Even with technical issues plaguing the roll-out of heath care exchanges, the Centers for Medicare and Medicaid services issued a manual describing the enrollment process for Exchanges in the individual market and the federally facilitated SHOP Exchange for small businesses. The manual is intended to provide guidance to those involved in the Exchange enrollment process, including health insurers, agents, brokers and third party administrators.
The manual sets a timeframe for initial enrollment and annual open enrollment.
In the SHOP market, the following applies-
|
Plan Selection Date |
Coverage Effective Date |
|
October 1, 2013 through December 15, 2013
|
January 1, 2014 |
|
Between the 1st and 15th of the month (beginning January 1, 2014) |
First day of the following month |
|
Between the 16th and last day of the month (Beginning January 1, 2014) |
First day of the second following month
|
|
October 15th through December 7 (beginning October 2014) |
January 1 of the following year |
In the individual market, the following applies-
|
Plan Selection Date |
Coverage Effective Date |
|
October 1, 2013 through December 15, 2013
|
January 1, 2014 |
|
Between the 1st and 15th of the month (January 1, 2014 – March 15, 2014) |
First day of the following month |
|
Between the 16th and last day of the month (December 16, 2013-March 31, 2014) |
First day of the second following month
|
|
October 15th through December 7 (beginning October 2014) |
January 1 of the following year |
Minimum Participation. The manual describes how minimum participation will work in accordance with state laws applicable to SHOP employers. The minimum participation rate is set to 70% (unless a state requires a different rate). If an employer cannot make this rate, it would have to re-apply at a later time when minimum participation standards can be met. Employees covered by another group health plan, Medicare or Medicaid or a military health plan are excluded from the minimum participation determination. Employees covered under an individual plan through an Exchange are counted.
Enrollment Process. The manual describes specifics of how to effectuate enrollment in an Exchange product.
Premium Payments. The manual offers different methods of paying premiums. Employers will be able to pay premiums directly to the insurer through a portal on the Exchange website.
This manual is intended to be a working document and continuously updated by CMS. For reference, the manual can be found by clicking here.
