Qualifying for Small Business Health Options Program (SHOP) Marketplace

To use the Small Business Health Options Program (SHOP) Marketplace to offer coverage to their employees, your business must meet certain requirements:

 

Small Business Health Options Program (SHOP) Marketplace Criteria

  • You must have 50 or fewer full-time equivalent employees. Use the tool to calculate the FTE to know if you have 50 FTE or less, as are counted for eligibility for SHOP.
  • You must offer coverage to all full-time employees. In general this means to those who work an average of 30 hours or more per week. You do not have to offer coverage to part-time employees, usually working 29 hours or less a week.
  • In most states, at least 70% of its full-time employees must enroll in the plan SHOP.
  • Employers requesting SHOP coverage between November 15 and December 15 of each year may offer coverage without fulfilling this requirement SHOP percentage.
  • You must have an office or place of work of employees within the service area SHOP.

 

How many of my employees must enroll in SHOP?

In many states, at least 70% of employees who are offered coverage must enroll for you to purchase health coverage through the Health Options Program for Small Business Health Insurance Market (SHOP). This percentage may be different in your state.

  • Employees covered by health insurance from another employer, Medicare, Medicaid, military insurance, or a program for veterans, are not included in the calculation.
  • Employees with individual private insurance (the kind you buy for themselves, not through an employer) are included in the calculation.

 

Example of SHOP Coverage (assuming a participation rate of 70% is required):

You offer coverage to 14 full-time employees

  • 2 have coverage through your spouse’s employer
  • 1 has coverage through Medicare
  • 1 has coverage through TRICARE

14 employees in total, less than 4 are not included in the calculation = 10 employees that count towards the required 70%

70% of 10 employees = 7. At least 7 employees must enroll for you to qualify for a plan SHOP.

 

Minimum Participation Rate

If you can not meet the minimum participation rate may apply for coverage during the annual enrollment period from November 15 to December 15. This period is designed to offer you a plan to SHOP employers who fail to meet the minimum participation rate.

To make it easier, we recommend that you ask your employees in advance if you are interested in health coverage you could offer them or if they already have coverage. This will give you an idea of ​​how many of your employees may enroll. You will not know exactly how many employees will be enrolled until you choose your coverage and the amount you contribute and the offer to their employees.

 

 Enrolling in Small Business Health Options Program (SHOP) Marketplace

  • Step 1: Create an account Market and fill out an application SHOP

  • Step 2: Create the application criteria

  • Step 3: Determine the contribution to the monthly premium

  • Step 4: Select the coverage and make an offer to employees

  • Step 5: Monitor employee participation and submit their entries

 

For questions or help with SHOP coverage , call 1-800-706-7893 (TTY: 711) Monday through Friday from 9:00 a.m. to 7:00 pm ET. Agents and brokers who work helping small businesses can use this number.