOLDER’S MAILBOX:

    1. *CFO BFC Electronic Obligations <CFOBFC.ElectronicObligations@irs.gov>

    2. Aliff Rose M <Rose.M.Aliff@irs.gov>

    3. Bahr Kevin <Kevin.Bahr@irs.gov>

    4. *W&I HCTC STAKEHOLDER ENGAGEMENT <WI.HCTC.Stakehldr.En@irs.gov>

      Note:

      If the form is forwarded from your personal e-mail, it will not be accepted and will be sent back.

      Note:

      Refer to IRM 10.5.1, Privacy Policy, for guidance on the use of IRS IT-approved encryption technology when conducting IRS official business.

  6. Once CFO assigns a vendor number, save and upload Form 3881-A to the Form 3881-A HCTC Vendor folder located on the HCTC SharePoint.

Recertifying with Form 3881-A

  1. Health Plan Administrators (HPA) and Third Party Administrators (TPA) must recertify annually to receive insurance payments from their participants via Electronic Funds Transfer (EFT) through the Direct Deposit Program as an Automated Clearing House (ACH) payment by submitting a new Form 3881-A.

  2. For Recertification:

    1. HQ Analysts will receive monthly notifications of expiring vendors from Beckley Finance Center via the HCTC Stakeholder mailbox.

    2. HQ Analysts will provide a one-month notification to P&A either through e-mail or spreadsheet of upcoming renewals.

    3. P&A will issue notifications as Forms 4442, Inquiry Referral, to the Enrollment Team. See IRM 3.11.29.14, Form 4442, Inquiry Referral.

    4. The Enrollment Team will generate a Letter 5974, Annual HCTC Vendor Renewal Certification, for the HPA/TPA. See IRM 3.11.29.13.9, Letter 5974.

    5. The Enrollment Team will batch the notifications as Forms 4442. See IRM 3.11.29.14.

    6. The Enrollment Team will notify P&A of completion and HQ will monitor the renewals.

Payment Submission / Lockbox / Daily Mail-Out Package

  1. HCTC participants are instructed to send their payments to a lockbox depository for payment processing.

  2. If payment(s) received at the lockbox require additional information to process, such as a missing or invalid Participant Identification Number, Lockbox will request the missing information from the Enrollment Team, via fax by 12:00 p.m. CST daily.

  3. The Enrollment Team will research the HCTC database for missing information/invalid Participant Identification Number and provide a response to Lockbox by 10:00 a.m. CST the next business day ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?.

  4. If the Enrollment Team supplies sufficient information for the missing/invalid PIN, the Lockbox site will process the remittance.

  5. If a valid PIN number cannot be located, Lockbox will reject the payment back to the participant with all original contents.

  6. The Lockbox site will return rejected payments/unprocessable items back to the participant, with a reject letter. A copy of the reject letter and all contents that were mailed to the participant will be sent from Lockbox to the Enrollment Team, with a Form 3210, Document Transmittal, as part of a daily mail out package.

  7. As part of the daily package mail-out to the Enrollment Team, Lockbox will include correspondence items and envelopes received at the Lockbox site in which the site processed the participant’s remittance. Correspondence includes an item received that is not a payment coupon or remittance.

  8. The Lockbox site must use an approved dedicated overnight private delivery/ freight service (e.g., FedEx, DHL, and UPS) to deliver shipments to the Enrollment Team.

  9. Once the shipment is received, the Enrollment Team will:

    1. Verify the contents were received and sign the acknowledgment copy of the Form 3210. The Enrollment team will return the signed, dated and acknowledged Form 3210, to the Lockbox site by 2:00 p.m. local time, ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?.

    2. Batch the content as Form 4442s. See IRM 3.11.29.14, Form 4442, Inquiry Referral.

  10. If Lockbox does not have a daily mail out package to send to the Enrollment Team, they will send an e-mail to the Stakeholder mailbox to advise there is no mail out package.

Insufficient Funds Notification

  1. Lockbox will send an e-mail to the Stakeholder mailbox when insurance premium payments have been returned due to insufficient funds.

  2. Insufficient Funds are worked by P&A and HQ.

Unprocessables / Rejects

  1. Lockbox will send the daily Payment Reject Letter Tracking Report, copies of the reject letter, and correspondence to the Enrollment Team. See IRM 3.11.29.21, Payment Submission / Lockbox / Daily Mail-Out Package and IRM 3.11.29.26, Daily Reports.

  2. The Rejected payments are worked by P&A and HQ.

  3. Once official notification of rejected payments is received, the payments are added to the Return of Funds (ROF) spreadsheet and tracked for the 27.5% reimbursement allowed on Standard Form 1034, Public Voucher for Purchases and Services other than Personal. See IRM 3.11.29.18, SF-1034, Public Voucher for Purchases and Services other than Personal, Monthly Payment Reconciliation.

  4. Once payments are researched to determine both the cause of the return and where the payment should now be applied, they are added to the database by P&A and comments are added or updated in the database.

Operations Assistance Request (OARs)

  1. Operations Assistance Request (OARs) from Taxpayer Advocate Services are normally received through the Stakeholder mailbox (*W&I HCTC STAKEHOLDER ENGAGEMENT <WI.HCTC.Stakehldr.En@irs.gov>) and are worked by P&A.

  2. If any OARs are received outside of the Stakeholder mailbox, refer to the HCTC Coordinator to be elevated to P&A.

Record Retention Requirements

  1. Forms 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, must be retained in AUSP Files or designated area for five (5) years, then retired to the Federal Record Center (FRC) to follow the Record Retention requirements for Document 12990, Records and Information Management Records Control Schedules.

  2. The Lockbox site must capture an image of the front and back of all remittances and the payment posting documents (vouchers, facsimiles, remittance photocopies) for all transactions they process.

    1. The Lockbox site must retain electronically processed remittances for a period of ?ve (5) business days after the electronic check processing (ECP) settlement date. These documents must be kept in a manner that is easily retrievable.

    2. The Lockbox site must retain paper vouchers or payment posting documents/ facsimiles/photocopies for a period of ?ve (5) business days after the ECP settlement date. These documents must be kept in a manner that is easily retrievable.

    3. RTR (Image) ?les must be retrievable for a period of 30 calendar days from creation.

Daily Reports

  1. The following daily reports are prepared and submitted by Lockbox through the Stakeholder mailbox.

    1. Daily Deposit Production Report

    2. Payment Reject Letter Tracking Report

  2. The Daily Deposit Production Report shows payments processed and other activity, such as overpayments.

  3. The Payment Reject Letter Tracking Report must include the following:

    1. The date the reject letter was mailed to the participant by Lockbox

    2. Participant’s last name

    3. Participant Identification Number (PIN)

    4. A reason the item was rejected (A-H)

    5. A daily count of the rejected items

  4. If the reject reason is "H" (other), a comment must be added to explain the reason the payment was rejected. If payment was rejected for an invalid or missing PIN (Reason Code D) and faxed to the Austin Enrollment Team, the date and time of fax is entered.

  5. The Lockbox Site must retain copies of rejected items such as reject letters, original payment coupons, remittances and correspondence on site for one year in retrievable format to support responses to government inquiries.

Weekly Reports

  1. There are three weekly reports for the HCTC program: Weekly Statistical Report, HCTC Production Report, and the HCTC Weekly Refund Report.

  2. Weekly Statistical Report. The report is received every Monday morning from the HCTC Coordinator or Entity Team Work Leader to provide weekly data on HCTC volumes.

  3. HCTC Production Report. This report is received from P&A each Monday.

  4. HCTC Weekly Refund Report. This report is received weekly from Beckley Finance Center and is used by HQ and P&A to reconcile payments. The report shows return of funds from Health Plan Administrators (HPAs)/ Third Party Administrators (TPAs). It is received with a zero balance if there are no return of funds for the week.

HCTC TAA, ATAA, and RTAA Certification Document

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Pension Benefit Guaranty Corporation (PBGC) Letter of Acknowledgment

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Pension Benefit Guaranty Corporation (PBGC) Pension Verification Letter

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Example of Form 1099-R

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Letter 3772 - End of Program Letter

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Letter 4510 - HCTC Reimbursement Request Denial

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Letter 4511 - HCTC Reimbursement Request - Insufficient Documentation

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Letter 4540 - HCTC Notice of Ineligibility

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Letter 4541 - HCTC Candidate Insufficient Documentation - System Letter

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Letter 4545 - HCTC Enrollment Letter

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Letter 5758 - Health Coverage Tax Credit Enrollment in Process

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Letter 5945 - HCTC Reimbursement Approval

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Letter 5974 - Annual HCTC Vendor Renewal Notification

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Letter 6009 - Refund of HCTC Payments

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Letter 6011 - Return of HCTC Funds

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