Status Update on SHOP Health Insurance Marketplaces

1. Status Update on SHOP Health Insurance Marketplaces May 29, 2014 Commonwealth Fund Webinar: An Update on the Health Insurance Marketplaces for Small Businesses

2. 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

3. 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 paper-based 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

4. 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)

5. 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

6. Plan for Launching OnlineFF-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

7. Plan for Launching OnlineFF-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

8. 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 andto 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

9. 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

10. SHOP Resources