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

Issue Date: October 17, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: What are the termination reasons on the 834 for the following reasons: - the enrollee is no longer eligible for coverage in a Qualified Health Plan (QHP) through the Marketplace - the enrollee's coverage is rescinded in accordance with 45 C.F.R. 147.128

Answer: There are two scenarios when an enrollee is no longer eligible for coverage in a QHP through the Marketplace, i.e.: 1) group moves out of state 2) child dependent ages off a parent's plan. The Federally-facilitated Small Business Health Options Program (FF-SHOP) is not currently supporting a specific termination transaction to remove an enrollee because of fraud. If the Centers for Medicare and Medicaid Services (CMS) determines a group should be terminated because of misrepresentation or fraud, the SHOP Call Center would withdraw the application from the online system, which would trigger a termination transaction.

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