California SHOP News and Notes

Courtesy of Health Net Pulse:

Several provisions of the Affordable Care Act (ACA) affect small businesses, their employees, and families. Currently, smaller businesses are less likely to offer health insurance coverage to their employees than larger companies: 57% of small businesses with 50 or fewer workers offered health benefits to employees in 2011, compared to 92% of businesses with 51 to 100 workers, and 97% of businesses with 101 or more workers.

Who is eligible?

Beginning in 2014, small employers (up to 50 employees/100 beginning in 2016) can apply to participate in SHOP.

  • Employer groups can enter SHOP at any time
  • SHOP-participating employers must make coverage available to all full-time employees

Small Employer Group tax credit eligibility

  • Tax credit for small employers who provide coverage through SHOP (available for 2-year period)
  • Must have 25 or fewer employees
  • Average employee wages must be under $50,000
  • Employer must contribute at least 50% toward the premium

The SHOP Enrollment Process

Employer Enrollment

  • Can enroll any time during the year
  • The SHOP can establish minimum participation standards and can limit enrollment of plans that do not meet these standards to Nov. 15–Dec. 15 of each year (in SHOP, the exchange establishes its rules)

Employee Open Enrollment

  • Yearly open enrollment period, based on the plan year, as usual

Special Enrollment

  • Employees who have certain qualifying events occur (e.g., birth, death of spouse, loss of job) will have a special enrollment period that lasts 30 days from date of qualifying event.
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