Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Employer/Employee Interaction and Eligibility
Program Area: Small Business Health Options Program (SHOP)
Question: Will the Federally-facilitated Small Business Health Options Program (FF-SHOP) verify dependent eligibility? For example, if a subscriber is enrolling a child over age 26, will the FF-SHOP verify that the child is eligible to continue past age 26 or will issuers have to verify this information?
Answer: Based on information submitted to the Centers for Medicare & Medicaid Services (CMS) on the Business Rules Template, the FF-SHOP will not allow a child over age 26 (or whatever upper-threshold age is defined by an issuer based on State law/regulation) to enroll in a particular FF-SHOP. For dependents over the allowable age, the employee application has a "disabled adult dependent/ward" category that may be used to enroll an individual in coverage. The FF-SHOP does not verify that a child is eligible to continue past age 26.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: June 26, 2014
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.