Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Premium Calculations and Other
Program Area: Small Business Health Options Program (SHOP)
Question: Will the geographic area premium rating factor in the small group market be based on the geographic area of the employee or that of the employer? Will this approach apply only for plans offered through the FF-SHOPs or will it apply market-wide?
Answer: As proposed in the Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards published on June 19, 2013 (Federal Register / Vol. 78, No. 118), the geographic area premium rating factor must be based on the group policy holder's principal business address in each state. This approach would apply both inside and outside of the FF-SHOP. This draft regulation was finalized as proposed.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 05, 2013
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