SHOP Marketplace

Introduction – SHOP Marketplace

The Small Business Health Options Program (SHOP) Marketplace is for small employers who want to provide health and dental coverage to their employees
Profit or non-profit organization must have 50 or fewer full-time equivalent employees (FTEs).

At least one full-time equivalent (FTE) employee other than owners, partners, or family members.
Few states are allowing up to 100 - state specific

SHOP can be applied any time of year
Offers high-quality plans from private insurance companies
Offer employees one plan, or let them choose from multiple plans
Offer only health coverage, health and dental coverage, or only dental coverage
Everything can be handled online — applying, choosing plans, managing your coverage, and paying your premiums
If employer has fewer than 25 employees, may qualify for a Small Business Health Care Tax Credit worth up to 50% of your premium costs

Eligibility requirements to use SHOP marketplace

Must have 50 or fewer full-time equivalent employees (FTEs).
Must offer coverage to all your full-time employees — generally workers averaging 30 or more hours per week.
Optional to offer coverage to part-time employees — generally those averaging less than 30 hours per week or seasonal workers.
At least 70% of the employees you offer insurance to must either enroll in your plan or have coverage from another source.
Without meeting a minimum participation requirement, can enroll in SHOP coverage between November 15 and December 15 any year.
Must have an office or employee work site within the state whose SHOP Marketplace you want to use

SHOP Marketplace insurance for multiple locations and businesses

Choose a single health plan for all your employees.
Create additional SHOP Marketplace accounts in each state where your employees work, and offer different plans in each location.

SHOP Marketplace coverage Start Date

Employer and employees ca enroll in SHOP Marketplace coverage during any month throughout the year and plan year will last for 12 months.
If employer and employee complete the SHOP Marketplace enrollment process by the 15th of the month, coverage will start on the 1st of the following month. If it is after 15th of the month, coverage will start on the 1st of the second following month.

Offer a choice of plans

In the SHOP Marketplace, Employer can offer one health and dental plan, or a choice of health and dental plans.
If Employer offers employees a choice of plans, you’ll select a plan category (like Bronze and Silver for health plans, and High and Low for dental plans) and set the percentage amount that employer want to contribute toward employees’ premiums. Employees can use contribution toward any plan offered within the plan category you select.

Small Business Health Care Tax Credit

The tax credit is worth up to 50% of Employer contribution toward employees' premium costs (up to 35% for tax-exempt employers)

Enrollment Steps – Employer

My eligibility --> Basic Information (EIN), Business Name, doing business as, preferred method of contact and spoken language etc.
Employer Information - Primary Contact --> Primary contact details, mailing address
Verify Eligibility --> Minimum eligibility confirmation
Employee roster --> Add employee details “First and last name, DOB, SSN, mailing address” etc. Can add up to 10 dependents
Employee Participation Code: Unique for each employee
Shop Attestation --> Electronic Signature
Confirmation --> Confirming the details
After verification, approval or rejected mail will be sent to employer
Create enrollment to continue with application status
Start coverage on (start date), Employee waiting period
Decide how you offer coverage
Select insurance company and plan from the category
Single insurance company and plan
Set employer premium contribution
Contribution method --> Fixed percentage
Dependents selection
Plan Selection
Summary and Submit
Your offer of coverage is complete --> Confirmation
Now employees can view the offer and submit it.

Enrollment Steps – Employees

System Flow

Wednesday, September 13, 2017