Posted on August 6, 2013
Yesterday, I finished my certification for the Federal SHOP Exchange. So I thought I would share the protocol required for a small business to enroll through the SHOP. Reasons small employers will be interested in purchasing health insurance through the SHOP include:
- Access to tax credits
- Tools to compare plans
- All Qualified Health Plans (QHP) will have Essential Health Benefits (EHB)
- The ability to base employee contributions on age-related premiums or a composite premium
- Less financial uncertainty due to premium increases at renewal
The procedure to enroll through the SHOP begins with the employer creating his/her SHOP account. The agent, broker, navigator or application assistant may assist the employer in creating his or her account if needed, but the employer must create his or her own Marketplace username and password and should not share this information with third parties. They can then be assisted with completing the application, where the employer will be prompted to enter the agent or broker’s National Producer Number (NPN) and other identifying information (if he is using an agent or broker).
Next, the employer will decide if the employees will enroll via one SHOP or if there are numerous locations if different states, if employes should enroll in the SHOP in each state. Keep in mind there is likely to be a multi-state plan in the SHOP that can provide coverage in more than one state. A roaster of full-time employees is submitted with some basic information. The employee must be listed on the roaster to be eligible to enroll in the plan. A decision should also be made about dependent coverage. Tax credits and cost sharing reductions are not available for dependents enrolled through the SHOP. Keep in mind that if an employer is offering affordable coverage, the employee will not be eligible to purchase coverage from the individual exchange. Once all of the information has been input the Exchange will show the employer a range of premiums for the plan that his company qualifies for. He can request more details about each plan. For 2014, the employer chooses one plan.Once the employer has chosen a reference plan, the next step is to decide on the employee contribution to the premium. It can be age adjusted or a flat amount based on the premium. Contributions for dependents will always be based on the underlying cost of coverage. After these decisions are made, the employer will be given the opportunity to look at different scenarios with different plans and premium contributions. The employer will need 70% of the employees to enroll in the plan. Valid waivers include spousal or dependent coverage under another group plan, or public health insurance. Now that the plan has been chosen and the contributions determined, the employees can enroll. Like the employer, each employee must create their own account with private logon information. Agents, brokers, navigators and application assistors can help but they should not see this information
The employer reviews the plan, establishes a waiting period for newly hired employees and sends the first month’s premium to the carrier. If there are new hires who become eligible during the year, the employer adds the employee to the roaster on his account and the employee enrolls via his/her account. There are also Special Enrollment Periods (SEP) which usually last 30 days. These are triggered by events such as a marriage, birth or adoption, change in dependent status, job status etc. The employee must update his/her account and enroll/dis-enroll accordingly. In the case of a termination COBRA and/or State Continuation applies and the employer must notify the employee of his right to remain on the plan at his expense. However, it might make more sense for them to enroll in the individual Marketplace to take advantage of the tax subsidy
The employer reviews the plan, establishes a waiting period for newly hired employees and sends the first month’s premium to the carrier. If there are new hires who become eligible during the year, the employer adds the employee to the roaster on his account and the employee enrolls via his/her account. There are also Special Enrollment Periods (SEP) which usually last 30 days. These are triggered by events such as a marriage, birth or adoption, change in dependent status, job status etc. The employee must update his/her account and enroll/dis-enroll accordingly. In the case of a termination COBRA and/or State Continuation applies and the employer must notify the employee of his right to remain on the plan at his expense. However, it might make more sense for them to enroll in the individual Marketplace to take advantage of the tax subsidy
http://benefitsadvisorblog.com/2013/08/06/a-preview-of-how-the-shop-exchange-will-work/?goback=%2Egde_2889111_member_263848329
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