SHOP Exchange Health Care – What You Need to Know

 In Blog, Health Care Reform

SHOP (Small Business Health Exchange Program)Shop Health Exchange

The Small Business Health Options Program (SHOP) is now open and ready to help small businesses have better options to buy their employee health care through the state health exchanges. The SHOP exchange has already rolled out this year to very little “fan-fare” and like many other provisions of The Affordable Care Act (ACA), there have been delays and changes to the SHOP Program.

Here are some frequently asked questions about the SHOP Program

What is a SHOP Exchange? The concept behind setting up a SHOP exchange health care program was to allow small business owners to become part of a much larger risk pool – eliminating the current problem of smaller companies having to pay more for health insurance.The Affordable Care Act (ACA) created the Small Business Health Options Program (SHOP) for small employers. The SHOP Marketplace is required by each state.

Who is Eligible for the SHOP Program? If you are a small business with under 50 employees, you are eligible to participate in SHOP. You must have a business address in the state where you are applying for health care and have at least one employee on payroll (Excluding your spouse or the business owner). Beginning in 2016, the SHOP program will be available to employers with 100 employees or less.

Are there participation requirements? Most states require at least 70% of your employees to be enrolled in the SHOP Exchange, however some states have a 75% requirement. The following states require a 75% participation: Arkansas Iowa New Hampshire New Jersey South Dakota Tennessee Texas

Can we make changes to our health care program during the year? No. Health care plan changes or contribution amounts are only allowed once per year on your annual enrollment period. You may however, add or remove eligible employees and their dependents throughout the year. (i.e: new hires, termination of an employee, qualifying events).

What health plan coverage options are available through SHOP? Currently, most SHOP Marketplaces are limiting employers to only offer employees a single plan. Additional choices or multiple plans could be offered by each state These are the current plan choices:

  1.     “Employer choice”: Employer selects one or more plans for employees.
  2.     “Hybrid choice”: Employer selects a metallic Plan (Bronze, Silver, Gold, Platinum) and allows the employees to select a plan from within that level.
  3.     “Employee choice”: Employee can choose any SHOP health plan that meets the benefit plan requirements.

How do I purchase a Health Care Plan on the SHOP Exchange? You can enroll in the SHOP Program through an insurance agent, broker or directly through the insurance company.

Will my business be eligible for the Small Business Health Care Tax Credit? Yes, Small employers with 25 or fewer employees who receive, on average, less than $50,000 a year in wages may be eligible for tax credits if they purchase the plan through the SHOP Marketplace. These tax credits are only available to employers who enroll through the SHOP exchange marketplace. For more information, please feel free to contact us at 800-514-3513



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