How to work with a SHOP-registered insurance agent or broker

You can work with a Small Business Health Options Program (SHOP)-registered agent or broker to enroll in SHOP insurance.

Need a SHOP-registered agent or broker?

Enter your ZIP code to find one in your area.

Getting help from an agent or broker

SHOP-registered agents and brokers can provide help with SHOP insurance — from comparing plans to helping you enroll. Specifically, they can help you:

In general, you won't pay more if you use an agent or broker.

Note: If you're not using an agent or broker, you can enroll through your insurance company.

Choosing an agent or broker

  • Work with your current agent or broker: You can continue working with your agent or broker as long as they're registered with SHOP.
  • Find a new agent or broker: Enter your ZIP code and check the box for small businesses, and you’ll get a list of SHOP-registered agents and brokers in your area. You can also enter your contact information on the Help On Demand tool and an agent or broker will reach out to you.

Questions?

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How to offer SHOP health insurance to your employees

Health insurance plans offered through the Small Business Health Options Program (SHOP) are quality, affordable health and dental insurance coverage for small businesses and their employees. SHOP plans are offered by private insurance companies, cover essential health benefits, and may not exclude coverage for treatments for pre-existing conditions.

Making a SHOP health insurance decision

You can generally enroll in SHOP coverage year-round. To find the best plan for your business and employees, think about price, benefits, and features. You may also want to consider:

  • Whether to offer your employees one plan or a choice of plans
  • Whether to offer medical coverage, dental coverage, or both
  • How much of your employees' premiums you’ll pay
  • Whether to offer coverage to dependents and part-time employees
  • When coverage starts
  • How long new employees must wait before they get a coverage offer

You should also check SHOP availability in your state. Some states may use their own websites for enrolling and managing SHOP coverage.

Employees may still be eligible for premium tax credits if the plan you offer isn’t considered “affordable”. Affordability is based on how much the employee pays for coverage for themselves and their dependents. If the plan isn’t affordable, the employee may enroll in a Marketplace plan instead.

Understanding SHOP insurance categories

There are 4 categories of SHOP plans to choose from. The categories have nothing to do with the quality of care. They're based on the way the cost of care will be shared between your employees and the insurance company.

Choosing a stand-alone dental plan

You can add dental coverage to your SHOP insurance offer or offer dental insurance by itself without a SHOP health plan. Some SHOP health insurance plans also include dental benefits.

As with health plans, you can choose how much of an employee’s dental premium you pay.

Talk to your insurance company or agent or broker to find out more about SHOP dental plans.

How to enroll through SHOP

You have 2 options for enrolling:

  • Work with a SHOP-registered agent or broker. You can use your current agent or broker or find a new one, as long as the agent or broker is registered with the applicable Marketplace to sell SHOP insurance. Find an agent or broker today.
  • Contact your insurance company and sign up with them. Find SHOP plans in your area. You may want to write down some important information such as the plan name, metal level, plan type, and plan ID to have handy when you contact the insurance company.

Remember, the specific enrollment steps may vary by insurance company. Talk with your insurance company or SHOP-registered agent or broker to make sure you're aware of any monthly deadlines for completing your enrollment.

Your agent, broker, or insurance company will be able to provide you with the information you and your employees will need.

Paying premiums & managing coverage

You'll pay your premiums to your insurance company, not HealthCare.gov. If you need to make changes or updates to your SHOP coverage during the year, contact your agent, broker, or insurance company.

Verifying your eligibility for SHOP

You must meet certain requirements to purchase insurance through SHOP. To verify that you can enroll in SHOP coverage, use the SHOP Eligibility Determination Form.

The SHOP Eligibility Determination Form only takes a few minutes to fill out, and you’ll find out instantly if you’re eligible for SHOP insurance. Just enter some basic information about your business, certify that you meet the eligibility requirements, review your form, and submit.

Save your completed form and eligibility results for your records. Proof of SHOP eligibility may be required to enroll in SHOP coverage through an insurance company or to claim the Small Business Health Care Tax Credit.

Note: Once you complete the SHOP Eligibility Determination Form, you should get an email that includes your SHOP eligibility results. Your eligibility results are also shown on the final page of the form.

How to renew your SHOP plan

About 45–60 days before your current SHOP coverage ends, contact your insurance company, agent, or broker to find out what plans and prices are available to you. Insurance companies may have different timelines for renewing coverage, so be sure to ask:

  • When you need to submit your enrollment for a coverage renewal
  • How long your employees will have to accept your renewal
  • When you should pay your first premium

Questions?

More Answers: How to offer SHOP health insurance to employees

I am unable to enroll in SHOP insurance by logging into my HealthCare.gov account. What do I do?

For SHOP plans that start on or after January 1, 2018, you don't pick a plan, apply, or enroll through HealthCare.gov. Instead, you enroll either through the insurance company or with the assistance of a Marketplace-registered agent or broker.

As a small business employer, do I have to offer insurance to my employees' dependents?

Generally no, but some states do require it. Check with your state's Department of Insurance.

If you do offer insurance to employee’ dependents, they can accept or reject your offer. If they decline it, they can enroll in a plan for individuals and families through the Marketplace, but they may not be eligible for savings through premium tax credits or cost-sharing reductions. If they’re not eligible for such savings, they'd have to pay full price.

If I don't offer insurance to dependents, can they get insurance through the Marketplace?

Yes. Dependents can get insurance for individuals and families through the Marketplace, if they are otherwise eligible. Depending on the entire household's income, if dependents aren’t eligible for other health coverage, they may qualify for savings through premium tax credits and cost-sharing reductions.

What if there are no SHOP plans available in my area?

You may still be able to enroll in a small group health plan through an agent or broker or directly with a health insurance company. However, it may not be considered SHOP coverage, and you generally will not be able to claim the Small Business Health Care Tax Credit. See what non-SHOP plans may be available to you at finder.healthcare.gov, or search for an agent or broker in your area.

You may also have other options for providing benefits to your employees besides traditional group coverage, such as with a Health Reimbursement Arrangement (HRA). Learn more about what other products and services may be available to you.

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Overview of SHOP: Health insurance for small businesses

The Small Business Health Options Program (SHOP) is for small employers who want to provide health and/or dental insurance to their employees — affordably, flexibly, and conveniently.

  • To purchase SHOP insurance, your business or non-profit organization generally must have 1 to 50 employees. See if your business qualifies for SHOP.
  • If eligible, you don't have to wait for an Open Enrollment Period. You can start offering SHOP coverage to your employees any time of year.

Self-employed or a business owner with no employees?

Learn more about your coverage options.

4 reasons to offer SHOP coverage

  1. SHOP insurance gives you choice and flexibility. You can:

    • Offer your employees one plan, or let them choose from multiple
    • Offer only health coverage, only dental coverage, or both
    • Choose how much you pay toward your employees' premiums and whether to offer coverage to their dependents
    • Decide how long new employees must wait before enrolling

  2. Get the information you need in one location. You can make an informed decision about your SHOP insurance options with the tools at HealthCare.gov:

  3. You can work with an agent or broker. You can use your current SHOP-registered agent or broker or find a new one to help you enroll in coverage.

  4. You may be able to get the Small Business Health Care Tax Credit. Enrolling in SHOP insurance is generally the only way for eligible small employers to take advantage of the Small Business Health Care Tax Credit. You may qualify if you have fewer than 25 full-time equivalent (FTE) employees making an average of about $56,000 or less.

Enrolling in SHOP insurance

Once you're ready to enroll in SHOP coverage, you have 2 options:

  • Contact your insurance company and enroll directly through them.
  • Enroll with the assistance of a SHOP-registered agent or broker.

Find out more about enrolling in SHOP insurance.

Questions?

More answers: Overview of SHOP: Health insurance for small businesses

Do I have to provide insurance to my employees?

If you have 1 to 50 full-time equivalent (FTE) employees, you're not required to provide insurance to your employees. You can choose to offer insurance through SHOP or any other source. But you don't have to, and there's no penalty if you don't.

If you have 50 or more employees, learn about the Employer Shared Responsibility Payment.

Can I enroll in the same SHOP coverage that I offer my employees?

Yes, as long as at least one of your employees (who isn't a business owner, partner or family member) also enrolls in your coverage.

If my only employee is my spouse or a family member, can I use SHOP to cover us both?

Generally, no. Spouses and family members don't count when determining if your business is eligible to use SHOP. To be eligible, you must have 1 to 50 full-time equivalent (FTE) employees who aren’t business owners, partners, or family members.

Can my employees enroll in SHOP coverage after the initial enrollment period?

Yes, but only if they qualify for a Special Enrollment Period due to a life change, like having a baby, adopting a child, or getting married.

For new employees hired after your initial SHOP enrollment period, you can decide on a waiting period before coverage can become effective. Waiting periods can't exceed 90 days.

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SHOP coverage for multiple locations & businesses

If you operate a business with employees in more than one state

You'll enroll in a Small Business Health Options Program (SHOP) plan in the state where your primary business site is located.

You can offer your employees SHOP coverage 2 ways:

Option 1: Choose a single health plan for all employees. Be sure to choose a plan with a multi-state or national provider network. Offer it to all full-time employees in each business location.

  • If you choose this option, employees in all of your business locations will be counted when calculating your minimum participation rate and eligibility determination.

Option 2: Offer different SHOP plans in each state where your employees work. As long as your business meets all requirements to participate in the state's SHOP, you can offer coverage even if you have just one employee in a location. You'll still need to offer coverage to all your full-time employees in each state.

  • The employees on each location's employee roster will be counted separately when calculating your minimum participation rate.
  • You'll have to verify your eligibility for each state where you offer SHOP coverage separately.
  • If you have business locations in a state that runs its own SHOP, you can get coverage through that state's SHOP. Select the state where your business operation is located, and we'll take you to your state’s SHOP website.

If you operate multiple businesses in a state or in more than one state under the same EIN

  • You can establish only one SHOP offer per EIN in each state. Learn more about controlled group rules from the IRS.
  • When you count full-time equivalent employees (FTEs) to determine eligibility for SHOP, you must include FTEs from all your businesses.

If you operate multiple businesses in a state or in more than one state with different EINs

  • You must create unique SHOP offers for each EIN. Controlled group rules apply when establishing the FTE count for your businesses — whether your businesses are all in one state or in multiple states.
  • For each business with its own EIN, you’ll need to:
    • Meet SHOP eligibility criteria independently
    • Count all the FTEs in all your businesses using controlled group rules
    • Create separate SHOP coverage offers
  • If you have remote employees, you can use your primary business address for all your remote employees, or use each of the locations where your remote employees work as a separate business location.

Questions?

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SHOP how-to guides, fact sheets, tools, and other resources for employers

For help with the Small Business Health Options Program (SHOP), check out these resources:

SHOP eligibility & prices

The Small Business Health Care Tax Credit

Applying & enrolling in SHOP insurance

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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Get information about your options based on your situation:

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