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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

SHOP Exchange Eligibility Criteria

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Question: What will the eligibility criteria of the SHOP Exchange be? Will associations qualify for group coverage?

Answer: The Affordable Care Act leaves the definition of small group size and up to the states - limited to either 50 or 100 full time employees. In California, small groups will be limited to those with 50 employees or less initially, with the option to raise it to 100 in 2017. The existing California state laws must also be observed, that means associations are not eligible for new small group coverage in the SHOP Exchange. Finally, the the Department of Health and Human Services (HHS) will issue regulations that could further define Shop Exchange eligiblity.

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