Additional rules under the ACA affecting small businesses

The Affordable Care Act (ACA) requires that there will be a Small Business Health Program (SHOP) in each State to assist qualified small employers in providing health insurance options to their employees. A qualified small employer is an employer with at least one but not more than 100 employees.  Until 2016, states have the option to reduce this threshold to 50.

The final rule recently issued by the Centers for Medicare & Medicaid Services (CMS) for the SHOP addresses two areas: (1) employee choice; and (2) special enrollment.  The final rule is effective July 1, 2013.

Transitional Policy for Employee Choice
The transitional policy delays the implementation of employee choice and premium aggregation for one year. In other words, employers can choose one single Qualified Health Plan for its employees, thereby eliminating its employee choice.  According to the final rule, issuers would not be operationally ready by October 13, 2013 to offer QHPs through SHOP if it implemented employee choice for 2014. Issuers now have more time to implement IT changes and provide education and outreach about employee choice.

Changes to Special Enrollment Period
The final rule amends special enrollment period for the SHOP to 30 days for most applicable triggering events so that it aligns with special enrollment periods established by HIPPA.  Additionally, the final rule provides a 60 day special enrollment period to select a Qualified Health Plan if an employee or dependent become eligible for premium assistance under Medicaid or CHIP or loses eligibility for Medicaid or CHIP.  The final rule states that the special enrollment rule related to Medicaid or CHIP was inadvertently omitted from the Affordable Care Act.

Remember, however, that any change to the health care of employees represented by a Union is a mandatory subject of bargaining, and that in many ways what the ACA requires is only a floor above which Union’s may negotiate something better for their employees. 

If you have questions or would like to discuss this in more detail, please contact your labor law counsel. 

By Linda Baldwin Jones | June 4, 2013

Legal Developments