Section 220-RICR-90-00-1.13 - SHOP ExchangeA. In General - §1311(b)(1)(B) of the ACA and its implementing regulation, 45 C.F.R. Part 155 Subpart H, incorporated above at § 1.3 of this Part, provide for the establishment of a Small Business Health Options Program (SHOP) Exchange that is designed to assist qualified employers and to facilitate the enrollment of qualified employees into Qualified Health Plans.B. Terms and Conditions - To participate in the SHOP Exchange, a qualified employer or a qualified employee must register with the Exchange and accept the terms and conditions for participation. The SHOP Exchange may from time to time modify such terms and conditions for participation in the SHOP Exchange.C. SHOP Enrollment - A qualified employer or a qualified employee shall submit a signed application for coverage prior to receiving coverage through the SHOP Exchange. All signatures required from a qualified employer or a qualified employee to complete an enrollment application may be obtained electronically. Any such electronic signature is valid and the legal equivalent of a signature obtained in another form.D. Agents and Brokers - The SHOP Exchange shall establish a process by which a qualified employer or qualified employee may designate an insurance agent or broker to act on his or her behalf in interactions with the SHOP Exchange. 1. In order to enroll qualified employers and qualified employees through the SHOP Exchange, the agent or broker must be certified to participate in the SHOP Exchange and must have established an account with the SHOP Exchange.2. A qualified employer or qualified employee may designate an agent or broker electronically.E. SHOP Premium Aggregation - The SHOP Exchange shall provide each qualified employer with a bill on a monthly basis that identifies the employer contribution, the employee contribution, and the total amount that is due to the Qualified Health Plan issuers from the qualified employer. The SHOP Exchange shall also collect from each employer the total amount due and make payments to Qualified Health Plan issuers in the SHOP for all enrollees.F. Due Date - The SHOP Exchange shall establish a monthly deadline by which premium payments must be received in order to make coverage effective on the first (1st) day of the following month.G. Grace Period - Qualified employers shall have a thirty (30) day premium non-payment grace period. If full payment is not received by the end of the grace period, the SHOP Exchange may terminate coverage effective on the last day of the grace period.220 R.I. Code R. 220-RICR-90-00-1.13
Amended effective 12/22/2019
Amended effective 12/31/2020
Amended effective 4/2/2023