California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 6 - Application, Eligibility, and Enrollment in the Shop Exchange › Section 6520 - Employer and Employee Application Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A small employer who is eligible to
				purchase coverage from a Qualified Health Plan (QHP) Issuer for its eligible
				employees through the Small Business Health Options Program (SHOP) pursuant to
				Section 6522, may apply to participate in
				the SHOP by submitting the following information to the SHOP:
(1) General employer information: business
				legal name and whether the employer is doing business under a fictitious name,
				Federal Employer Identification Number, State Employer Identification Number,
				organization type (private, nonprofit, government, church/church affiliated),
				Standard Industry Classification (SIC) code, principal business address, and
				mailing address;
(2) The number of
				eligible employees being offered enrollment in SHOP and the total number of
				full-time equivalent (FTE) employees employed by the qualified employer, as
				calculated in accordance with Health and Safety Code Section
				1357.500(k)(3)
				and Insurance Code Section
				10753(q)(3);
(3) Whether you have employed 20 or more
				employees for 20 or more weeks in the current or preceding calendar
				year;
(4) Whether the qualified
				employer is offering dependent health coverage or dental coverage for spouses,
				registered or non-registered domestic partners and/or dependent
				children;
(5) The qualified
				employer's desired health coverage or dental coverage effective date;
(6) Whether the qualified employer is subject
				to COBRA or Cal-COBRA continuation coverage regulations;
(7) Whether the qualified employer is
				currently offering health coverage or dental coverage, and if so, through which
				issuer;
(8) Whether the qualified
				employer intends to claim the Small Business Health Care Tax Credit with the
				IRS;
(9) The name, primary phone
				number, and email address for the primary contact and business owner/authorized
				company officer for the qualified employer and the preferred method of
				communication;
(10) Whether the
				qualified employer used an insurance agent and if so, the agent's name, general
				agency name (if applicable), CA insurance license number, the agency Federal
				Employer Identification Number if applicable, and whether the agent is an
				insurance agent certified by Covered California. If the qualified employer uses
				an insurance agent, the qualified employer must have that agent certify that he
				or she understands he or she may be subject to a civil penalty for providing
				false information under Health and Safety Code Section
				1389.8
				and Insurance Code Section
				10119.3.
(11) Information about the qualified
				employer's qualified employees, in the employee application in subdivision
				(d);
(12) The employer's offer of
				health coverage or dental coverage, and the reference plan or dental reference
				plan which includes:
(A) The employer's
				contribution rate to each of its qualified employee's health plan premiums
				pursuant to Section
				6522(a)(5)(A);
(B) The employer's health plan premium
				contribution rate for spouse or non-registered domestic partner, or dependent
				children health coverage, if applicable; and
(C) The employer's selection for one, two
				contiguous, three contiguous, or four contiguous tiers of health coverage,
				pursuant to 45 CFR Section
				156.140(b) (bronze, silver,
				gold, or platinum) (February 25, 2013), hereby incorporated by
				reference;
(D) Whether the
				qualified employer wishes to include infertility benefits to qualified
				employees;
(E) Effective August 1,
				2021, if the qualified employer is offering dental coverage to qualified
				employees, the employer must select a dental reference plan. The qualified
				employer must indicate its contribution rate for qualified employees' QDP
				premiums pursuant to Section
				6522(h)(3). The
				qualified employer must indicate its QDP premium contribution rate for spouse's
				or non-registered domestic partner's, or dependent children's coverage, if
				applicable;
(13) New
				qualified employer application submissions are due five days prior to the
				requested effective date. Completed submissions received after this date will
				carry an effective date no earlier than the first of the following month unless
				the qualified employer submits a signed CCSB New Business Late Submission
				Acknowledgement Form (Rev. 3/18), hereby incorporated by reference. Exceptions
				for exceptional circumstances will be considered on a case-by-case
				basis.