A further application process supports employees whose employers are on the Small Employer Exchange (or SHOP), where employees are using the exchange to access to employer-sponsored coverage. As with the application processes for the individual exchange, the user is required to have an account before starting an application. The employee must either create a new account or log into an existing one. Having done so, they are taken to the application script which captures information about the employee and also the members of their household if they are to be considered for enrollment on the employer-sponsored coverage as well.
The application consists of the following:
Upon completion of the application, the employee's details including their SSN are sent to the plan management system to determine whether this person has been entered on a roster of qualified employees for any employer(s) in the SHOP and whether the open enrollment period for any of those employers is currently active. If active, then summary information about the options available to the employee in the SHOP will be presented on the HCR eligibility results page. If the employee is eligible, they can continue to enroll on the plan subsidized by their employer. Otherwise, they are informed that they can't be found in the roster of qualified employees for employers in the SHOP. If found on the roster and the enrollment period is not active, this too is communicated to the employee.
As well as the determination for employer-sponsored coverage, employees are also presented with the option to apply for assistance in the individual exchange, as they may be eligible for a program within the insurance affordability programs.
The employee affordability check is performed as part of the individual application flow. As previously mentioned, if employer-sponsored coverage is not considered affordable, then the employee may be entitled to premium tax credits and cost-sharing reductions they would otherwise be ineligible for. The information that is necessary for this affordability determination is about the employee, the household, and those with income in that household. A lot of the same questions are asked as part of the individual application process. The affordability check is necessary in the individual application because it is a prerequisite for an eligibility determination for Insurance Assistance. If a person is eligible for employer sponsored insurance that is un-affordable; then they can proceed to check their eligibility for Insurance Assistance. If eligible for employer sponsored insurance which is affordable, then the employee cannot be determined eligible for Insurance Assistance. However, eligibility for affordable coverage does not preclude eligibility for Medicaid. It is in the best interests of the employee to look for the best coverage options and Medicaid may be suitable; meaning the employee goes without coverage under the QHP subsidized by the employer.
Continuing to enroll on a plan offered by their employer follows the same pattern to plan selection and enrollment as in the individual exchange. The employee selects the household members for coverage, before being taken into the plan management screens for the Small Employer exchange. Eligible plans are displayed with premiums minus the amount subsidized by their employer contribution, as well as the date from which the coverage is offered.
As with applications for the other insurance affordability programs, conditional verifications are used on the application case to check that information entered on the application is consistent with information available through the federal data hub. For employees, this is their social security number and state residency status. Client attested information that has not been verified or considered reasonably compatible is displayed to the employee on completion of the application. Client-reported information that cannot be verified or considered reasonably compatible requires case worker intervention in order for the application case to be authorized.