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.
Ready to enroll in SHOP coverage?
You’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 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:
You should also check 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 isn’t considered “affordable”. Affordability is based on how much the employee pays for coverage for themselves and their dependents. If the plan isn’t affordable, the employee may enroll in a Marketplace plan instead.
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.
|Plan category||The plan pays, on average||The employee pays, on average|
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.
You have 2 options for enrolling:
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.
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.
The SHOP Eligibility Determination Form only takes a few minutes to fill out, and you’ll find out instantly if you’re eligible for SHOP insurance. Just enter some basic information about your business, certify that you meet the 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 the Small Business Health Care Tax Credit.
Note: 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.
About 45–60 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:
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.
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 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.
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.
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.