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: Will quarterly rate increases be allowed in the SHOP?
Answer: Issuers participating in SHOP will be able to submit trend increases to their rates at the time of their original QHP application and, after that, whenever submitting new rates. We intend to propose an amendment to 45 CFR 155.705(b)(6) clarifying that, consistent with the general rules for the small group market, issuers in all SHOPs will be permitted to increase rates no more frequently than quarterly. We also intend to propose that issuers with plans offered through the FF-SHOPs will be able to submit non-trend rate updates on a quarterly basis beginning in July 2014. (As we have previously explained in guidance, it will not be possible for the FF-SHOPs to process non-trend rate changes until the third quarter of 2014.) Issuers will be notified when the FF-SHOPs begin processing non-trend quarterly rate updates. Regardless of when an employer enrolls in a plan through a SHOP, the rates applied to that employer's plan must be guaranteed for the 12 months of the plan year.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 02, 2013
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