(a) SHOP rating and premium payment requirements. QHP issuers offering a QHP through a SHOP must:
- (1) Accept payment from a qualified employer or an enrollee, or a SHOP on behalf of a qualified employer or enrollee, in accordance with applicable SHOP requirements.
- (2) Adhere to the SHOP timeline for rate setting as established in § 155.706(b)(6) of this subchapter;
- (3) Charge the same contract rate for a plan year; and
- (4) Adhere to the premium rating standards described in § 147.102 of this subchapter regardless of whether the QHP being sold through the SHOP is sold in the small group market or the large group market.
- (b) Enrollment periods and processes for the SHOP. QHP issuers offering a QHP through the SHOP must adhere to enrollment periods and processes established by the SHOP, consistent with § 155.726 of this subchapter, and establish a uniform enrollment timeline and process for enrolling qualified employers and employer group members.
(c) Enrollment process for the SHOP. A QHP issuer offering a QHP through the SHOP must:
- (1) Provide new enrollees with the enrollment information package as described in § 156.265(e); and
- (2) Enroll all qualified employees consistent with the plan year of the applicable qualified employer.
- (d) Participation rules. QHP issuers offering a QHP through the SHOP may impose group participation rules for the offering of health insurance coverage in connection with a QHP only if and to the extent authorized by the SHOP in accordance with § 155.706 of this subchapter.
- (e) Employer choice. QHP issuers offering a QHP through the SHOP must accept enrollments from groups in accordance with the employer choice policies applicable to the SHOP under § 155.706(b)(3) of this subchapter.
- (f) Identification of SHOP enrollments. QHP issuers offering a QHP through the SHOP must use a uniform enrollment form, maintain processes sufficient to identify whether a group market enrollment is an enrollment through the SHOP, and maintain records of SHOP enrollments for a period of 10 years following the enrollment.
- (g) Applicability date. The provisions of this section apply for plan years beginning on or after January 1, 2018.
[83 FR 17069, Apr. 17, 2018]