Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Issuer Participation Requirements and Other
Program Area: Small Business Health Options Program (SHOP)
Question: Will issuers still send customers (consumers) premium invoices directly or will the Federal government collect premiums for individuals as well as SHOP business and send them to the health plan via the 820?
Answer: In the first year of the FF-SHOP (2014), QHP issuers will be responsible for billing enrollees and employers to obtain required premium payments. The Federally-facilitated Exchange will not participate in the billing or collection of premiums. Beginning on or after January 1, 2015, the FF-SHOP will bill and collect premiums from the employer, and remit premiums to the appropriate issuers. The FF-SHOP will provide premium aggregation services to health plans via an electronic transaction, expected to be the ASC X12 Other Premium Payment 820 (Version 5010).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 24, 2013
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