Title 45—Public Welfare--Volume 1
PART 157—EMPLOYER INTERACTIONS WITH EXCHANGES AND SHOP PARTICIPATION
§ 157.10   Basis and scope.
(a) Basis. This part is based on the following sections of title I of the Affordable Care:
(1) 1311. Affordable choices of health benefits plans.
(2) 1312. Consumer Choice.
(3) 1321. State flexibility in operation and enforcement of Exchanges and related requirements.
(4) 1411. Procedures for determining eligibility for Exchange participation, advance payments of the premium tax credit and cost-sharing reductions, and individual responsibility exemptions.
(5) 1412. Advance determination and payment of the premium tax credit and cost-sharing reductions.
(b) Scope. This part establishes the requirements for employers in connection with the operation of Exchanges.
§ 157.20   Definitions.
The following definitions apply to this part, unless otherwise indicated:
Federally-facilitated SHOP has the meaning given to the term in § 155.20 of this subchapter.
Full-time employee has the meaning given to the term in § 155.20 of this subchapter.
Large employer has the meaning given to the term in § 155.20 of this subchapter.
Qualified employee has the meaning given to the term in § 155.20 of this subchapter.
Qualified employer has the meaning given to the term in § 155.20 of this subchapter.
Small employer has the meaning given to the term in § 155.20 of this subchapter.
§ 157.200   Eligibility of qualified employers to participate in a SHOP.
(a) General requirement. Only a qualified employer may participate in the SHOP in accordance with § 155.710 of this subchapter.
(b) Continuing participation for growing small employers. A qualified employer may continue to participate in the SHOP if it ceases to be a small employer in accordance with § 155.710 of this subchapter.
(c) Participation in multiple SHOPs. A qualified employer may participate in multiple SHOPs in accordance with § 155.710 of this subchapter.
§ 157.205   Qualified employer participation process in a SHOP for plan years beginning prior to January 1, 2018.
(a) General requirements. When joining the SHOP, a qualified employer must comply with the requirements, processes, and timelines set forth by this part and must remain in compliance for the duration of the employer's participation in the SHOP.
(b) Selecting QHPs. During an election period, a qualified employer may make coverage in a QHP available through the SHOP in accordance with the processes developed by the SHOP in accordance with § 155.705 of this subchapter.
(c) Information dissemination to employees. A qualified employer participating in the SHOP must disseminate information to its qualified employees about the process to enroll in a QHP through the SHOP.
(d) Payment. A qualified employer must submit any contribution towards the premiums of any qualified employee according to the standards and processes described in § 155.705 of this subchapter.
(e) Employees hired outside of the initial or annual open enrollment period. Qualified employers must provide employees hired outside of the initial or annual open enrollment period with:
(1) An enrollment period to seek coverage in a QHP in accordance with § 155.725(g) of this subchapter; and
(2) Information about the enrollment process in accordance with § 155.725 of this subchapter.
(f) New employees and changes in employee eligibility. Qualified employers participating in the SHOP must provide the SHOP with information about dependents or employees whose eligibility status for coverage purchased through the employer in the SHOP has changed, including:
(1) Newly eligible dependents and newly qualified employees. In a Federally-facilitated SHOP or in a State Exchange that uses the Federal platform for SHOP functions, a qualified employer must provide information about a newly qualified employee on or before the thirtieth day after the day that the employee becomes a newly qualified employee; and
(2) Loss of qualified employee status.
(g) Annual employer election period. Qualified employers must adhere to the annual employer election period to change their program participation for the next plan year described in § 155.725(c) of this subchapter.
(h) Applicability date. The provisions of this section apply for plan years beginning prior to January 1, 2018. Section 157.206 is applicable for plan years beginning on or after January 1, 2018.
§ 157.206   Qualified employer participation process in a SHOP for plan years beginning on or after January 1, 2018.
(a) General requirements. When joining the SHOP, a qualified employer must comply with the requirements, processes, and timelines set forth by this part and must remain in compliance for the duration of the employer's participation in the SHOP.
(b) Selecting QHPs. During an election period, a qualified employer may make coverage in a QHP available through the SHOP in accordance with the processes developed by the SHOP in accordance with § 155.706 of this subchapter.
(c) Information dissemination to employees. A qualified employer participating in the SHOP must disseminate information to its qualified employees about the process to enroll in a QHP through the SHOP.
(d) Employees hired outside of the initial or annual open enrollment period. Qualified employers must provide employees hired outside of the initial or annual open enrollment period with information about the enrollment process.
(e) Participation in the SHOP and termination of coverage or enrollment through the SHOP. (1) Changes affecting participation. Employers must submit a new single employer application to the SHOP or withdraw from participating in the SHOP if the employer makes a change that could end its eligibility under § 155.710 of this subchapter.
(2) If an employer receives a determination of ineligibility to participate in the SHOP or the SHOP terminates its eligibility to participate in the SHOP, unless the SHOP notifies the issuer or issuers of the determination of ineligibility or termination of eligibility, the employer must notify the issuer or issuers of QHPs in which their group members are enrolled in coverage of its ineligibility or termination of eligibility within 5 business days of the end of any applicable appeal process under § 155.741 of this subchapter, which could include when the time to file an appeal lapses without an appeal being filed, when the appeal is rejected or dismissed, or when the appeal process concludes with an adjudication by the appeals entity, as applicable.
(3) Employers must promptly notify the issuer or issuers of QHPs in which their group members are enrolled in coverage if it wishes to terminate coverage or enrollment through the SHOP, unless the SHOP notifies the issuer or issuers.
(f) Applicability date. The provisions of this section apply for plan years beginning on or after January 1, 2018.