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

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SHOP Exchanges: The Basics

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Shop exchanges the basics

SHOP Exchanges: The Basics

Timothy Stoltzfus Jost

Washington and Lee University College of Law


Shop exchanges

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 exchanges1

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

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

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

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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