The 644-page final rule also provides states with new options in terms of operating their own Small Business Health Options Program (SHOP). States can set the size of the small group market at either one to 50 or one to 100 employees until 2016 when employers with up to 100 employees can participate in a SHOP.
Starting in 2017, states will have the option to let businesses with more than 100 employees buy large group coverage through the SHOP.
Through the SHOP, states may allow employers to select a single plan to cover their employees or offer multiple levels of coverage.
"These policies give states the flexibility they need to design an Exchange that works for them," said HHS Secretary Kathleen Sebelius in a press statement announcing the final rules. "These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today."
HIX, which were created by the Patient Protection and Affordable Care Act, are expected to provide health insurance coverage for an estimated 11.5 million people, including members of Congress, in 2014.