Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Premium Calculations and Quarterly Rate Changes
Program Area: Small Business Health Options Program (SHOP)
Question: Does one set of rates apply for the entire calendar year, or can an issuer provide rates that change by month or quarter due to trend assumption changes?
Answer: In the individual market, one set of rates applies for the entire calendar year. A rate is good until the end of a calendar year, so someone enrolling in June would have that rate until December 31 of that year. In SHOP, once a group has effectuated coverage, the rate is locked in for 12 months. If an issuer submitted trend increases during the initial QHP application window, approved rates will be applied as scheduled.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: June 28, 2013
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