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Posted by on Oct 31, 2013 in Healthcare Reform

Offering Covered California SHOP and Reporting Requirements

Offering Covered California SHOP and Reporting Requirements

Small businesses that choose to offer coverage through the SHOP must:

  • Offer coverage to all full time employees (employees working an average of 30 hours per week.)
  • Meet a minimum employee participation rate of 70%
  • Contribute a minimum of 50% of the cost of the least expensive plan in their selected metal tier toward their employees’ eligible premium.

Although Federal regulation does not require employee choice prior to January 1, 2015, California has elected to implement employee choice beginning January 1, 2014. Employee choice permits employers to determine a level of coverage from one of the four metal tiers (e.g. Platinum, Gold, Silver and Bronze) and the amount they want to contribute toward their employee’s premium. Under this employer “defined contribution” arrangement employees will then be able to select from any health plan offered in the metal tier the employer selected.

REQUIRED EMPLOYER REPORTING

Employers are required to report new hires or terminations prior to the effective date of the change.

Employers can report these changes via CalHEERS or by calling the SHOP Service Center at 877.453.9198.

Small employer’s wanting to enroll in the SHOP must have the majority of their employees working in California. For the 2014 plan year, no more than 49% of their eligible employees can reside outside of California.

For more information, call Warner Pacific at 800-801-2300.