1. VIRGINIA’S HEALTH INSURANCE SHOP MARKETPLACE --THE BASICS--
ACA
Name
Enroll VA Title
Work Address
T: Work Number

2. What is the Federally Facilitated SHOP Marketplace?
The Small Business Health Options Program
Part  of  the  Health  Insurance  Marketplace  created  by   the  Affordable  Care  Act  (ACA)    
Offers  small  employers  a  choice  of  qualified  health  
and  dental  plans  and  tools  for  making informed
choices  
Gives  otherwise  eligible  qualified  small  employers  
access  to  the  Small  Business
Health  Care  Tax  Credit— worth  up  to  50%  of  employer’s  premium  contributions

3. Changes with the ACA for Small Employers

4. Who Can Purchase SHOP Coverage and When?
Small employers:  
That have 1-50 full-time equivalent employees with at least one employee who is not a co‐owner or spouse  
Including tax-exempt and religious employers that offer coverage to all full-time employees    
In the FF-SHOP: employees working on average 30 or more hours/week  
Visit the SHOP FTE Calculator:  

5. When Can You Purchase SHOP Coverage?
Enroll in FF-SHOP coverage:    
Initial group enrollment can occur anytime during the year-no limited Open Enrollment period  
Before 15th of month for coverage starting next month  
After 15th of month for coverage starting 2nd following month    

6. Requirements for Employee Participation in FF-SHOP
SHOP sets a “minimum participation rate” for the SHOP:  
Set at 70% in most states using FF-SHOP “Employee participation rate”: Calculated by the number of employees enrolling in coverage, divided by the number of employees offered coverage.    
Employees aren’t counted if they have coverage through another job, another person’s job, or a government program. Employees’ dependents aren’t counted either.    
Online SHOP application calculates this and determines whether employer met minimum requirement.         
Exception to the minimum participation requirement:    
From November 15th-December 15th each year, employers can enroll in FF-SHOP coverage without having to meet this minimum participation requirement     

7. Benefits of Plans through SHOP
All health plans sold through the SHOP Marketplace meet new coverage standards:  
Must offer “essential health benefits”-items and services within 10 categories such as doctor visits, preventative care, hospitalization and Rx.  
Plans meeting new coverage standards are known as “Qualified Health Plans”  
Benefit from broad protections under the healthcare law. Insurers: Face limits on the portion of premium dollars used for administrative and overhead costs. 
Must disclose and justify proposed rate hikes of 10% or more, which are subject to review by a state or the U.S. Department of Health and Human Services.  
Can’t sell coverage charging higher rates based on an individual’s pre-existing health conditions or health status, or charge more for women.  
Face limits on charging additional premiums for older employees  
Generally must pool risks across a state’s small group market  

8. What are the Benefits to My Small Business
What are the Benefits to My Small Business? The Small Business Health Care Tax Credit
Helps certain small employers afford employee overage:    
•  Those with fewer than 25 “full-time equivalent” employees
•  That means employers whose employees’ wages average less than $51,000 in 2016     
•  Who contribute at least 50% of employees’ premium costs  
Starting in 2014:  
•  Available only to employers with employees enrolled in a Qualified Health Plan  through the SHOP      
•  Worth up to 50% of employer’s premium contribution to SHOP health and dental plans (up to 35% for tax exempt employers)    
•  Can be claimed for two consecutive years   
Visit the SHOP Tax Credit Estimator  
      

9. Features of SHOP for 2016:
Small employers can access the SHOP on HealthCare.gov to:  
Browse, select, and offer employees health and dental coverage that begins in 2016    
Have employees enroll in SHOP coverage online  
Find and authorize a SHOP-registered broker to help with online enrollment  
•  No paper applications will be distributed or accepted.  
•  SHOP-registered agents and brokers can access new online features and manage accounts when authorized by clients  
•  Employers in 14 states can offer employees a choice of plans within a single plan category  
•  SHOP Call Center will assist employees, as well as employers, agents and brokers  

10. Browse Before Buying Find Premium Estimates:
Online tool shows price estimates for the Federally- facilitated SHOP Qualified Health Plans and Qualified Dental Plans in their area    
Price estimates are based on the age-ranges of employees and location of business    
Agents, brokers or Navigators can help employers use this tool  
Employers can get final quotes for 2015 coverage as part of the online enrollment process on HealthCare.gov  
 Visit HealthCare.gov for Premium Estimates:  
   
Useful information for employers to have on hand:  
•  Number of full-time employees  
•  Age of employees  
•  Whether the employer is offering coverage to
dependents  

11. Different Plan Options for Different Budgets
Plans are grouped by category: Bronze, Silver, Gold, and Platinum:  
Categories generally reflect how plans share the costs of care with the average enrollee-through copays, coinsurance and out-of-pocket limits.  
Categories don’t have any bearing on the amount or quality of care enrollees get  
All plans cover “essential health benefits” but plans can differ in other ways-even within a plan category-such as the provider network, prescription drug formularies and any additional benefits offered.    
Categories help consumers compare plans with similar cost sharing    

12. Employee Choice: Flexibility and Control
Advantages of offering employees a choice of plans:  
Less hassle for employers  
Better fit for employees    
More competitive benefits  
More competition between insurers  
Employer gets and pays just one monthly bill  
Employer sets choice limits  

13. So, How Do I Enroll in SHOP?

14. STEPS FOR EMPLOYERS TO ENROLL

15. Step 1: Creating an Account

16. Step 2: Verify Your Eligibility

17. Step 3: Create Enrollment Criteria

18. Step 3: Create Enrollment Criteria (continued)

19. Step 4: Enroll Employees
IMPORTANT!!!

20. How Do My Employees Enroll?

21. Step 5: Submit Application

22. Need Assistance? FF-SHOP offers many ways to get help:
From the Toll Free SHOP Call Center: 1‐ (TTY: 711)  
Available M-F 9:00am-7:00pm ET    
Assists employers, employees, agents and brokers from a SHOP- registered agent or broker  
Employers who create an online SHOP Marketplace account can:  
Search online to find one locally    
Authorize that agent or broker to manage the employer’s SHOP account online  
From a Navigator or other assister:  
Enroll VA Toll Free Number
“Find Local Help” on HealthCare.gov lets employers locate one in their area  
– no SHOP Marketplace account needed  

23. For More Information
Online SHOP Information and tools:     
Information on the Small Business Healthcare Tax Credit:  
Credit-for-Small-Employers  
   
ACA rules, guidance, Agent and Broker Resource Page:  

24. Small Business Resources

25. Twitter-@EnrollVirginia
QUESTIONS?
Phone Number
Facebook-

26. Thank you!
ENROLL Virginia! is a nonprofit, nonpartisan entity that assists individuals and small businesses to obtain health insurance including commercial health coverage through the federally facilitated health insurance marketplace, to qualify for applicable tax subsidies, and to comply with the U.S. Patient Protection and Affordable Care Act and avoid penalties for failure to do so. The program is paid for by a federal grant (Funding Opportunity Number CA- NAV from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services)  and administered by the Virginia Poverty Law Center.  The contents provided here are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.