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Small Business Health Options Program (SHOP) FAQ

Guidance for FAQ regarding Employer/Employee Interaction and Application

Program Area: Small Business Health Options Program (SHOP)

Question: What business rules can the employer specify for enrolling employees? (E.g., full-time only, no dependents, certain locations only, waiting period for new hires, etc.) How will the employer specify the business rules for enrolling employees?

Answer: Employers participating in the FF-SHOP are required to offer coverage to all full-time employees (those working on average 30+ hours per week). Depending on state law, dependent coverage is optional when an employer establishes a group policy. Thus, an employer may be able to choose to offer employee-only coverage in the FF-SHOP and exclude dependents from enrolling. In terms of limiting coverage to certain geographic locations, the Patient Protection and Affordable Care Act requires all employers applying for FF-SHOP coverage to offer coverage to all full-time employees, regardless of geographic location, as a condition of FF-SHOP participation. (See 45 CFR 155.710 Eligibility standards for SHOP) As part of the initial application process, an employer will specify employees eligible for coverage on the employee roster. Issuers will only receive information on those employees who enroll from the roster. After the initial application, enrollment information passed to Issuers will already have factored in applicable new hire waiting periods and will specify when coverage must be effectuated.

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

Issue Date: July 05, 2013

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