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CMS posts group exchange application drafts

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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.”

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The SHOP exchanges

The drafters of the Patient Protection and Affordable Care Act of 2010 (PPACA) included the SHOP provision in an effort to create a kind of Web-based supermarket for small group health coverage.

PPACA opponents continue to fight to block implementation of the act.

If the individual and small group health insurance exchange (HIX) provisions take effect and work as drafters expect, the first coverage sold through the SHOP exchanges would start to take effect Jan. 1, 2014.

CMS officials have posted drafts of SHOP employee application documents online in connection with a federal Paperwork Reducation Act (PRA) review process.

CMS is supposed to put questionnaires, application documents and other forms through a formal review process whenever it makes a new effort to collect information from members of the public.

Employees of employers that use the SHOP system can submit SHOP coverage applications “online, using a paper application, over the phone through an agent or broker or a call center operated by an exchange, or in person through an agent, broker, or navigator,” CMS officials say.

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