Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Premium Calculations and Other
Program Area: Small Business Health Options Program (SHOP)
Question: When an employer group moves its headquarters (a change in primary business location) and that move is to a different rating area, will the FF-SHOPs apply the new geographic rating factor to the coverage when the move occurs?
Answer: Pursuant to 45 C.F.R. 155.705(b)(6)(ii) and 156.285(a)(3), issuers may not vary rates for a qualified employer during the employer's plan year. The FF-SHOPs, therefore, may apply a new geographic rating factor only upon renewal. If an employer group moves its principal business address to a different geographic rating area in the same state, the FF-SHOPs will re-run the eligibility determination process to verify that the employer is still located in the same state. If the employer moves to a different state and continues to opt to offer coverage to all full-time employees through the SHOP in which it has its principal business address, the group will lose its eligibility for enrollment in the SHOP in its former state, and would have to re-apply to participate in the SHOP in its new state.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 02, 2013
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