The Federally-facilitated SHOP Marketplace

The Federally-facilitated SHOP Marketplace

Health Insurance Options for Small

Businesses

March 2015

What Small Employers Use to FaceWhat Small Employers Use to Face

Many obstacles to offering health insurance to employees• Difficulty comparison shopping between plans

• Unpredictable premium increases

• Higher rates for groups with: o Women o Older workers o Workers who have chronic conditions or high-cost illnesses

• Waiting periods for coverage of pre-existing conditions 

What SHOP Offers Small EmployersWhat SHOP Offers Small Employers

SHOP Health Plans: • Can’t deny coverage to small employers (guaranteed availability / renewability)

• Can’t limit benefits or sell coverage with higher rates:o For those with pre-existing health conditionso For womeno Based on employees’ health status

• Must disclose and justify proposed premium hikes of 10% or more, which the state or the U.S. Department of Health and Human Services review (pools risks across the small group market, not by employer – inside and outside the SHOP Marketplace – stabilizing premiums)

• Limit on the portion of premium dollars used for administrative and overhead costs (80% MLR)

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Healthcare.govHealthcare.gov

• Small employers HealthCare.gov to:o Browse, select and offer employees health planso Employees enroll themselves onlineo Find and authorize a SHOP-registered broker to help with online

enrollment

• SHOP-registered brokers can access new online features and manage accounts when authorized by clients

• SHOP Call Center will assist employees, as well as employers, agents and brokers

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Need Assistance?Need Assistance?

SHOP offers many ways to get help:

From the Toll Free SHOP Call Center: 1-800-706-7893 (TTY: 711)• Available M-F 9:00am-7:00pm ET • Assists employers, agents and brokers, and employees

From a SHOP-registered agent or broker• Once an account is created, employers can:

o Search online to find one locally o Authorize that agent or broker to manage the employer’s SHOP account online

From a Navigator or other assister• “Find Local Help” on HealthCare.gov lets employers locate one in their area• https://localhelp.healthcare.gov – no SHOP Marketplace account needed