Reform Alert - News from the Blues' Office of National Health Reform

Revised paper applications for employers and employees

June 21, 2013

The Affordable Care Act (ACA) requires the Center for Medicare and Medicaid Services (CMS) to develop and provide to each state a single, streamlined application for (Small Business Health Options) SHOP enrollment. Alternatively, states may elect to develop and use their own application, subject to approval by CMS, but Michigan is currently not developing its own applications. Draft applications for employers and employees, including logic for the online applications, were initially proposed in January 2013.

On May 31, 2013, CMS released revised paper applications for employers and employees. Many of the changes to the paper application were clarifications in the directions, including the addition of a section to help employers determine if their business may be eligible. CMS also strengthened the language regarding providing false information on the application and provided employees with the opportunity to opt out of dental coverage. You can view the revised applications by following the links provided below.

The SHOP also changed the follow-up deadline and now anticipates following up within one to two weeks of application submission, instead of three to four weeks. CMS does not promise to make a decision on eligibility within that timeframe, but states that employers and their employees will get information about the next steps to complete for health coverage through the SHOP.

Employers and their employees will be able to submit an application for the SHOP online, using a paper application, over the phone through an agent or broker, or in person through an agent, broker, or navigator. In most cases, CMS expects that small employers will be able to receive a real-time eligibility determination when applying online. Coverage effective dates may be earlier for applications filed online than for those filed on paper.

Where can I find more information?
Revised applications can be found here: Application for Employers and Application for Employees.

 

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

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