New York SHOP program removes online enrollment & premium billing

New York SHOP program removes online enrollment & premium billing

Starting this month, NY State of Health (NYSOH) made several changes to the state’s SHOP program in an effort to give the federal tax credit to as many small businesses as possible.   

In New York, 98% of businesses have fewer than 100 employees and over 40% of the workforce is employed in these small businesses. The recent changes impacting these businesses were allowed through the November 2017 rule that allows small employers to enroll directly through issuers and brokers and still receive the small business tax credits.  

According to the NYSOH webinar on the topic, these changes will:  

  • Make it easier for small employers to access federal tax credits  
  • Make it easier for issuers to participate in SHOP  
  • Align the SHOP enrollment processes with those outside the small group market 
What changed? 

With these changes, NYSOH will continue to certify all plans for SHOP, maintain a shopping portal where members can view available plans and provide employer eligibility determinations. It will no longer provide employee eligibility determinations, online enrollment, or premium billing and collection. Online enrollment and premium billing will now be handled directly by the issuer or through a certified broker.  

Now the standard process for small groups will be to receive an employer eligibility determination, proceed to anonymous shopping on NYSOH’s site, and, when they’re ready to enroll, go directly to an issuer or certified broker. Existing groups will receive automatic eligibly notifications when it’s time to renew. They will then renew directly with the issuer or a certified broker.   

What brokers need to know  
  • SHOP will now allow brokers to obtain multiple NYSOH new eligibility determinations (10 or more) on one form This can be downloaded in your NYSOH account or you can request the form by emailing NYSOHbrokersupport@health.ny.gov  
  • NYSOH will use its broker newsletter as the main form of communication for any future updates.  – To see previously newsletters go to: https://info.nystateofhealth.ny.gov/ProducerToolkit  
Industry Updates  

Softheon’s team is always on the lookout for the latest updates in healthcare policy. Back in January, FF-SHOP experienced changes that impacted how small businesses enrolled in and managed their coverage. Our team has experience with helping state exchanges adapt to the ever-changing industry, most notable through our partnership with Access Health CT.  

For more information and demos of the new broker portal features, view the NYSOH webinar. 

 The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon. Please direct any questions or comments to research@softheon.com. 

Jen Eyring

Jen Eyring is the Director of Marketing at Softheon. Prior to this role, she focused on creating instructional documentation for Softheon’s five core solutions and their corresponding operating procedures. She has also acted as a Product Manager for our Foundry solution. Jen holds a BA in Writing, Rhetoric, and Technical Communication from James Madison University.

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