Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Premium Calculations and Tobacco Surcharge
Program Area: Small Business Health Options Program (SHOP)
Question: If an employee or enrollee's dependent already enrolled in coverage through the FF-SHOPs decides to participate in a wellness program in the middle of a plan year after initially declining the offer of such enrollment, will his or her premium be reduced immediately or retroactively to the time of open enrollment?
Answer: In the FF-SHOPs, an employee's or employee's dependent's premium will be established for a period of one year upon enrollment, renewal, or re-enrollment of that employee or dependent. At that time, the enrollee or dependent can agree to participate in a wellness program meeting the standards of section 2705 of the Public Health Service Act, such as a tobacco cessation program in order to avoid the tobacco premium surcharge. If the employee or dependent does not agree at that time to participate in such a wellness program, the employee or dependent will have an opportunity to avoid the tobacco premium surcharge upon renewal or reenrollment for subsequent coverage.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 13, 2013
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