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How to enroll in SHOP insurance

How to appeal a SHOP decision

Small employers can appeal a Small Business Health Options Program (SHOP) eligibility decision.

SHOP decisions you can appeal

Employers can appeal two kinds of SHOP actions:
  • Denial of SHOP eligibility
  • SHOP not making an eligibility determination in a timely manner
If you're determined ineligible to participate in SHOP, you'll get a notice with details specific to your situation. You have 90 days from the date of this notice to request an appeal.
If your state is running its own SHOP, the appeals process may be different. Refer to your state's SHOP for more details.

How to file a SHOP appeal

Your SHOP eligibility determination notice will explain how to file an appeal for your specific situation.
Employers can appeal by filling out theย SHOP appeals form for employers (PDF).
Then, mail your completed appeal form to:

Health Insurance Marketplace
465 Industrial Boulevard
London, KY 40750-0061
An authorized representative, like an agent or broker, can file an appeal for you. You may also get help in aย language other than English.
Note:ย Keep a copy of your appeals form for your records.

After you file an appeal

You'll get a letter or phone call saying that your appeal was received. It will provide a description of the appeals process and instructions for submitting additional materials if needed.

Questions?