The Small Business Health Options Program SHOP. A service of Maryland Health Benefit Exchange

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1 The Small Business Health Options Program SHOP A service of Maryland Health Benefit Exchange

2 What is the SHOP? SHOP = the Small Business Health Options Program The SHOP helps small business owners enroll for group health insurance The SHOP allows eligible small business owners access to the small business health care tax credit. The SHOP provides small businesses access to group health insurance rates and benefits. 2

3 SHOP- Eligibility The SHOP is open to.. Employers with Maryland-based businesses or non-profit organizations with a principle business address within Maryland. Employers with 50 or fewer full-time equivalent employees, including part-time employees. In 2016, this will increase to 100 or fewer fulltime employees. Employers must have at least one common-law employee that is not the business owner or their spouse. Employers must offer coverage to all full-time employees. 3

4 SHOP- Eligibility SHOP Eligibility Process: A SHOP Administrator will review the employer s application to confirm that each of the eligibility requirements is met. A SHOPAdministrator will notify the employer of their eligibility determination. Eligibility for the Small Business Health Care Tax Credit is determined by the IRS. 4

5 Enrollment Options Employee Choice The employer selects a metal level, and the employees may choose any plan offered by any insurance company within that metal level. Benefits Employees are free to choose between a broader selection of plans to meet their individual needs. Allows employers to recruit and retain in a competitive environment. Platinum Gold Silver Bronze Employer Choice Carrier A B C D E F Employee Choice 5

6 Enrollment Options Employer Choice The employer selects a menu of qualified health plans across metal levels from a single insurance company. Employees may choose from one of those plans. Benefits Employees can choose from a variety of coverage levels that best meet their needs. Allows employers to recruit and retain in a competitive environment. 6

7 Enrollment Options Metal Levels SHOP offers varying levels of insurance plans, known as metal levels. Each metal level covers a different percentage of the total plan's essential health-benefit expenses. Metal levels offered are platinum, gold, silver and bronze. 7

8 SHOP Benefits for Small Businesses Benefit 1: Tax credits to help pay the employer s share of employee premium costs if qualified Benefit 2: Flexibility in contributing to employee premiums Benefit 3: Simplicity in paying for employee premiums Benefit 4: More coverage options for businesses and their employees Benefit 5: Excellent customer service for questions about plans 8

9 SHOP Benefits for Small Businesses Tax Credits The small business health care tax is available for plans purchased through the Maryland Health Connection SHOP Marketplace. It may be claimed for any two consecutive years beginning in Small businesses will still be able to deduct any premium costs not covered by the tax credit. For qualifying small businesses, up to 50 percent of your contribution to employee premiums may be covered by the tax credit (or 35 percent for tax-exempt small employers). 9

10 SHOP Benefits for Small Businesses Flexibility Flexibility for employers to contribute to employee premiums Fixed Percent contribution: o The employer pays a set percentage of an employee s health insurance premiums, which can be different for employees and dependents. Fixed Dollar contribution: o An employer will set a fixed dollar amount for how much the employer and employee will contribute towards an employee s health insurance premiums. 10

11 SHOP Benefits for Small Businesses Simplicity Simple administration of the health plans offered to employees Employers can easily o o o o Set when and how long their employees open enrollment period is any month, any time of year Set the waiting period before new employees can enroll Use online tools to add and drop employees and dependents Receive a single monthly bill for all employee premiums, regardless of how many insurance companies employees choose 11

12 SHOP Benefits for Small Businesses Plan Quality All plans are certified by the Maryland Health Benefit Exchange. Both health and dental coverage are available. All plans include the essential health benefits & preventive services such as: Doctor Visits Emergency Care Maternity Care Mental Health Care Cancer Screenings Birth Control Hospital Stays Prescriptions Pediatric Care Substance Abuse Treatment Routine Vaccinations Flu & Pneumonia Shots 12

13 SHOP Benefits for Small Businesses Coverage Options Maryland small business owners now have the ability to see all of the health insurance options available to them in one location. 13

14 SHOP Benefits for Small Businesses 2015 SHOP-Authorized Insurance Carriers Medical Carriers Aetna CareFirst Coventry Evergreen Health Kaiser Permanente United Healthcare Dental Carriers CareFirst DentaQuest Dominion Dental 14

15 Employer Enrollment in SHOP Enrolling in SHOP is easier than ever! Steps to Enroll: Step 1 Select a SHOP-authorized broker Step 2 Complete a SHOP Eligibility Application Step 3 Select a metal level or plan(s) 15

16 SHOP Brokers What is a SHOP-Authorized Broker? SHOP-authorized brokers are insurance brokers who can provide free help enrolling small businesses and their employees in a health plan. Producer Referral Program: Employers can get assistance finding a SHOP-authorized broker by calling: Click here to see a list of SHOP-authorized brokers: Employers can also contact a SHOPAdministrator for assistance with finding a SHOP-authorized broker. 15

17 SHOP Administrators What is a SHOP Administrator? SHOPAdministrators provide Maryland Health Connection s small business marketplace services. Three SHOP Administrators offer: More than 30 years of experience of excellent service and timely, courteous professionalism with small business employers Access to the SHOP Marketplace through their web portals Free services for Maryland's small business community 17

18 SHOP Administrators What does a SHOP Administrator do? SHOP Administrators: Assist businesses with selecting a SHOP-authorized broker. Process SHOP eligibility applications. Provide businesses easy administration of their SHOP health insurance and benefits program and multiple ways to pay a single monthly bill. Manage the initial SHOP implementation and set-up as well as the ongoing new hires, eligibility changes and open enrollment process. Provide daily customer service support services. 18

19 SHOP Administrators Who are the SHOP Administrators? BenefitMall Group Benefit Services Kelly Exchange Services

20 Help Spread the Word Inform the Small Business Community About the SHOP How Can You Help? Add SHOP information to your organization s website with a link to the SHOP informational page: Offer SHOP brochures in your lobby, waiting rooms or directly to your clients. Add SHOP information to your resource guides for small business owners. 20

21 Help Spread the Word Inform the Small Business Community About the SHOP How Can You Help? Request a SHOP speaker for your next meeting or workshop. Talk to your clients about SHOP. We can provide your team members with SHOP talking points. Distribute SHOP print materials at community events. Contact us to discuss how your organization can partner with Maryland Health Benefit Exchange to spread the word about the SHOP. Jenny Garrison, Outreach Coordinator jenny.garrison@maryland.gov

22 Questions? For additional information regarding SHOP, please send all inquiries to: or call Betty Vassilaros, SHOP Manager at

23 Thank You!