Small Business Health Options Program (SHOP)

Small Business Health Options Program (SHOP)


        HHS Issues Final Notice of Benefit
        and Payment Parameters for 2016


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The final rule includes provisions to streamline administration of the SHOP. For example, the final rule:

     • Allows SHOPs to assist employers in the administration of continuation
     coverage (COBRA)
enrolled in through a SHOP

     • Allows a SHOP to elect to renew an employer’s offer of coverage, where
     the employer remains eligible to participate in the SHOP and has taken no action
     to modify its offer of coverage or withdraw from the SHOP during its annual
     election period, so long as the offered coverage remains available through
     the SHOP

     • Modifies the calculation of minimum participation rates in the SHOP to
     align with the current practice of issuers in many states and to include other
     types of coverage in the calculation of the group’s rate (this policy is limited to
     the federally facilitated SHOP, effective for plan years beginning on or after
     Jan. 1, 2016; states may decide how to calculate minimum participation rates for
     state SHOPs and the non-SHOP small group market)

     • Aligns SHOP qualified health plan (QHP) certification in SHOPs that certify
     QHPs on a calendar year basis with rolling enrollment in the SHOP, so that
     employers can start coverage through the SHOP at the beginning of any
     month, with coverage lasting for 12 months

     • Finalizes an exception to the rule regarding 12-month plan years in the
     SHOP for states with merged individual and small group risk pools under federal
     law

     • Specifies that a qualified employer that fails to pay its premium for federally
     facilitated SHOP coverage in a timely manner can be reinstated in its prior
     coverage only once per calendar year

     • Specifies that, effective Jan. 1, 2016, certain termination notices will be
     provided by the SHOP.

On Feb. 27, 2015, the Department of Health and Human Services (HHS) published its final Notice of Benefit and Payment Parameters for 2016. This final rule describes benefit and payment parameters applicable to the 2016 benefit year, including standards relating to:

     • The reinsurance program’s annual contribution rate for 2016.

     • The 2016 open enrollment period.

     • The 2016 annual limitations on cost-sharing.


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