On/Off-Exchange Decision Record
Help users document the selected coverage path, subsidy consequences, reimbursement availability, and evidence for an on-exchange or off-exchange decision.
Purpose
Help users document the selected coverage path, subsidy consequences, reimbursement availability, and evidence for an on-exchange or off-exchange decision.
When to use
Use when a participant, advisor, or support lane needs to document why a coverage path was selected or routed for review.
Who should use this
Employee support owner, advisor, broker, HR, compliance reviewer, or participant support lane.
Review boundary
Exchange path, subsidy eligibility, tax reconciliation, and reimbursement consequences can be fact-specific and should be routed to the appropriate advisor or reviewer.
Resource sections
Coverage path under consideration
- Identify on-exchange, off-exchange, or unknown path.
- Capture the reason the path matters.
- Separate facts from advice.
Why on-exchange may matter
- Flag Marketplace application, subsidy, CSR, and eligibility implications.
- Record review owner for subsidy questions.
- Retain source or reviewer note.
Why off-exchange may matter
- Flag carrier/direct enrollment, plan availability, and reimbursement considerations.
- Note any subsidy tradeoff questions.
- Route uncertain questions.
APTC/CSR interaction reminder
- Identify whether APTC or CSR coordination is relevant.
- Link the coordination worksheet when used.
- Avoid tax or subsidy determinations outside assigned role.
ICHRA reimbursement availability reminder
- Confirm whether the selected path is intended to support reimbursement.
- Link offer, affordability, or opt-out records if applicable.
- Route reimbursement uncertainty.
Payment and enrollment path
- Record where enrollment and first payment confirmations should live.
- Flag payment-risk escalation needs.
- Confirm owner for participant reminders.
Participant decision note
- Capture participant decision or next step under approved workflow.
- Do not over-collect personal facts.
- Retain the note location.
Review owner
- Name advisor, tax, Marketplace, or compliance reviewer where needed.
- Record open questions.
- Use escalation if the path affects eligibility, subsidy, or reimbursement.
Evidence location
- Record path decision, review notes, enrollment/payment confirmation location, and advisor notes.
- Export or print this record if needed.
- Link related evidence resources.
Evidence to retain
- Coverage path decision record - Retain with the audit file, evidence map, or review record as applicable.
- APTC/CSR review note, if applicable - Retain with the audit file, evidence map, or review record as applicable.
- ICHRA affordability or opt-out note, if applicable - Retain with the audit file, evidence map, or review record as applicable.
- Enrollment confirmation location - Retain with the audit file, evidence map, or review record as applicable.
- Payment confirmation location - Retain with the audit file, evidence map, or review record as applicable.
- Advisor/reviewer note - Retain with the audit file, evidence map, or review record as applicable.
Evidence is not saved in this static version. Assign an owner, repeat the process consistently, review exceptions, explain the rationale, and retain copies in the employer file or local project record.
Print, Copy, or Export This Resource
No database records or server-side files are created. Use these browser-only actions to retain a local copy.
Exchange path, subsidy eligibility, tax reconciliation, and reimbursement consequences can be fact-specific and should be routed to the appropriate advisor or reviewer.