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Small Business Health Options Program (SHOP) FAQ

Guidance for FAQ regarding Employer/Employee Interaction and Minimum Participation Rate

Program Area: Small Business Health Options Program (SHOP)

Question: Will an employer be able to participate in the FF-SHOP if it does not meet the 70 percent minimum participation requirement?

Answer: For coverage effective January 1, the guaranteed availability requirements in the Public Health Service Act (PHSA) 2702 will apply, as required in 45 CFR 147.104(b)(1)(i). During this special enrollment period (November 15 - December 15), an employer is not subject to a minimum participation requirement and any employer otherwise qualifying for FF-SHOP coverage will be able to enroll in the FF-SHOP regardless of its level of employee participation. Outside of this period, the minimum participation requirement will be enforced for new groups applying for FF-SHOP coverage. This guaranteed availability requirement will be in effect as of November 15 -December 15, 2013. Outside of the annual special enrollment period, the FF-SHOP will hold an employer's application until the employer meets the 70 percent minimum participation requirement (or the threshold required in that employer's state). The FF-SHOP will not send any information to Issuers until the group has met the minimum participation requirement.

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: July 05, 2013

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