Section 4500.100  Illinois SHOP

a)         This Section applies at any time the Exchange operates a SHOP for the small group market. The Exchange may delegate or defer functions of the Illinois SHOP to HHS through a federal platform agreement.

b)         The Exchange adopts the following provisions for the SHOP and related standards for individuals and entities to participate in the SHOP or in QHPs offered through the SHOP, except that references to the "Federally-facilitated SHOP" or "FF-SHOP" are substituted with "Illinois SHOP" unless the applicable section of the Code of Federal Regulations contains a conflicting or additional requirement for the type of Exchange operating in Illinois (see 45 CFR 155.706(a) (Apr. 17, 2018) (no later editions or amendments)):

1)         Sections 4500.40 through 4500.90;

2)         the functions of an Exchange provided in 45 CFR 155, Subparts E, K, and M as those provisions of the Code of Federal Regulations were in effect on June 4, 2024 (no later editions or amendments), as modified by this Part; and

3)         45 CFR 155, Subpart H as those provisions of the Code of Federal Regulations were in effect on June 4, 2024 (no later editions or amendments), as modified by this Part.

c)         The following provisions do not apply to the Illinois SHOP (see 45 CFR 155.706(a)):

1)         Requirements related to individual eligibility determinations in 45 CFR 155, Subpart D as those provisions of the Code of Federal Regulations were in effect on June 4, 2024 (no later editions or amendments);

2)         Requirements related to enrollment of qualified individuals described in 45 CFR 155, Subpart E;

3)         The requirement to issue certificates of exemption in accordance with 45 CFR 155.200(b) (Dec. 27, 2019) (no later editions or amendments); and

4)         Requirements related to the payment of premiums by individuals, Indian tribes, tribal organizations, and urban Indian organizations under 45 CFR 155.240 (May 27, 2014) (no later editions or amendments).

d)         A QHP issuer must not change its rates in the SHOP more frequently than quarterly and must not vary rates for a qualified employer during the employer's plan year. In addition to the Department's filing and approval requirements under Section 355 of the Code and 50 Ill. Adm. Code 2026, updated rates must be submitted to the SHOP at least 60 days before their effective date, which must be January 1, April 1, July 1, or October 1 of the calendar year (see 45 CFR 155.706(b)(6)).

e)         The uniform group participation rate requirements for Federally-facilitated Exchanges in 45 CFR 155.706(b)(10)(i) also apply while Illinois has a State-based Exchange on the Federal Platform.