Eligibility Requirements for the SHOP Marketplaces

In 2015, small businesses that offer coverage through the Federally-facilitated SHOP (FF-SHOP) may be able to offer employees a choice of QHPs and qualified dental plans (QDP) within a given metal level or issuer, or a single QHP or QDP.

To qualify for an FF-SHOP, a business must:

  • Be located in an FF-SHOP’s service area (generally a state)
  • Have at least one eligible employee on payroll
  • Have 25 or fewer full-time equivalent (FTE) employees on payroll
    • This methodology includes part-time employees, but not seasonal employees (those working fewer than 120 days per year).
    • While the FF-SHOP must determine eligibility using the definitions above, State-based SHOP Marketplaces have flexibility in their counting approaches for 2014 and 2015.
  • Offer coverage to all full-time employees (those working an average of 30 or more hours per week)

 

 

Employers and employees are assured that the QHPs offered meet network adequacy and benefit design standards of the SHOP. The FF-SHOPs provide flexibility in the amount that members of the small group contribute towards the total premium. Employers may also choose to offer coverage to employees’ dependents. Premiums for the employers and employees are not based on their health or medical history, but can only vary based on age, family composition, geographic area, and tobacco use.

Premium tax credit and cost-sharing reductions are not available through the SHOP Marketplace. However, employers meeting certain size and average wage requirements may receive a small business health care tax credit on their tax returns of up to 50 percent of the employer’s contribution to health insurance premiums. Generally, this credit is only available for coverage provided through a SHOP.

Questions about your businesses eligibility to enroll through the SHOP Marketplace? Contact your Total Benefit Solutions, Inc affordable care act specialist at (215)355-2121 or toll free at (800)924-6718.