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Eligibility Factor Self- Attestation Accepted without Additional Verification Self- Attestation Accepted with Post- Enrollment Verification (Y/N) Electronic Data Source Used (Y/N) If Yes, please describe in comments Paper Documentatio n Required from the Individual (Y/N) Non- Applicabl e (N/A) Comments 5e. Waiting period exception #5 (describe): YES NO NO NO COBRA cancelled or ended 5f. Waiting period exception #6 (describe): YES NO NO NO non-custodial parent dropped coveraged 5g. Waiting period exception #7 (describe): YES NO NO NO urgent medical care needed 5h. Waiting period exception #8 (describe): YES NO NO NO current coverage does not meet medical need 5i. Waiting period exception #9 (describe): YES NO NO NO reach benefit or lifetime limit 5j. Waiting period exception #10 (describe): YES NO NO NO domestic vilolence 6. Other eligibility factors or exceptions to eligibility factors: (Please describe in the space provided below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION C - Additional Factors of Eligibility for Separate CHIP 11