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SHOP Exchanges: The Basics

SHOP Exchanges: The Basics. Timothy Stoltzfus Jost Washington and Lee University College of Law. SHOP Exchanges. Exchanges to make coverage more accessible and affordable to small businesses

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SHOP Exchanges: The Basics

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  1. SHOP Exchanges: The Basics Timothy Stoltzfus Jost Washington and Lee University College of Law

  2. SHOP Exchanges • Exchanges to make coverage more accessible and affordable to small businesses • Should increase the market power of small businesses and choice for small businesses and their employees • Proposed regulations take a practical approach to implementation and offer flexibility to employers

  3. SHOP Exchanges • Must exist in each state (either as state or federal exchanges) • May be separate or combined with individual exchange • Individual and small group risk pools may be combined or kept separate

  4. Which Employers May Participate? • Serves small employers (1-100, or, at state option, 1-50 until 2016) • States may expand to larger employers beginning in 2017 • Proposed regulations would not cover businesses without employees

  5. SHOP Exchanges: Proposed Regulation Options • Required: employer choice of actuarial value tier, employee choice of qualified health plan (QHP) • States can offer employers options: • (1) employees can choose any QHP offered in the SHOP in any tier; • (2) employers select specific tiers from which an employee may choose a QHP; • (3) employers select specific QHPs from different tiers of coverage from which an employee may choose a QHP; or • (4) employers to select a single QHP to offer employees.

  6. SHOP Exchanges: Proposed Regulations • Rolling enrollment for employers, but upon enrollment locked into one year periods (and premiums locked in) • Must offer exchange coverage to all employees • Exchange must provide aggregate bill • Employers must notify exchange about employee change of status • Employers with multiple worksites can offer access to single exchange or to exchanges where employees located

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