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SHOP Exchanges: The Basics

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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
• 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
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
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
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.
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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