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SHOP Enrollment Begins

Enrollment for the Small Business Health Options Program (SHOP) in Covered California begins today. A webinar hosted by Covered California detailed the process for employers seeking quotes and selecting coverage, along with the application for employees. The applications are similar to the process for individuals and families, but simplified.

Employers start by submitting an application and roster of employees to seek a quote for the cost of coverage through Covered California. Then employers are deemed eligible to participate in the SHOP and can begin plan selection. Employers choose the contribution level (e.g. 60% of premiums) and whether or not to offer coverage to dependents. Then employers must select a standard metal tier and corresponding actuarial value, followed by a reference plan. The employer will pay fixed costs equivalent to the reference plan and employees will pay the difference between any higher cost plans.

SHOP employer contribution

Through each step, the SHOP estimates costs specific to the employee roster, along with any potential tax credits to the business. Rates are based on the zip code of the employer and the age of employees.

SHOP tier level

Once the employer has made selections for the reference plan and contributions, open enrollment begins, and employees can apply for coverage. Open enrollment is generally about 30 days, although this can be altered based on the needs of employers. Employers can log into their Covered California account to track enrollment progress.

shop employer app process

Employees must submit applications individually during the open enrollment period. The application takes about 30 minutes and consists of basic household information. Tools for matching medical needs and provider networks to plans are available to aid in plan selection. Employees browse carrier and plan options within the selected tier and then make a selection, enrolling in the plan. Monthly premium contributions are withdrawn from employees’ paychecks. Employees declining coverage still have to declare that they are waiving coverage through the online system.

shop employee app process

After the online applications are complete, Covered California will conduct a final review for eligibility. The group will be approved and the employer will be invoiced. Payment is due by the start date of coverage. While each employee can choose from multiple plans and insurance companies, employers only have to make one payment per month to Covered California, which then compensates the insurance carriers.

Coverage through the SHOP will be effective starting January 1. To offer coverage starting January 1, employers should complete applications by the third week of December. At least 70% of employees per employer must participate in the SHOP.

For employers looking for a quick quote, they can submit a request to Covered California without filling out an application.

For more information and to view the slide deck for the SHOP enrollment webinar, see Covered California’s SHOP page. You can also contact the SHOP Service Center at 877-453-9198 or contact a certified insurance agent.

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