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, cover essential health benefits, and may not exclude coverage for treatments for pre-existing conditions.

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 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.

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 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 category The cost of care paid by the insurance company, on average The cost of care paid by your employees, on average

Bronze

60%

40%

Silver

70%

30%

Gold

80%

20%

Platinum

90%

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 employee’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. 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. Find an agent or broker today using Find Local Help or Help On Demand.
  • 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.

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.

Note: You should not create an account, log into your existing account, or start an application on HealthCare.gov for SHOP coverage, even if that is how you have enrolled in SHOP coverage in the past.

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 meet certain requirements to purchase insurance through SHOP. To verify that you can enroll in SHOP coverage, use the 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 the 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.

How to renew your SHOP plan

About 45–60 days before your current SHOP coverage ends, contact your insurance company, agent, or broker to see 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

I am unable to enroll in SHOP insurance by logging into my HealthCare.gov account. What do I do?

For SHOP plans that start on or after January 1, 2018, you don't pick a plan, apply, or enroll through HealthCare.gov. Instead, you enroll either through the insurance company or with the assistance of a Marketplace-registered agent or broker.

As a small business employer, do I have to offer insurance to my employees' dependents?

Generally no, but some states do require it. Check with your state's Department of Insurance.

If you do offer insurance to employee’ dependents, they can accept or reject your offer. If they decline it, they can enroll in a plan for individuals and families through the Health Insurance Marketplace, but they may not be eligible for savings through premium tax credits or cost-sharing reductions. If they’re not eligible for such savings, they'd have to pay full price.

If I don't offer insurance to dependents, can they get insurance through the Marketplace?

Yes. Dependents can get insurance for individuals and families through the Marketplace, if they are otherwise eligible. Depending on the entire household's income, if dependents aren’t eligible for other health coverage, 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 generally will 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.

You may also have other options for providing benefits to your employees besides traditional group coverage, such as with a Health Reimbursement Arrangement (HRA). Learn more about what other products and services may be available to you.