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Employees Enrollment In SHOP

Agents and brokers may assist employees in the same way they assist employers with SHOP application and enrollment directly on the SHOP website. 

  • Agents and brokers can help employees and their dependents complete an application and enroll in a SHOP; employees and their dependents can also register and enroll themselves using an online portal.
  • There is a straightforward process for an employee to enroll and an annual open enrollment period to make changes.
  • Employers need to add new employees to their rosters for them to be eligible to enroll in a SHOP.

The employee must first log directly into his or her own Marketplace account. The agent or broker may assist the employee in creating his or her account if needed, but the employee or legally authorized representative must create his or her own Marketplace username and password and should not share this information with third parties, including agents and brokers. The agent or broker will then assist with completing the application, where the employee will be prompted to enter the agent or broker’s National Producer Number (NPN) and other identifying information.

The following screen lists the steps in the employee enrollment and plan selection process. It is important to note both the steps of enrollment and the additional information listed below each step in the process.

  • Step 1:
    After the employer chooses a qualified health plan (QHP), Agents can help employees complete the application. 

    • An employee can choose to decline health insurance.
    • For the employer to be able to offer coverage to employees under SHOP, at least 70% of the total number of full-time employees must participate and sign up for coverage (excluding from the calculation all employees who have other creditable coverage, such as another group plan or public health insurance, such as Medicare, Medicaid, or TRICARE).
    • Note: As a reminder, if an employer offers affordable coverage to an employee, the employee is ineligible for premium tax credits in the Individual Marketplace. Employer-sponsored insurance is considered unaffordable if an employee’s share of the self-only coverage is more than 9.5% of the worker’s household income. Because employers will not know their employees’ household income, the Internal Revenue Service (IRS) has proposed regulations which include several affordability safe harbors.

    Step 2:
    In 2014, because the employer will select a single QHP, agents can then help the employee input his or her personal information, including information for dependents, if applicable.

    Step 3:
    The employee will need to decide whether to enroll dependents if dependent coverage is offered.

    • Under the Affordable Care Act, employers participating in a SHOP are not required to offer dependent coverage in 2014.
    • If dependent coverage is offered, the employee decides whether to enroll his or her dependents, based on such factors as net price after employer contribution. Dependents covered through a SHOP plan are ineligible for premium tax credits and cost-sharing reductions.
    • If the employee decides to enroll dependents, agents can help with the enrollment process.
    • Each year before the plan renewal date, employees will have an annual open enrollment period of at least 30 days, as determined by the SHOP. Employees can change their enrollment selection and enroll an existing dependent, if applicable, during these annual open enrollment periods. The SHOP will notify each qualified employee about the annual open enrollment period before it begins.
    • During the plan year, employees may also be eligible for special enrollment periods (SEPs), under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), due to triggering events, such as birth, adoption, marriage, loss of eligibility for public health insurance programs, or loss of group coverage through another employer.

    Dependent Enrollment

    Agents may help employees enrolled in a SHOP plan to enroll their dependents in the same plan. Dependent enrollment can occur during initial enrollment, the annual open enrollment period, or SEPs throughout the year.

    New Employees

    When a small business owner hires new employees, agents can assist new employees who wish to enroll in the employer’s SHOP plan.

    Once an employer has added the new employees to the roster, those employees are eligible to enroll in coverage through a SHOP. The SHOP or applicable insurance companies may request proof an employee is on payroll or that a dependent is eligible for coverage when they enroll.

    There may be a waiting period set by the employer for new employees. The length of the waiting period can be changed during an employer’s annual renewal, but cannot exceed 90 days.

Next Topic: Enrollment Timeline

If you are an agent see Insurance Agents and Obamacare.


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