States using HealthCare.gov for SHOP no longer process employee enrollments, determine employee eligibility, or accept employee appeal requests related to enrollment eligibility. If you:

• Applied for your employer’s SHOP Marketplace coverage and were denied coverage: Contact your employer or insurance company for more information about employee enrollment and eligibility.
• Are eligible for your employer’s SHOP Marketplace coverage, due to a qualifying life event, but couldn’t enroll during a Special Enrollment Period because the insurance company denied you coverage: You can file a SHOP employee complaint. Note: Employee dependents aren't eligible for a Special Enrollment Period if your employer doesn’t offer coverage to dependents.

Ways to report that you could not enroll in SHOP coverage

You can report this information to SHOP by:

• Calling the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
• Sending an email to shop@cms.hhs.gov documenting the concern and providing supporting evidence. Note: Don’t include Personally Identifiable Information (PII) — like your Social Security Number — in your email. Call the SHOP Call Center at the number above if any PII needs to be provided as a part of your SHOP employee complaint submission.

You have 90 days from the date of your Special Enrollment Period ineligibility notice to submit this information to SHOP.

Note: Keep a copy of your complaint for your records.

After you've contacted SHOP

You'll get a response saying that your complaint was received. It will provide a description of the process and instructions for submitting additional materials, if needed.

Questions?

• An employee should contact their employer or insurance company with questions regarding their SHOP health and/or dental coverage — including plan year start and end dates, payment-related inquiries, life changes, and/or claims-related questions.
• For all other questions related to the SHOP employee complaint process, contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).

Employees with a Small Business Health Options Program (SHOP) insurance offer in 2017 can login to HealthCare.gov to accept or decline their offer

We're testing the use of star ratings for SHOP plans this year in several states and will use this test to improve the program.

If you get a notice from the Marketplace that says you need to send documents with your child’s date of birth to confirm that you’re eligible for a Special Enrollment Period, you need to send the Marketplace confirmation of the new child’s date of birth. Send a document for each new child, if there’s more than one, and your notice asks for documents for more than one person.

If you get a notice from the Marketplace saying you need to submit documents to confirm your loss of coverage, you can upload or mail documents. Find types of documents to submit.

If you get a notice from the Marketplace saying that you need to submit documents to confirm your marriage, you can upload or mail the Marketplace documents for the person (or people) on your application who got married in the past 60 days. If 2 people on your application got married to each other, you only need to submit one document that shows both of their names.

If you get a notice from the Marketplace saying you need to submit documents to confirm your move, you can upload or mail documents. Uploading is the fastest and most efficient way to get us the documents.

IMPORTANT: Upload or mail documents as soon as possible. If you don’t submit documents by the deadline, you won’t have Marketplace coverage.

Small employers who don’t offer group health coverage to their employees can help employees pay for medical expenses through a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). If your employer offers you a QSEHRA, you can use it to help pay your household’s health care costs (like your monthly premium) for qualifying health coverage.

Family & household relationships

We need to know about everyone who is applying for health coverage and their relationships to each other.

We ask for your race, ethnicity, and preferred language so we can make sure everyone gets the same access to health care. This information is confidential, and it won’t be used to help decide what health programs people are eligible for. Providing your race and ethnicity is optional, so you don’t need to answer these questions to complete your application.

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans. Medicaid and CHIP benefits vary somewhat between states.

These programs may also have different names in different states. Select your state below to see what the program is called in your state.

If you use advance payments of the premium tax credit (APTC) to reduce the cost of your Marketplace premiums, you must file a tax return to report these payments, even if you don't usually file taxes. When you (and the tax filers on your application) file your federal income tax returns, you must "reconcile" any premium tax credits that you used during the year.