Filing a SHOP employee complaint

States using HealthCare.gov for the Small Business Health Options Program (SHOP) no longer process employee enrollments, determine employee eligibility, or accept employee appeal requests related to enrollment eligibility. If you:

  • Applied for your small employer’s SHOP Marketplace offering and were denied coverage: Contact your employer or insurance company for more information about employee enrollment and eligibility.
  • Are eligible for your small employer’s SHOP Marketplace coverage, based on a qualifying life event, but couldn’t enroll during a Special Enrollment Period because the insurance company denied you coverage: You can file a SHOP employee complaint. Note: A dependent of an employee isn’t eligible for a Special Enrollment Period if your employer doesn’t offer coverage to dependents.

Ways to file a complaint

You can file a complaint by:

  • Calling the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
  • Sending an email to shop@cms.hhs.gov documenting the concern and providing evidence to support the complaint. Note: Don’t include Personally Identifiable Information (PII) — like your Social Security Number — in your email. Call the SHOP Call Center at the number above if any PII needs to be provided as a part of your SHOP employee complaint submission.

You have 90 calendar days from the date of your Special Enrollment Period ineligibility notice to submit a complaint to SHOP.

Note: Keep a copy of your complaint for your records.

After you file a complaint

You'll get a response saying that your complaint was received. It will provide a description of the complaint process and instructions for submitting additional materials, if needed.

Questions?

  • An employee should contact their employer or insurance company with questions regarding their SHOP health and/or dental coverage — including plan year start and end dates, payment-related inquiries, life changes, and/or claims-related questions.
  • For all other questions related to the SHOP employee complaint process, contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).