45 CFR 155.725 - Enrollment periods under SHOP.

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§ 155.725 Enrollment periods under SHOP.
(a) General requirements. The SHOP must—
(1) Adhere to the start of the initial open enrollment period set forth in§ 155.410; and
(2) Ensure that enrollment transactions are sent to QHP issuers and that such issuers adhere to coverage effective dates in accordance with§ 156.260 of this subchapter.
(b) Rolling enrollment in the SHOP. The SHOP must permit a qualified employer to purchase coverage for its small group at any point during the year. The employer's plan year must consist of the 12-month period beginning with the qualified employer's effective date of coverage.
(c) Annual employer election period.
(1) Notwithstanding any other paragraph in this section, for coverage beginning in 2015 in a Federally-facilitated SHOP, a qualified employer's annual election period may begin no sooner than November 15, 2014.
(2) The SHOP must provide qualified employers with a standard election period prior to the completion of the employer's plan year and before the annual employee open enrollment period, in which the qualified employer may change its participation in the SHOP for the next plan year, including—
(i) The method by which the qualified employer makes QHPs available to qualified employees pursuant to§ 155.705(b)(2) and (3);
(ii) The employer contribution towards the premium cost of coverage;
(iii) The level of coverage offered to qualified employees as described in§ 155.705(b)(2) and (3); and
(iv) The QHP or QHPs offered to qualified employees in accordance with§ 155.705.
(d) Annual employer election period notice. The SHOP must provide notification to a qualified employer of the annual election period in advance of such period.
(e) Annual employee open enrollment period. The SHOP must establish a standardized annual open enrollment period for qualified employees prior to the completion of the applicable qualified employer's plan year and after that employer's annual election period.
(f) Annual employee open enrollment period notice. The SHOP must provide notification to a qualified employee of the annual open enrollment period in advance of such period.
(g) Newly qualified employees. The SHOP must provide an employee who becomes a qualified employee outside of the initial or annual open enrollment period an enrollment period to seek coverage in a QHP beginning on the first day of becoming a qualified employee.
(h) Effective dates. The SHOP must establish effective dates of coverage for qualified employees consistent with the effective dates of coverage described in § 155.720.
(i) Renewal of coverage. If a qualified employee enrolled in a QHP through the SHOP remains eligible for coverage, such employee will remain in the QHP selected the previous year unless—
(1) The qualified employee terminates coverage from such QHP in accordance with standards identified in§ 155.430;
(2) The qualified employee enrolls in another QHP if such option exists; or
(3) The QHP is no longer available to the qualified employee.
(j)
(1) Special enrollment periods. The SHOP must provide special enrollment periods consistent with this section, during which certain qualified employees or a dependent of a qualified employee may enroll in QHPs and enrollees may change QHPs.
(2) The SHOP must provide a special enrollment period for a qualified employee or dependent of a qualified employee who:
(i) Experiences an event described in§ 155.420(d)(1), (2), (4), (5), (7), (8), (9), or (10);
(ii) Loses eligibility for coverage under a Medicaid plan under title XIX of the Social Security Act or a State child health plan under title XXI of the Social Security Act; or
(iii) Becomes eligible for assistance, with respect to coverage under a SHOP, under such Medicaid plan or a State child health plan (including any waiver or demonstration project conducted under or in relation to such a plan).
(3) A qualified employee or dependent of a qualified employee who experiences a qualifying event described in paragraph (j)(2) of this section has:
(i) Thirty (30) days from the date of a triggering event described in paragraph (j)(2)(i) of this section to select a QHP through the SHOP; and
(ii) Sixty (60) days from the date of a triggering event described in paragraph (j)(2)(ii) or (iii) of this section to select a QHP through the SHOP;
(4) A dependent of a qualified employee is not eligible for a special election period if the employer does not extend the offer of coverage to dependents.
(5) The effective dates of coverage are determined using the provisions of§ 155.420(b).
(6) Loss of minimum essential coverage is determined using the provisions of§ 155.420(e).
[77 FR 18464, Mar. 27, 2012, as amended at 78 FR 33239, June 4, 2013; 78 FR 65095, Oct. 30, 2013; 79 FR 30350, May 27, 2014; 79 FR 42986, July 24, 2014]

Title 45 published on 2014-10-01.

The following are only the Rules published in the Federal Register after the published date of Title 45.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2015-07-07; vol. 80 # 129 - Tuesday, July 7, 2015
    1. 80 FR 38652 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016; Correcting Amendment
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, HHS, Centers for Medicare & Medicaid Services (CMS)
      Final rule; correcting amendment.
      Effective Date: This correction document is effective July 7, 2015. Application Date: The correction is applicable as of April 28, 2015.
      45 CFR Part 155

Title 45 published on 2014-10-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 45 CFR Part 155 after this date.

  • 2015-07-07; vol. 80 # 129 - Tuesday, July 7, 2015
    1. 80 FR 38652 - Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016; Correcting Amendment
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, HHS, Centers for Medicare & Medicaid Services (CMS)
      Final rule; correcting amendment.
      Effective Date: This correction document is effective July 7, 2015. Application Date: The correction is applicable as of April 28, 2015.
      45 CFR Part 155