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How to enroll in SHOP insurance

How to offer SHOP health insurance to your employees

Health insurance plans offered through the Small Business Health Options Program (SHOP) are quality, affordable health and dental insurance coverage for small businesses and their employees. SHOP plans are offered by private insurance companies, coverย 
, and may not exclude coverage for treatments forย 
.
Notice:
Ready to enroll in SHOP coverage?
Youโ€™ll either work with a SHOP-registered agent or broker or work through your insurance company. This may be different from how you have enrolled in SHOP coverage in the past. Some important things to remember:
  • You donโ€™t need to create an account on HealthCare.gov or log into your existing account.
  • You wonโ€™t start an application through HealthCare.gov.
  • You will need to use theย Eligibility Determination Formย to verify your eligibility for SHOP.

Making a SHOP health insurance decision

You can generally 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 youโ€™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 checkย SHOP availability in your state. Some states may use their own websites for enrolling and managing SHOP coverage.
Employees may still be eligible for premium tax credits if the plan you offer isnโ€™t consideredย 
. Affordability is based on how much the employee pays for coverage for themselves and their dependents. If the plan isnโ€™t affordable, the employee may enroll in a Marketplace plan instead.

Understanding SHOP insurance categories

There are 4 categories of SHOP plans to choose from. The categories have nothing to do with the quality of care. They're based on the way the cost of care will be shared between your employees and the insurance company.
SHOP health coverage: Estimated averages for a typical population. Your employees' costs will vary.
Plan categoryThe plan pays, on averageThe employee pays, on average
Bronze60%40%
Silver70%30%
Gold80%20%
Platinum90%10%

Choosing a stand-alone dental plan

You can add dental coverage to your SHOP insurance offer or offer dental insurance by itself without a SHOP health plan. Some SHOP health insurance plans also include dental benefits.
As with health plans, you can choose how much of an employeeโ€™s dental premium you pay.
Talk to your insurance company or agent or broker to find out more about SHOP dental plans.

How to enroll through SHOP

You have 2 options for enrolling:
  • Work with a SHOP-registered agent or broker.ย You can use your current agent or broker or find a new one, as long as the agent or broker is registered with the applicable Marketplace to sell SHOP insurance.ย Find an agent or broker today.
  • Contact your insurance company and sign up with them.ย Find SHOP plans in your area.ย 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.
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 provide you with the information you and your employees will need.

Paying premiums & managing 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 meetย certain requirementsย to purchase insurance through SHOP. To verify that you can enroll in SHOP coverage, use theย SHOP Eligibility Determination Form.
The SHOP Eligibility Determination Form only takes a few minutes to fill out, and youโ€™ll find out instantly if youโ€™re eligible for SHOP insurance. Just enter some basic information about your business, certify that you meet theย eligibility requirements, review your form, and submit.
Save your completed form and eligibility results for your records. Proof of SHOP eligibility may be required to enroll in SHOP coverage through an insurance company or to claim theย Small Business Health Care Tax Credit.
Note:ย Once you complete the SHOP Eligibility Determination Form, you should get an email that includes your SHOP eligibility results. Your eligibility results are also shown on the final page of the form.

How to renew your SHOP plan

About 45โ€“60 days before your current SHOP coverage ends, contact your insurance company, agent, or broker to find out what plans and prices are available to you. Insurance companies may have different timelines for renewing coverage, so be sure to ask:
  • When you need to submit your enrollment for a coverage renewal
  • How long your employees will have to accept your renewal
  • When you should pay your first premium

Questions?

More Answers: How to offer SHOP health insurance to employees