Status Update on SHOP
Health Insurance Marketplaces
Commonwealth Fund
Webinar:
An Update on the Health
Insurance Marketplaces
for Small Businesses
May 29, 2014
Current Operational Status of SHOP
Marketplaces – 2014
• Many State-based Marketplaces have successfully
launched an online SHOP
– These states have employee choice and back-end billing
and payment support for employers (premium aggregation)
– Some State-based Marketplaces are utilizing a paper-based
direct enrollment approach until they launch their online
SHOP
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Current Operational Status of SHOP
Marketplaces – 2014 (continued)
• CMS opened Federally-facilitated SHOP (FF-SHOP)
Marketplaces 10/1/13
– Eligible employers may enroll in FF-SHOPs utilizing a paperbased direct enrollment approach
– A dedicated call center is available to assist employers and
those working with employers, such as insurance
agents/brokers
• Last month CMS launched two new SHOP tools on
HealthCare.gov: FTE Calculator and SHOP Tax Credit
Estimator
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Current Operational Status of SHOP
Marketplaces – 2014 (continued)
• Enrollment in SHOPs continues in all states
– Unlike the Individual Marketplace, employee groups may
enroll in SHOP coverage for the first time at any point
throughout the year
• An eligible employer buying SHOP coverage in 2014
may qualify for the Small Business Health Care Tax
Credit (worth up to 50% of employer contributions for
tax years beginning in 2014 or later)
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Looking Ahead to 2015: Online FF-SHOP
Marketplaces
• CMS is making steady progress toward launching
online FF-SHOP Marketplaces, for states not running
their own SHOP
• FF-SHOP Marketplaces planned functionality
includes:
– Employers and agents/brokers able to browse available plan
options before enrolling in SHOP
– Employers able to assign an agent/broker to help them enroll
• Agents/brokers able to manage client accounts and provide ongoing
customer support
– Employers able to customize their offer of coverage
– Employers able to manage their accounts online, including
checking on their account balance and making payments
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Plan for Launching Online FF-SHOP
Marketplaces
• Lessons learned from last year have been
incorporated into the plan
• An incremental delivery schedule has been
developed
• CMS plans to phase in available functionality
beginning with 3-5 states in October
• Employers in these 3-5 states will be able to:
– Establish a Marketplace account, assign an agent/broker to
their account, obtain an eligibility determination, upload
employee roster, and browse available plans
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Plan for Launching Online FF-SHOP
Marketplaces (continued)
• Full implementation in all states utilizing the FF-SHOP
platform is scheduled for November 15, 2014
• Internal testing is underway
• External testing with independent testers and
participating insurance companies will begin this
summer and continue until the FF-SHOP
Marketplaces go live later this year
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Employee Choice
• Employee choice allows employers enrolling in a
SHOP to offer employees all medical and dental plan
options at a coverage level selected by the employer
and to receive one bill and make one payment, no
matter how many plans their employees choose
• CMS recently finalized a rule establishing a transition
policy for employee choice for 2015
• Unlike last year, all states + DC have the ability to
implement employee choice for 2015
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Employee Choice (continued)
• A state insurance commissioner may recommend that the SHOP
provide employers only with the option of offering employees a
single QHP and (if applicable) a single dental plan
• A state’s recommendation must adequately explain how not
implementing employee choice would be in the best interests of
small employers and their employees and dependents, given the
likelihood that implementing employee choice would cause
issuers to price products and plans higher in 2015 due to issuers’
beliefs about adverse selection
• This transition policy applies only to 2015
• CMS expects employee choice to be available in all 50 States +
DC by 2016
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SHOP Resources
Resource
Resource Link
Centers for Medicare & Medicaid Services (CMS)
http://www.cms.gov/
The Center for Consumer Information & Insurance
Oversight (CCIIO)
http://www.cms.gov/cciio/index.html
FF-SHOP Marketplace Call Center
1-800-706-7893
1-800-706-7915 – TTY
Monday – Friday (9: 00 a.m. – 7:00 p.m. ET)
FF-SHOP Marketplace
https://www.healthcare.gov/small-businesses/
FF-SHOP Employer Application (used for FF-SHOP
direct enrollment in 2014)
https://www.healthcare.gov/downloads/shopemployer-application.pdf
Full-time Equivalent (FTE) Employee Calculator
https://www.healthcare.gov/fte-calculator/
SHOP Tax Credit Estimator
https://www.healthcare.gov/small-business-taxcredit-calculator/
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