Employee Benefits Compliance, Exchanges, Exchanges / Marketplaces / Subsidies, Laws, Regulations & FAQs, Marketplaces, Small Employers

SHOP Exchange Proposed Rules Issued: March 2013

On March 1, 2013 HHS issued proposed rules on small business health exchanges, also known as the Small Business Health Options Program (SHOP). The rules propose to amend certain standards established in the previously issued final rule on the Establishment of Exchanges.

Special Enrollment Periods

The earlier final rule set a special enrollment period at 60 days from the date of the triggering  event.

The newly proposed rule makes several changes to the special enrollment period for the SHOP, to make it consistent with the rules that currently apply to group health plans:

  • Changes the notice period from 60 days to 30 days for most applicable triggering events. 
  • Adds becoming newly eligible or becoming newly ineligible for premium assistance under Medicaid or the Children’s Health Insurance Program (CHIP) as a triggering event and allows 60 days for the special enrollment period in this situation

Selecting QHPs in the SHOP

The earlier final rule required the SHOP to allow employers the option to offer employees all QHPs at a particular metal level of coverage chosen by the employer.  Additionally, the SHOP may allow employers to offer one or more QHPs to qualified employees by other methods.

Under newly proposed rules, and for plan years beginning on or after January 1, 2014 and before January 1, 2015, a SHOP would not be required to permit qualified employers to offer their qualified employees a choice of QHPs at a single metal level of coverage but would have the option of doing so.

Federally-facilitated SHOPs (FF-SHOPs), however, would not exercise this option during this initial period (i.e., for plan years beginning on or after January 1, 2014 and before January 1, 2015), but would instead assist employers in choosing a single QHP to offer their qualified employees.  After January 1, 2015, FF-SHOPs will begin to offer employee choice and premium aggregation.