VIRGINIA’S HEALTH INSURANCE SHOP MARKETPLACE --THE BASICS-- 2015-2016 ACA Name Enroll VA Title Email Work Address T: Work Number

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  

Changes with the ACA for Small Employers

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: https://www.healthcare.gov/shop‐calculators-fte/  

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    

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     

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  

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   https://www.healthcare.gov/shop-calculators-taxcredit/       

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  

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:    https://www.healthcare.gov/see‐plans/small-business/   Useful information for employers to have on hand:   •  Number of full-time employees   •  Age of employees   •  Whether the employer is offering coverage to dependents  

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    

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  

So, How Do I Enroll in SHOP?

STEPS FOR EMPLOYERS TO ENROLL

Step 1: Creating an Account

Step 2: Verify Your Eligibility

Step 3: Create Enrollment Criteria

Step 3: Create Enrollment Criteria (continued)

Step 4: Enroll Employees IMPORTANT!!!

How Do My Employees Enroll?

Step 5: Submit Application

Need Assistance? FF-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, 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-1-888-392-5132 “Find Local Help” on HealthCare.gov lets employers locate one in their area   https://localhelp.healthcare.gov – no SHOP Marketplace account needed  

For More Information Online SHOP Information and tools: www.HealthCare.gov/small-businesses      Information on the Small Business Healthcare Tax Credit:   www.irs.gov/uac/Small-Business-Health-Care-Tax- Credit-for-Small-Employers       ACA rules, guidance, Agent and Broker Resource Page: www.cms.gov/cciio/  

Small Business Resources

Twitter-@EnrollVirginia QUESTIONS? Phone Number email@enroll-virginia.com www.enroll-virginia.com Facebook-www.facebook.com/enrollva Twitter-@EnrollVirginia

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-13-001 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.