The SHOP Marketplace. August 14, 2014

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1 The SHOP Marketplace August 14, 2014

2 What is the SHOP Marketplace? SHOP = Small Business Health Optins Prgram Part f the Health Insurance Marketplace created by the Affrdable Care Act (ACA) Offers emplyers a chice f health insurance plans and dental plans and tls fr making infrmed chices Offers qualified small emplyers access t the enhanced Small Business Health Care Tax Credit nw wrth up t 50% f emplyer s premium cntributins Wrks with new insurance refrms t spur cmpetitin based n price and quality Nte: If yu have fewer than 50 full-time-equivalent emplyees, yu re nt required t ffer health insurance, and there s n penalty if yu chse nt t. 2

3 Wh Can Purchase SHOP Cverage? Small emplyers wh: Have 50 r fewer full-time emplyees in 2014 Have at least ne cmmn law emplyee Offer cverage t all f their full-time emplyees Emplyees wrking n average 30 r mre hurs per week Meet minimum participatin rates In many states using Federally Facilitated SHOP Marketplace, at least 70% f full-time emplyees must accept yur ffer f insurance Self emplyed, wner-nly cmpanies use individual Marketplace Sle prprietrs and sharehlders > 2% S crp. with n emplyees Owners, c-wners and their spuses 3

4 The Small Business Health Care Tax Credit A tax credit fr emplyers: With fewer than 25 full-time equivalent emplyees Whse emplyees wages average less than $50,000 per year Wh cntribute at least 50% f emplyees premium csts Wh ffer emplyees a Qualified Health Plan thrugh the SHOP In Federally Facilitated SHOP, in 2014, this means : emplyer must have a determinatin f eligibility frm the SHOP and emplyees must be enrlled in a SHOP Qualified Health Plan The tax credit is wrth: Up t 50% f emplyer s premium cntributin (up t 35% fr tax exempt emplyers) starting in

5 SHOP fr Plans with Cnfidence All SHOP Qualified Health Plans: Meet new cverage standards Must ffer essential health benefits -- items and services within 10 categries such as dctr visits, preventive care, hspitalizatin and Rx Benefit frm brad prtectins under the health care law. Insurers: Face limits n the prtin f premium dllars they can keep fr administrative and verhead csts. Must disclse and justify prpsed rate hikes, generally f 10% r mre, which state r the U.S. Department f Health and Human Services can review Can t sell cverage charging higher rates based n an individual s pre-existing health cnditins r health status, r charge mre fr wmen Face limits n charging additinal premiums fr lder emplyees Generally must pl risks acrss a state s small grup market 5

6 Hw SHOP Wrks: Different Plan Optins fr Different Budgets The SHOP Marketplace ffers emplyer chice Of insurance cmpanies, Qualified Health Plans and plan genersity Plan chices are gruped by metal level : Brnze, Silver, Gld, Platinum Metal levels generally reflect the plan s genersity in cvering the cst f benefits fr an average enrllee Plan benefits can vary within metal levels: Plans must ffer essential health benefits but can differ in ther ways, such as in the netwrks f prviders, Rx frmularies they ffer Level Plan Pays (n average) Emplyee Pays (n average) Brnze 60 % 40 % Silver 70 % 30 % Gld 80 % 20 % Platinum 90 % 10 % 6

7 Brwse Befre Buying in the Federally Facilitated SHOP Find Premium Estimates Online tl shws price estimates fr the Federally Facilitated SHOP Qualified Health Plans and Qualified Dental Plans in yur area Price estimates are based n the age-ranges f emplyees and lcatin f business Agents, brkers r Navigatrs can help yu use this tl Healthcare.gv/find-premium-estimates/ Useful infrmatin t have n hand Number f full-time emplyees Age f emplyees Whether yu ll be ffering cverage t dependents 7

8 Buying SHOP Cverage: When & Hw? When can yu ffer a SHOP Qualified Health Plan? Get started nw, r Offer anytime during the year These timing ptins als apply t ffering a SHOP Qualified Dental Plan Hw d yu buy a SHOP Qualified Health Plan? Fr Federally Facilitated SHOP, in 2014 nly must use Direct Enrllment Wrk directly with an agent, brker r insurance cmpany Similar t hw small businesses have gtten cverage in the past Use the same prcess fr buying a SHOP Qualified Dental Plan With Direct Enrllment yu ll: Select a SHOP Qualified Health Plan t ffer emplyees (and a SHOP Qualified Dental Plan, if applicable.) Have the agent, brker, r insurer help enrll thse emplyees wh accept Pay the insurance cmpany, directly r with the help f an agent r brker In states running their wn SHOP Marketplace Enrllment prcesses may differ Many ffer nline enrllment 8

9 Federally Facilitated SHOP Eligibility: What Yu Need t Knw Emplyers using Direct Enrllment in 2014 may still qualify fr the Small Business Health Care Tax Credit if they: Have emplyees enrlled in a SHOP Qualified Health Plan Meet ther requirements fr the credit, and Receive an eligibility determinatin frm the SHOP Marketplace Means the SHOP Marketplace finds yu meet the requirements t buy SHOP cverage An eligibility determinatin frm the Federally Facilitated SHOP in 2014 Is nt required befre buying SHOP cverage Gal: t help yu get benefits f cverage and tax credit sner Dn t need t apply at all if nt seeking the tax credit Is required fr thse wh want t claim the Small Business Health Care Tax Credit Must get determinatin befre the end f 2014 Recmmend sending in applicatin within a week f enrllment; n later than December 1 If yu re determined nt t be eligible after buying SHOP cverage Yu can t claim the tax credit, but Yur insurance cmpany need nt end yur cverage 9

10 Federally Facilitated SHOP Eligibility: Hw t Apply T apply t the Federally Facilitated SHOP Marketplace, yu can: Ask an agent, brker r insurance cmpany fr help Get help frm a Marketplace-apprved Navigatr r assister Get the paper applicatin and instructins frm HealthCare.gv Apply by phne thrugh the SHOP Emplyer Call Center The SHOP Marketplace will ntify yu: By phne and By regular mail, if yu request this Within 3-5 days f receipt Rle f the SHOP Marketplace : Determines whether yu re eligible t participate in the SHOP This determinatin is a requirement fr receiving the tax credit Des nt determine whether yu re eligible t receive the tax credit. This is an IRS matter 10

11 Hw SHOP Wrks: Mving Tward Emplyee Chice A key gal f the SHOP: Optins fr small emplyers and their emplyees Such as ffering emplyees a single plan r a chice f plans In 2014: The Federally Facilitated SHOP Marketplace ffers emplyer chice, but n emplyee chice ptin States running wn SHOP can ffer emplyee chice ptin -- many d In 2015: The SHOP in all states may ffer small emplyers an emplyee chice ptin 11

12 The Bttm Line The SHOP helps small businesses by: Giving emplyers a chice f health insurance plans Prviding cmparisns between health plans Prviding exclusive access t tax credits fr many small emplyers Mre features and ptins cming fr

13 Fr Mre Infrmatin SHOP Emplyer Call Center (Fr small emplyers and thse assisting them): / TTY HealthCare.gv Emplyer SHOP Applicatin: HealthCare.gv/dwnlads/shp-emplyer-applicatin.pdf Find lcal assistance: Lcalhelp.HealthCare.gv CMS.gv/CCIIO Infrmatin n the Small Business Healthcare Tax Credit: Emplyers 13

14 Questins April M. Washingtn, MMPA Public Affairs Specialist U.S. Department f Health and Human Services 61 Frsyth St., SW Suite 5B95 Atlanta, GA Regin IV - AL, FL, GA, KY, MS, NC, SC, TN Office: (404) Fax: (404) Fllw us n

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