Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Premium Calculations and Other
Program Area: Small Business Health Options Program (SHOP)
Question: Will the geographic area premium rating factor in the small group market be based on the geographic area of the employee or that of the employer? Will this approach apply only for plans offered through the FF-SHOPs, or will it apply market-wide?
Answer: We intend to propose in future rulemaking that the geographic area premium rating factor must be based on the employer's primary business location in each state. This would apply both inside and outside of the SHOP. In the context of the FF-SHOPs, we intend to propose that an employer, except multi-state employers, generally may have only one SHOP account per state. Multi-state employers will still be able to establish either one SHOP account for all employees or establish multiple SHOP accounts in each state with a business location. We intend to propose that, where a multi-state employer has established an account in more than one state, the primary business location of the business in each applicable state must be used for geographic rating area purposes.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 02, 2013
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