Cal. Code Regs. tit. 10, § 6464 – Identity Verification Requirement.

(a) Definitions. For purposes of this section, the following terms shall have the following meanings:
1. (1) RIDP: Remote Identity Proofing service;
2. (2) FDSH: Federal Data Service Hub;
3. (3) Certified Representative:
  1. (A) Service Center Representative: An Exchange employee operating in a call center as set forth in 45 C.F.R. Section 155.205(a) (December 22, 2016), hereby incorporated by reference;
  2. (B) Certified Enrollment Counselor as defined in section 6650;
  3. (C) Certified Application Counselor as defined in section 6850;
  4. (D) Certified Insurance Agent as defined in section 6410;
  5. (E) Certified Plan-Based Enroller as defined in section 6410;
  6. (F) Medi-Cal Eligibility Staff as described in California Code of Regulations, title 22, section 50105;
  7. (G) Certified Medi-Cal Managed Care Plan Enroller as defined in section 6900.
(b) Paper Applications
1. (1) The Exchange shall accept only paper applications for health insurance coverage that are accompanied by a signature in ink, under penalty of perjury in the declaration and signature section of the Exchange's paper application as defined in section 6470(d).
2. (2) The Exchange shall not accept or process any paper application lacking a signature in ink, under penalty of perjury in the declaration and signature section of the Exchange's paper application as defined in section 6470(d).
(c) Non-paper Applications
1. (1) Prior to initiating an application as set forth in section 6470, an applicant shall consent to have their identity verified.
2. (2) Prior to initiating an application as set forth in section 6470, an applicant shall submit their identity for verification using one of the following methods:
  1. (A) Visual Verification
    1. 1. An applicant shall mail, present in person, or electronically transmit through CalHEERS to the Exchange or to a Certified Representative acceptable proof of identity as follows:
      1. (i) A copy of a valid identification card issued by a federal, state, or local governmental entity that bears a recognizable photograph of the applicant or other identifying information of the individual such as name, age, sex, race, height, weight, eye color, or address, including school identification card, voter registration card, Military Dependent's identification card, Native American Tribal document, U.S. Coast Guard Merchant Mariner card, a Certificate of Naturalization (Form N-550 or N-570), Certificate of U.S. Citizenship (Form N-560 or N-561), Permanent Resident Card or Alien Registration Receipt Card (Form I-551), Employment Authorization Document Card that includes a photograph (Form I-766), Foreign Passport or identification card issued by a foreign embassy or consulate that contains a photograph, U.S. Visa that contains a photograph, Border Crossing Card (Form DSP-150), or
      2. (ii) Two of the following: a birth certificate, Social Security card, marriage certificate, divorce decree, employer identification card, high school or college diploma (including high school equivalency diplomas), property deed or title, an adoption decree for the adoptee, foreign school record that includes a photograph, notice from a public benefits agency, or a union or worker center identification card.
    2. 2. If submitted in person or by mail, a Certified Representative shall upload a copy of the identity documents to CalHEERS.
  2. (B) Remote Identity Proofing
    1. 1. If the applicant does not elect to have their identity verified pursuant to subdivision (c)(2)(A), they shall consent to allowing the Exchange or Certified Representative to use the FDSH RIDP service or other HHS-approved data source to access their identity information.
    2. 2. The applicant shall provide at least two pieces of personal information which will be compared with information obtained from the FDSH RIDP service or other HHS-approved data source.
    3. 3. Based on the comparison referenced in subdivision (c)(2)(B)2. of this section, the FDSH RIDP service or other HHS-approved data source will either verify the applicant's identity or provide information on how to complete an alternative identity verification process.
3. (3) If the Exchange is unable to verify the identity of an applicant in accordance with subdivision (c)(2) of this section, neither the Exchange nor a Certified Representative shall accept an application for health insurance from that same applicant until one of the following is satisfied:
  1. (A) The applicant successfully completes the alternative identity verification process, which may include collection of a photograph of the applicant's face, and the FDSH RIDP service or other HHS-approved data source informs the Exchange or Certified Representative of such;
  2. (B) The applicant completes the visual verification process as set forth in subdivision (c)(2)(A) of this section; or
  3. (C) The applicant submits a paper application in accordance with subdivision (b) of this section.
(d) An applicant who successfully completes the identity verification requirements set forth in this section may, if otherwise permitted, apply for health insurance for themself and for members of their household, without those household members also satisfying the requirements set forth in this section.
(e) Consumers, as defined in section 6650, who submitted an application prior to the effective date of this section are subject to the requirements of this section if they make a change to the Primary Contact screen.
(f) This section shall not apply to individuals applying through CCSB (as defined in section 6410).

Note: Authority cited: Section 100504(a)(6), Government Code. Reference: Sections 100503(a), 100503(h) and 100503(s), Government Code; and 45 C.F.R. Section 155.205.

History

1. New section filed 9-17-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-17-2014 (Register 2014, No. 38). A Certificate of Compliance must be transmitted to OAL by 9-19-2016 or emergency language will be repealed by operation of law on the following day.

2. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 9-19-2017 or the language in the emergency order of 9-17-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).

3. Refiling of 9-17-2016 order, including further amendment of subsections (c)(2)(A)1.(i)-(ii), (c)(3)(A) and (f), on 11-28-2016 as a deemed emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 833 (Stats. 2016, c. 30); operative 11-28-2016 (Register 2016, No. 49). A Certificate of Compliance must be transmitted to OAL by 9-18-2019 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 9-17-2016 order, including further amendment of subsections (a)(3)(A), (a)(3)(C), (b)(1)-(c)(1), (c)(2)(A)1.(i), (c)(2)(B), (c)(2)(B)3., (c)(3)(A)-(B) and (e) and amendment of Note, transmitted to OAL 8-27-2019 and filed 10-9-2019; amendments effective 10-9-2019 pursuant to Government Code section 11343.4(b)(3) (Register 2019, No. 41).

5. Editorial correction of subsections (a)(3)(A), (a)(3)(C), (b)(1)-(c)(1), (c)(2)(A)1.(i), (c)(2)(B), (c)(2)(B)3., (c)(3)(A)-(B) and (e), correction of Note and addition of History 4 (Register 2025, No. 5).

6. Amendment filed 2-10-2025; operative 2-10-2025 pursuant to Government Code section 11343.4(b)(3) (Register 2025, No. 7).

7. Amendment of subsections (a)(3)(C), (c)(1), (c)(2)(A)1.(i), (c)(2)(B)2., (c)(2)(B)3. and (c)(3)(A), repealer of subsections (c)(1)(A)-(c)(1)(B)2. and (c)(2)(B)2.(i)-(iii) and amendment of Note filed 10-13-2025; operative 10-13-2025 pursuant to Government Code section 11343.4(b)(3) (Register 2025, No. 42).