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 email@example.com 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.
- 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).