H&W: FAQs on SHOP Minimum Participation

160045027The CMS issued guidance in the form of two FAQs that relaxed participation requirements for small employers that buy group health coverage through the exchange (SHOP).  See below.

Renewal FAQ

Will employers need to meet the minimum participation requirement upon renewal for renewals occurring from November 15-December 15?

No. For operational and consumer consideration reasons, employers will not have to meet the FF-SHOP’s minimum participation rate for renewals occurring during Nov. 15-Dec. 15. Because under guaranteed availability requirements at § 147.104(b)(1) an employer must be allowed to purchase coverage from Nov. 15-Dec. 15, even if the employer cannot meet minimum participation requirements, we believe it would impose undue burden on issuers, employers, their employees, and the FF-SHOP to non-renew coverage under the exception to guaranteed renewability for failure to meet minimum participation rates and then re-enroll employers under guaranteed availability during this period. Therefore, the FF-SHOP will not impose (and QHP issuers offering coverage through the FF-SHOP may not enforce) minimum participation requirements for renewals occurring between Nov. 15-Dec. 15.

Delayed Enrollment FAQ

Are state-based SHOPs delaying open enrollment until January 2014 or later able to deny enrollment during 2014 to small employers that fail to meet minimum participation requirements?

No. The exception to guaranteed availability allowing issuers to restrict enrollment for small employers that fail to meet minimum participation requirements requires that enrollment be available to such employers from Nov. 15-Dec. 15 of the preceding year. If that exception is not met, such as in the case of SHOPs that did not provide for open enrollment during that period for plans available in 2014, guaranteed availability requires that small employers, even those that fail to meet minimum participation requirements, be permitted to enroll at any point during 2014.

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