(a)SHOP rating and premium payment requirements. QHP issuers offering a QHP through a SHOP must:
(1) Accept payment from the SHOP on behalf of a qualified employer or an enrollee in accordance with § 155.705(b)(4) of this subchapter;
(2) Adhere to the SHOP timeline for rate setting as established in § 155.705(b)(6) of this subchapter; and
(3) Charge the same contract rate for a plan year.
(b)Enrollment periods for the SHOP. QHP issuers offering a QHP through the SHOP must:
(1) Enroll a qualified employee in accordance with the qualified employer's annual employee open enrollment period described in § 155.725 of this subchapter;
(2) Provide special enrollment periods described in § 155.420 excluding paragraphs (d)(3) and (6);
(3) Provide an enrollment period for an employee who becomes a qualified employee outside of the initial or annual open enrollment period as described in § 155.725(g) of this subchapter; and
(4) Adhere to effective dates of coverage in accordance with § 156.260 and those established through § 155.720 of this subchapter.
(c)Enrollment process for the SHOP. A QHP issuer offering a QHP through the SHOP must:
(1) Adhere to the enrollment timeline and process for the SHOP as described in § 155.720(b) of this subchapter;
(2) Receive enrollment information in an electronic format, in accordance with the requirements in §§ 155.260 and 155.270 of this subchapter, from the SHOP as described in § 155.720(c);
(3) Provide new enrollees with the enrollment information package as described in § 156.265(e);
(4) Reconcile enrollment files with the SHOP at least monthly;
(5) Acknowledge receipt of enrollment information in accordance with SHOP standards; and
(6) Enroll all qualified employees consistent with the plan year of the applicable qualified employer.
(d)Termination of coverage in the SHOP. QHP issuers offering a QHP through the SHOP must:
(1) Comply with the following requirements with respect to coverage termination of enrollees in the SHOP:
(i) General requirements regarding termination of coverage established in § 156.270(a);
(ii) Requirements for notices to be provided to enrollees and qualified employers in § 156.270(b) and § 156.290(b); and
(iii) Requirements regarding termination of coverage effective dates as set forth in § 156.270(i).
(2) If a qualified employer chooses to withdraw from participation in the SHOP, the QHP issuer must terminate coverage for all enrollees of the withdrawing qualified employer.
(e)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 § 155.705 of this subchapter.
Title 45 published on 2014-10-01.
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This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.