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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.

HHS Final SHOP Rules

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Question: Was there anything for brokers to hang their hats on in the HHS Rules pertaining to the small group market?

Answer: Nothing really earth shaking, mostly housekeeping details. Have a look:

  • Requires SHOP to use the same special enrollment periods as the individual Exchange - October 1, 2013 to March 31, 2014 - and offer newly qualified employees coverage outside of open enrollment periods.

  • Adds a definition of minimum participation requirements (percent of employees that must participate) and permits the SHOP to impose such rules. SHOP QHP health plans cannot impose minimum participation rules.

  • Affirms that Exchanges have the latitude to determine the extent to which employers may limit choice for their employees.

  • Adds requirement that SHOP develop and offer a premium calculator.

  • Adds a requirement that SHOP must report employer contribution and employee enrollment to the IRS.

  • Removes requirement that SHOP continue coverage if an employer fails to take action during an election period.

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