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 their employer-sponsored coverage. As with the application processes for the individual exchange, the user is required to have an account before entering this flow, so must either create a new account or log into an existing one. Having done so, they will be taken into an application script which captures information about the employee and also the members of their household if they want to consider enrolling them on their employer-sponsored coverage too.
The application consists of a section to identify if applying for coverage for just the employee, or to cover other family members, then a section to gather information about the employee themselves, followed by an optional section about the other members of their household.
On completing the application, the employee's details including 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 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 presented with the option to apply for assistance in the individual exchange, they may be eligible for a program within the insurance affordability programs.
It is as part of the individual application flow that the employee affordability check is performed. As mentioned previously, 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 involves asking about the employee, the household, and the income within that household - this amounts to a lot of the same information that is already 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 eligible for ESI and this is unaffordable then continue to determine eligibility for insurance assistance. If eligible for ESI which is affordable then the employee cannot be determined eligible for insurance assistance, however the eligibility for affordable coverage does not impact 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 in the individual exchange where 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.