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ACA: Delays in SHOP Enrollment

Cover Oregon, the state-based marketplace for Oregonians, also announced a delay in its SHOP roll-out. They anticipate that sometime in mid-October, the site will be opened first to agents who can help small employers get rates, compare plans, and enroll in group coverage. Functionality for employers will be limited to browsing plans during that “beta testing” time which is expected to last about two weeks. When Cover Oregon believes the SHOP site is ready for full release, they will open to small employers for self-service and allow them to upload census data, get rates, compare plans, and enroll. They currently anticipate that will happen in late October or early November.

More information on the Idaho and Montana federal SHOP application and enrollment process are available at HealthCare.gov. The website for Oregon SHOP information is CoverOregon.com.

Employers Won’t Face Penalty for Missing October 1 Exchange Notification Deadline

The Department of Labor (DOL) clarified recently that employers will not be penalized if they fail to notify their employees about the ACA’s health insurance marketplaces by October 1.

In an FAQ on their website, the DOL stated, “If your company is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace by October 1, 2013, but there is no fine or penalty under the law for failing to provide the notice.” Read the full text of the FAQ.

Eager to Enroll in Individual Coverage through the Marketplace?

Some Things to Consider…

While the Affordable Care Act’s new Health Insurance Marketplaces are up and running, it’s important to note a few things:

  • If you live in Oregon, the site’s full functionality is not open to everyone at this point. You’ll be able to browse plans and rates, get an estimate of eligibility for financial assistance, and search for an agent or other community partner in your area. But if you want to apply for financial assistance, get a quote, or enroll in coverage during the first few weeks of October, you will need to go through a Cover Oregon-appointed insurance agent or other community partner. Cover Oregon is limiting initial access while it irons out technical issues.
  • If you live in Idaho or Montana, you have the ability to enroll now, however technical issues are expected for the first few weeks.
  • The initial open enrollment period will continue through March 2014.
  • Your actual plan benefits will not be effective until January 2014 at the earliest*

With those things in mind, we recommend individuals wait a few weeks before visiting the marketplaces to research options and enroll in coverage. A knowledgeable insurance agent can answer your questions and help you navigate the many details you may need to consider.
As a reminder, if you don’t qualify to receive financial assistance, there is no requirement for you to enroll through the Marketplace.

*For a January 1, 2014 effective date, enrollment must be completed by December 15, 2013; coverage will not be effective retroactively if you enroll later. Enrollment must be completed by the 15th of the prior month for 2014 effective dates of February, March, or April. If enrollment is not completed by March 15, 2014, then the applicant won’t be eligible for coverage until January 1, 2015, unless they have a qualifying event such as involuntary loss of other coverage or acquired a new dependent.

Health Plan Renewal Mailings

Starting January 1, 2014, all health insurance plans must meet specific requirements of the ACA.

Individual and Family Policyholders

In Oregon, individual policies are currently renewed on a calendar year basis. So for Oregonians with individual plans, that means their current plan will end on December 31, 2013, and they will have new plans to choose from that meet the ACA requirements. Any new policies issued in 2014 will renew January 1 annually and accumulators will be based on a calendar year regardless of when the individual enrolls.

Small Employer Group Clients

Small employers can keep their current renewal period, unless they change insurers or go into the Health Insurance Marketplace prior to their current renewal date. Current plan designs will end upon the small group’s renewal in 2014, and they will have new plan designs to choose from that meet the ACA requirements at that time. In Oregon out-of-pocket accumulators will be based on a calendar year.

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