Get details about a letter you got about your Marketplace coverage or financial help changing because you also have Medicare.
Small employers can appeal a Small Business Health Options Program (SHOP) eligibility decision.
SHOP decisions you can appeal
Employers can appeal two kinds of SHOP actions:
- Denial of SHOP eligibility
- SHOP not making an eligibility determination in a timely manner
If you're determined ineligible to participate in SHOP, you'll get a notice with details specific to your situation. You have 90 days from the date of this notice to request an appeal.
If your state is running its own SHOP, the appeals process may be different. Refer to your state's SHOP for more details.
How to file a SHOP appeal
Your SHOP eligibility determination notice will explain how to file an appeal for your specific situation.
Employers can appeal by filling out the SHOP appeals form for employers (PDF).
Then, mail your completed appeal form to: Health Insurance Marketplace 465 Industrial Boulevard London, KY 40750-0061
An authorized representative, like an agent or broker, can file an appeal for you. You may also get help in a language other than English.
Note: Keep a copy of your appeals form for your records.
After you file an appeal
You'll get a letter or phone call saying that your appeal was received. It will provide a description of the appeals process and instructions for submitting additional materials if needed.
Questions?
- See all SHOP tools, calculators, fact sheets, how-to guides, videos, and other resources for employers.
- Contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
For help with the Small Business Health Options Program (SHOP), check out these resources:
SHOP eligibility & prices
- The Full-Time Equivalent (FTE) Calculator: Find out if SHOP is right for your business
- Find SHOP plans & prices
- Minimum Participation Rate Calculator: Find out if you meet the participation requirement
The Small Business Health Care Tax Credit
Applying & enrolling in SHOP insurance
- Employer Guide to SHOP Insurance (PDF, 211 KB).
Working with SHOP-registered agents and brokers
Choosing health insurance plans
Questions?
- Contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
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