Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding 834 Transaction and Effectuation Transaction
Program Area: Small Business Health Options Program (SHOP)
Question: Are FF-SHOP Issuers required to hold enrollment confirmation/effectuations until after payment is received?
Answer: Issuers participating in the FF-SHOP Marketplaces are not required to hold enrollment confirmation/effectuations until after payment is received. In fact, per Section 156.285(c)(7)(iii), issuers participating in FF-SHOP Marketplaces are required to effectuate SHOP coverage unless the issuer receives a cancellation transaction prior to the coverage effective date. Cancellation transactions will be sent to issuers if the FF-SHOP does NOT receive the initial binder payment by a specified date prior to the coverage effective date.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 01, 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.