In 2014--a few short weeks away--the Affordable Care Act will take steps to
remove key barriers that small employers have traditionally faced when offering
health insurance to their employees.
Together, new insurance reforms and the Small Business Health Options
Program, the SHOP, will help curb premium growth, and spur competition based on
price and quality.
The Affordable Care Act does not require small employers with fewer than 50
full-time or full-time-equivalent employees to offer health coverage to their
workers. But the ACA does provide small employers with access to a SHOP
Marketplace in every state, offering coverage through qualified health plans
that may take effect as early as January 1, 2014.
The SHOP Marketplace helps small businesses compare different plans, to find
a plan that fits their budget and meets the needs of their business and
employees. And, it will provide many small businesses access to an
expanded Small Business Health Care Tax Credit, which in tax years beginning in
2014 will be worth up to 50 percent of employer-paid premium costs, to help them
afford coverage for their employees and dependents.
Since it first became available in 2010, the Small Business Health Care Tax
Credit has been worth up to 35 percent of employer-paid premium costs, and has
provided more than $1 billion in tax credits.
For tax years beginning in 2014, the credit will be available only for
coverage purchased through the SHOP Marketplace.
Employers can offer coverage through the SHOP Marketplace at any time during
the year. If you want your employeesf coverage to begin on January 1, 2014, the
current deadline is December 15. In the Federally-facilitated SHOP, we
intend to extend this enrollment deadline to December 23.
For small businesses in states with a SHOP Marketplace thatfs run by the
federal government, we are making changes to make sure that you can take
advantage of SHOP coverage and the tax credit as soon as possible.
Specifically, for 2014, small employers will enroll their employees in coverage
through an agent, broker, or insurer that offers a certified SHOP plan and has
agreed to conduct enrollment according to HHS standards.
This process, called gdirect enrollment,h is similar to how most small
employers get insurance today. You donft need to apply for SHOP eligibility
before enrolling, or to use HealthCare.gov, unless youfd like to see information
on your plan options, including which insurance companies offer SHOP Qualified
Health Plans in your area.
The agent, broker, or insurer will enroll your employees, and the SHOP
Marketplace will review your application and can determine later whether your
business and employees are eligible for SHOP coverage. You donft need to wait
for the SHOP to determine your eligibility, because it doesnft affect your
ability to enroll in a Qualified Health Plan, like the ones the SHOP offers.
Even if the SHOP later determines that youfre not eligible to enroll through the
SHOP, you and your employees may remain enrolled in your chosen plan in the
small group market.
The main reason for you to get the SHOP eligibility determination in 2014, is
to allow you, to claim the expanded the Small Business Health Care Tax Credit at
the end of your tax year—as long as you also meet all the other requirements for
the tax credit.
If you donft think you qualify for the tax credit, you donft need to apply
for SHOP eligibility. You also have the option to wait until youfve
received an official notice of eligibility from the SHOP Marketplace before
enrolling your employees in a SHOP Plan.
Your agent, broker, or insurer can help you fill out a paper application and
send it in to the SHOP Marketplace, or you can mail the application in yourself,
if you want. The SHOP Marketplace will notify you about eligibility by
phone or e-mail and by regular mail if you request it.
When you use direct enrollment, you can still go on HealthCare.gov to get
information about plans available in your area and help you find the best fit
for your company and employees. You can also download a paper application for
SHOP eligibility there. Lastly, you can get help through the toll-free
SHOP Employer Call Center at 1-800-706-7893 (TTY: 1-800-706-7915).
This change to gdirect enrollmenth in states with a Federally-facilitated
SHOP Marketplace wonft affect the process for getting SHOP coverage in states
running their own SHOP Marketplace.
What else you need to know
If you want your employeesf coverage to begin on January 1, the current
enrollment deadline is December 15. In the Federally-facilitated SHOP, we
intend to extend this deadline to December 23.
But, you can offer coverage through the SHOP Marketplace at any time during
the year. If your employee enrollments are submitted between the 1st and 15th
day of the month, your group coverage begins the first day of the next
month. For example, if your employee enrollments are submitted on February
10, 2014, your group coverage begins March 1, 2014. For enrollments submitted
after the 15th of the month, coverage begins the second following month. So, if
employee enrollments are submitted on February 18, your group coverage will
begin on April 1.
Be sure to check HealthCare.gov in coming months for new tools and
information. This winter you will be able to go online and enter the ages
of your employees to get more precise premium information, and compare
plans.
In addition, we anticipate that small employers throughout the country will
have online access to an online SHOP Marketplace by November 2014. Also, for the
first time ever, small employers in all 50 States and the District of Columbia
will be able to offer their employees a choice of plans from multiple issuers
while making a single monthly payment, for coverage taking effect on or after
January 1, 2015.
For more information on the SHOP Marketplace, visit HealthCare.gov or call
the SHOP Employer Call Center at 1-800-706-7893 (TTY: 1-800-706-7915),
Monday through Friday, 9 a.m. to 7 p.m. EST.