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

Issue Date: October 03, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: How will Federally-facilitated Small Business Health Options Program (FF-SHOP) issuers receive domestic partners on 834 enrollment transactions? If the domestic partner comes in as a dependent, how will the FF-SHOP rate domestic partners under age 21 for billing purposes? Will the FF-SHOP include the domestic partner in the 3-child maximum for purposes of rating?

Answer: The FF-SHOP will send 53 'Life Partner' code for domestic partners. The 3-child maximum for purposes of rating only applies to the following relationships: 1. Son/Daughter 2. Stepson/Stepdaughter 3. Adopted Son/Daughter 4. Foster Child

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.