How to offer SHOP health insurance to employees
Small Business Health Options Program (SHOP) health insurance plans are quality, affordable health and dental insurance for small businesses and their employees. SHOP plans are offered by private insurance companies and cover essential health benefits and pre-existing conditions.
Ready to enroll in SHOP coverage? There’s a new way to sign up for plans that start on or after January 1, 2018. You’ll either work with a SHOP-registered insurance agent or broker or handle everything yourself through your insurance company. Learn more about how to enroll in SHOP insurance (PDF).
For plans starting on or after January 1, 2018, you will no longer use HealthCare.gov to apply, select, enroll in, or manage your SHOP insurance. Some important things to remember when enrolling in 2018 SHOP coverage:
- You don’t need to create an account on HealthCare.gov or log in to your existing account.
- You won’t start an application through HealthCare.gov.
- Use the new Eligibility Determination Form to verify your eligibility for SHOP.
Making a SHOP health insurance decision
You can enroll in SHOP coverage year-round. To find the best plan for your business and employees, think about price, benefits, and features. You may also want to consider:
- Whether to offer your employees one plan or a choice of plans
- Whether to offer medical coverage, dental coverage, or both
- How much of your employees' premiums you’ll pay
- Whether to offer coverage to dependents and part-time employees
- When coverage starts
- How long new employees must wait before they get a coverage offer
You should also check SHOP availability in your state. Some states may use their own websites for enrolling and managing SHOP coverage. Select your state to find out.
Understanding SHOP insurance categories
When you compare SHOP insurance, you'll see 4 categories of plans. The categories have nothing to do with the quality of care. They're based on how the insurance company and your employees will share the costs of care.
| Plan category | The insurance company pays | Your employees pay |
|---|---|---|
Bronze |
60% |
40% |
Silver |
70% |
30% |
Gold |
80% |
20% |
Platinum |
90% |
10% |
Choosing a stand-alone dental plan
If you want to, you can add dental coverage to your SHOP insurance offer or offer dental insurance by itself without a SHOP health plan. Learn more about SHOP dental coverage.
Some SHOP health insurance plans also include dental benefits. If you pick a plan that includes dental coverage, you don’t need to select a separate dental plan.
How to enroll with the new SHOP enrollment process
For coverage starting on or after January 1, 2018, HealthCare.gov offers SHOP information and resources to help you decide on coverage, but you can’t sign up for SHOP insurance starting on or after January 1, 2018, through HealthCare.gov. Instead, you have 2 options for enrolling:
Contact your insurance company and sign up with them. If you are searching with HealthCare.gov’s See SHOP Plans and Prices tool, you may want to write down some important information such as the plan name, metal level, plan type, and plan ID to have handy when you contact the insurance company.
Work with a SHOP-registered agent or broker. You can use your current agent or broker or find a new one, as long as the agent or broker is authorized to sell SHOP insurance. Find an agent or broker today using the Find Local Help tool.
Remember, the specific enrollment steps may vary by insurance company. Talk with your insurance company or SHOP-registered agent or broker to make sure you're aware of any monthly deadlines for completing your enrollment.
Your agent, broker, or insurance company will be able to help you with the information you and your employees will need.
Note: You should not create an account, log in to your existing account, or start an application on HealthCare.gov for SHOP coverage that starts on or after January 1, 2018.
Paying premiums & managing coverage
For 2018 SHOP coverage, you'll pay your premiums to your insurance company, not HealthCare.gov. If you need to make changes or updates to your SHOP coverage during the year, contact your agent, broker, or insurance company.
Verifying your eligibility for SHOP
You must meet certain requirements to qualify for SHOP insurance. To verify that you can enroll in SHOP coverage, use the new SHOP Eligibility Determination Form.
The SHOP Eligibility Determination Form only takes a few minutes to fill out, and you’ll get an instant determination. Just enter some basic information about your business, certify that you meet 4 eligibility requirements, review your form, and submit.
Save your eligibility determination results for your records. Proof of SHOP eligibility may be required to enroll in SHOP coverage through an insurance company or to claim the Small Business Health Care Tax Credit.
Questions?
- See all SHOP tools, calculators, fact sheets, how-to guides, videos, and other resources for employers.
- Contact the SHOP Call Center at 1-800-706-7893 (TTY: 711) weekdays from 9 a.m. to 5 p.m. ET. Agents and brokers selling SHOP coverage can use this number too.
More Answers: How to offer SHOP health insurance to employees
- I am unable to enroll in SHOP insurance by logging in to my HealthCare.gov account. What do I do?
With the new sign-up process for SHOP plans that start on or after January 1, 2018, you can no longer pick a plan, apply, or enroll through HealthCare.gov. Instead, you will enroll either through the insurance company or with the assistance of an agent or broker.
Note: You should not log in to your existing HealthCare.gov account, create a new one, or start an application on HealthCare.gov if you are enrolling in 2018 SHOP coverage.
- As a small business employer, do I have to offer insurance to my employees' dependents?
Generally no, but some states require it. Check with your state's Department of Insurance.
Dependents can accept or reject your offer. If they decline it, they can enroll in a plan through the Health Insurance Marketplace, but they won't be eligible for savings through premium tax credits or cost-sharing reductions. They'd have to pay full price.
- If I don't offer insurance to dependents, can they get insurance through the Marketplace?
Yes. If the dependents don't have access to other health insurance, they can get insurance through the Marketplace. Depending on the entire household's income, they may qualify for savings through premium tax credits and cost-sharing reductions.
- What if there are no SHOP plans available in my area?
You may still be able to enroll in a small group health plan through an agent or broker or directly with a health insurance company. However, it may not be considered SHOP coverage, and you may not be able to claim the Small Business Health Care Tax Credit. See what non-SHOP plans may be available to you at finder.healthcare.gov, or search for an agent or broker in your area.