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Privacy Act Statement

Effective October 1, 2013

The Patient Protection and Affordable Care Act (Public Law No. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law No. 111-152), and the Social Security Act authorizes DC Health Link to collect the information on your application and any necessary supporting documentation, including social security numbers, to determine whether you and the listed people on your application are eligible for health coverage or help paying for health coverage.

We need the information you told us on your application about yourself and the other people listed on your application to determine eligibility for: (1) enrollment in a qualified health plan through DC Health Link, (2) insurance affordability programs (such as Medicaid, advanced payment of the premium tax credits, and cost sharing reductions), and (3) certifications of exemption from the individual responsibility requirement. As part of that process, we will electronically verify the information you told us on your application; communicate with you or your authorized representative, if you choose to have one; and eventually provide the information to the health plan you select so that they can enroll any eligible individuals in a qualified health plan or insurance affordability program. We will also use the information in the future to conduct activities such as verifying your continued eligibility for health coverage or help paying for health coverage, processing appeals, reporting on and managing the insurance affordability programs for eligible individuals, performing oversight and quality control activities, combatting fraud, and responding to any concerns about the security or confidentiality of the information.

While providing the information we ask you on the application (including social security numbers) is voluntary, failing to provide the information may delay or prevent you from obtaining health coverage or help paying for health coverage through the DC Health coverage. You should also know that if you don't have an exemption from the shared responsibility payment and you don’t maintain qualifying health coverage for three months or longer during the year, you may be subject to a tax penalty. If you don't provide correct information on this form or knowingly and willfully provide false or fraudulent information, you may be subject to a penalty and other law enforcement action.

  1. In order determine if you and the people on your application are eligible for health coverage or help paying for health coverage, and to operate DC Health Link, we will electronically check the information you told us on your application with the information in other electronic data sources. We will need to share your information with other District and Federal government agencies, such as the Internal Revenue Service (IRS), the Social Security Administration (SSA), and the Department of Homeland Security (DHS);
  2. Other electronic data sources, including consumer reporting agencies;
  3. Employers identified on applications for eligibility determinations;
  4. Applicants/enrollees, and the authorized representatives of applicants/enrollees;
  5. Agents, Brokers, and issuers of Qualified Health Plans, as applicable, who are certified by DC Health Link who assist applicants/enrollees;
  6. Contractors we engage to help run DC Health Link; and
  7. Anyone else as required by law.

This statement provides the notice required by the Privacy Act of 1974 (5 U.S.C. § 552a(e)(4)).