Coverage Options for Small Businesses 2017-05-22T20:28:10+00:00

Coverage Options for Small Businesses

The Small Business Health Options Program (SHOP) is a new program that simplifies the process of buying health insurance for your small business.

The SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs). The advantages of using SHOP include:

  • You control the coverage you offer and how much you pay toward employee premiums.
  • You can compare health plans online on an apples-to-apples basis, which helps you make a decision that’s right for your business.
  • You may qualify for a small business health care tax credit worth up to 50% of your premium costs. You can still deduct from your taxes the rest of your premium costs not covered by the tax credit. Beginning 2014 the tax credit is available only for plans purchased through SHOP.

Compare plans and apply online

The Small Business Health Options Program (SHOP) is designed for small employers with 50 or fewer full-time equivalent employees. With one online application, on your own or with the help of an ENROLL Virginia Navigator or other assister, you can compare price, coverage, and quality of plans in a way that’s easy to understand.

You can enroll in a plan and begin coverage any time.

How to know if you qualify for the SHOP Marketplace

In order to use the Small Business Health Options Program (SHOP) Marketplace to offer health insurance to your employees, your business must meet all of these requirements:

  • You must have 50 or fewer full-time equivalent employees (FTEs). Use the FTE Calculator to see if you qualify based on how SHOP counts FTEs.
  • You must offer coverage to all your full-time employees — generally workers averaging 30 or more hours per week. You don’t have to offer coverage to part-time employees — generally those averaging less than 30 hours per week or seasonal workers. (You can offer coverage to part-timers if you want to.)
  • In Virginia, as in most states, at least 70% of the employees you offer insurance to must either enroll in your plan or have coverage from another source. Use the SHOP Minimum Participation Rate Calculator to see how many of your employees must accept your offer.
    • If you don’t meet your minimum participation requirement, you can enroll in SHOP coverage between November 15 and December 15 any year. During this period you can enroll without meeting a minimum participation requirement.
  • You must have an office or employee work site within the state whose SHOP Marketplace you want to use.

Non-profit organizations can also use the SHOP Marketplace if they meet all the requirements.

Steps your employees take to get SHOP health insurance

Once you choose SHOP health insurance coverage that works for your business, your employees can sign up for it online through the Marketplace.

After you choose your health insurance plan, you or the Marketplace will notify your employees and tell them how to sign up. There are tools to help you create an employee roster, set up an employee email distribution list, or download the offer of coverage and distribute it to your employees manually.

Once your employees get the offer, they follow a few steps:

  • Verify their information to confirm that the name, date of birth, and Social Security information you provided are correct
  • Provide additional information like address, contact preferences, tobacco use, and whether they have dependents that need coverage. This information will give them a better idea of what their costs will be.
  • Review the plan to see if it meets their needs. Your employees can see how much they will pay each month as a premium, what their deductible will be, and how much their total out-of-pocket costs could be. All of these steps can be done directly through the Marketplace.
  • Next, employees decide whether they want to accept or decline coverage for themselves and their dependents. If they accept the plan, they can view, download, and print a summary of the plan coverage.

Coverage won’t take effect until you approve the plan. Once the employee enrollment period is over, you can see who accepted coverage (including dependents if you’re offering dependent coverage). You can calculate the total costs to your business and decide if the plan you’ve chosen works for you. At this point, you can decide to approve the plan or explore other SHOP options.

Have questions about the SHOP Marketplace for businesses with 50 or fewer employees?

Call 1-800-706-7893 (TTY users: 1-800-706-7915). Hours: Monday through Friday, 9 a.m. to 5 p.m. EST.