Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Employer/Employee Interaction and Eligibility
Program Area: Small Business Health Options Program (SHOP)
Question: If a group is larger than the small group threshold and subsequently the size falls below the small group threshold, will the group be allowed to keep its existing products, or will it be required to purchase new products?
Answer: An employer has the right to renew or continue in force coverage originally purchased in the large or small group market, even though the employer may no longer meet the definition of a large or small employer. If the employer voluntarily drops the coverage, however, that employer would only be able to purchase coverage in the relevant market (and the coverage would have to comply with the relevant market requirements). Please reference Insurance Standards Bulletin Series, Group Size Issues under Title XXVII of the Public Health Service Act, Transmittal 99-03, available at http://cciio.cms.gov/resources/files/Files2/10112011/hipaa_99_03_508.pdf.pdf.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 03, 2013
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