Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding 834 Transaction and Termination Transaction
Program Area: Small Business Health Options Program (SHOP)
Question: For what reasons may an issuer terminate an enrollee's coverage in a plan offered through the Federally-facilitated Small Business Health Options Program (FF-SHOP) for the 2014 plan year?
Answer: For plan years beginning before January 1, 2015, issuers may terminate an enrollee's coverage in a plan offered through the FF-SHOP for the following reasons. See 45 C.F.R. 155.430(b). 1) an enrollee is no longer eligible for coverage; 2) non-payment of premiums; or 3) the enrollee's coverage is rescinded in accordance with 45 C.F.R. 147.128 (that is, the enrollee performs an act, practice or omission that constitutes fraud or makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage). As of the 2015 plan year, FF-SHOP issuers may not send termination or cancellation transactions to the Centers for Medicare & Medicaid Services (CMS). All termination and cancellation transactions must be initiated by the FF-SHOP for plan years beginning on and after January 1, 2015.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 04, 2014
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