Health Insurance Exchanges

On July 11, 2011, the Department of Health and Human Services (HHS) released proposed guidelines for Health Insurance Exchanges (HIX). These exchanges are meant to expand health care competition and choice by offering private and government insurance programs to groups of individuals and businesses with up to 100 employees.

Small Business Health Options Program (SHOP)

SHOP—the small group provision of HIX—was included in the guidelines released July 11, 2011 with the goal of allowing small businesses (up to 100 employees, as the state may direct) and their employees to purchase coverage at competitive rates.

Guidelines include:

  • One uniform employee application form required for SHOP.
  • If the number of employees exceeds the defined maximum, after the company has purchased coverage, employers can remain in the program indefinitely (to allow for company growth).
  • Within the SHOP, employers have the flexibility to offer one or more plans, and employees can choose from different levels of coverage (bronze, silver, gold, platinum, or catastrophic).
  • The Department of Health and Human Services may require a minimum number of participants for an employer to take part in the program.
  • States may allow large groups (100+ employees) to purchase coverage from insurers within the SHOP beginning in 2017.

For specifics on the proposed guidelines for Health Insurance Exchanges and how it affects states, carriers, agents and brokers, and employers, please visit the Department of Health and Human Services.

Paychex Insurance Agency Can Help

Paychex Insurance Agency is a full-service organization that has taken a leadership role in transforming how businesses adapt to and benefit from the rapidly changing insurance industry. We're ready to offer information and assistance to help you and your clients navigate the recent Health Care Reform initiatives.

Health Care Reform Updates

With access to legislative and regulatory specialists in Washington, D.C. and expert, in-house sources or legal and compliance guidance, Paychex Insurance Agency is your source for Health Care Reform knowledge, tools, and resources.

* Client-specific questions received by Paychex Insurance Agency are referred to those individuals' tax or benefits professionals.

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