The Centers for Medicare & Medicaid Services (CMS) has posted drafts of the paper and online applications for workers who may end up shopping for health coverage through the new small group exchanges (CMS-10438).
The new application processes could affect employees of small employers that get their health benefits through the Small Business Health Options Program (SHOP) exchanges.
The draft paper form is 3 pages long and includes four separate sections. The first section covers basic employee identification information. It includes spaces for indicating which language the employee prefers to read and speak, and an optional question about race.
The application asks employees who indicate that they’re American Indians or Alaskan Natives to give the name of the “federally recognized tribe.”
An employee also must sign in a box that states, “I have provided true answers to all the questions on this form to the best of knowledge. I know that if I’m not truthful there may be a penalty.”
The draft online application process is similar but includes somewhat more detailed questions and response options.
When filling out the Web application, employees will get a question about whether they have “used tobacco at any time in the last 12 months” and a question about any coverage dependents might have.
A question that will give a worker a chance to describe any dependents added to the coverage includes 13 basic descriptor options, ranging from “Husband/wife” to “Grandchild,” and an “Other” option that lists 14 additional options, ranging from “Adopted son/daughter” to “Collateral dependent.”