Do You Want to Provide Coverage to Your Employees?
Your Health Idaho’s Small Business Health Options Program (SHOP) is a new marketplace designed to offer small businesses with up to 50 employees access to private health insurance options for their employees. Once you choose a plan that is right for your business, you can decide how much to pay toward employees’ premiums.
Starting in 2014, in order for small businesses to be eligible for the Small Business Healthcare Tax Credit, small businesses must purchase a health plan for their employees through The SHOP Marketplace.
There is no penalty for small businesses for not enrolling in SHOP.
How do I find information on Small Business SHOP Plans?
Small Business health and dental plans are available from different health insurance companies in Idaho. To find out more details about the plans, visit the individual insurance company pages or call the insurance company or an agent or broker directly.
Small Business Health Plans:
Small Business Dental Plans:
Best Life: http://www.bestlife.com/ID/index.html
BlueCross of Idaho: http://shoppers.bcidaho.com
The Guardian Life Health Insurance Company: http://www.guardianlife.com/small-business-exchanges/
When can I select a small business plan for my employees?
You may enroll in SHOP on a rolling monthly basis. The deadline to enroll is always the 15th of the month for coverage to be effective the 1st of the following month.
You must select a by December 15, 2013 to have coverage start for your employees by January 1, 2014. After this period,
How do I enroll in coverage on the Your Health Idaho Small Business SHOP Marketplace?
You enroll in small business coverage directly through a Your Health Certified agent or broker or insurance company. For help locating an agent or broker visit YourHealthIdaho.org or call the Your Health Idaho Consumer Resource Center at 1-855-YH-IDAHO (1-855-944-3246).
- Contact a Your Health Idaho agent or broker or health insurance company that sells SHOP plans on Your Health Idaho.
- Look through plans and pick a plan that works for your business.
- Once you select a plan, the insurance company will provide premium costs for you and your employees, and each of you will be able to enroll directly with the insurance company.
- Upon enrollment, you will pay your first month’s premium directly to the insurance company.
- If you plan to claim the Small Business Healthcare Tax Credit, you will need to fill out an application for the SHOP marketplace. You can download the application and mail it in for processing or call the SHOP Small Employer call center at 1-800-706-7893 to apply for eligibility by phone.
The Small Business Healthcare Tax Credit
Starting in 2014, in order to be eligible for the Small Business Health Care Tax Credit small businesses must enroll in a plan that is sold on the Your Health Idaho SHOP marketplace.
For some small businesses with fewer than 25 full-time equivalent employees earning an average of about $50,000 a year or less, your business may be eligible for a small business healthcare tax credit starting in 2014, if you purchase your employees’ insurance plans on the Your Health Idaho insurance marketplace.
To qualify for the small business healthcare tax credit, business owners must pay at least 50% of their full-time employees’ premium costs and select a plan available through Your Health Idaho. You are not required to offer coverage to your part-time employees or to employees’ dependents in order to qualify.
The tax credit available for policies beginning on January 1, 2014 is worth up to 50% of your contribution toward employees’ premium costs, (up to 35% for tax-exempt employers).
Below is an example of a tax credit for a small business employer who qualifies for the maximum tax credit worth 50% of their premium contribution in 2014:
To find out if you qualify for the small business healthcare tax credit you can visit the IRS website HERE. Additionally, you can also consult with an agent or broker and your tax advisor or accountant to learn if you qualify.
SHOP Frequently Asked Questions
How do I know if I’m eligible to use the Your Health Idaho SHOP Marketplace?
To participate in the Your Health Idaho SHOP Marketplace, you must:
- Have a principal business address within the Idaho, or you can offer coverage to each eligible employee through the SHOP Marketplace account serving that employee’s primary worksite.
- Have at least one common-law employee on payroll (not including a business owner or sole proprietor or their spouses if they’re on payroll). For the definition of a common-law employee, visit the IRS website at irs.gov/Businesses/Small-Businesses-&-Self-Employed/Employee-(Common-Law-Employee).
- Employ 50 or fewer full-time equivalent employees (FTEs), including part-time employees. For example, 2 half-time employees generally equal 1 full-time equivalent employee. Beginning no later than January 1, 2016, SHOP will be available for employers with 100 or fewer FTEs.
- Offer coverage to all your full-time employees — those working an average of 30 or more hours per week
To calculate full-time equivalent employees when you apply for SHOP:
- Use the most recent year.
- Exclude seasonal employees (those working fewer than 120 days a year) from all calculations.
- Count the number of people who worked an average of 30 or more hours a week.
- Add to this amount the number of hours worked per week by non-full time employees divided by 30.
Example: Mike owns a business with 20 employees. He has
- 15 employees working an average of 40 hours per week
- 2 employees working an average of 15 hours per week
- 1 employee working an average of 25 hours per week
- 2 employees working an average of 27 hours per week
Here’s how Mike calculates his FTEs:
- Number of full-time employees = 15
- Non full-time employee hours (15+15+25+27+27)/30 = 3.6 or 3 FTEs (always round down when calculating FTEs)
-Mike has 18 FTEs
How many of my employees must enroll in the SHOP Marketplace?
In Idaho, 70% of your eligible employees must enroll in the plan(s) you offer in order for you to participate in the SHOP Marketplace at any point during the year.
When doing this calculation:
- Don’t include dependents of your employees or employees with coverage through another job, another person’s job, Medicare, Medicaid, the Department of Veterans Affairs (VA), the Indian Health Service, or TRICARE. For example, if you have 10 employees but one has coverage through the VA and another has Medicare, you’ll do the 70% calculation based on 8 employees, not 10.
- Do include employees with other types of individual health insurance. In the example above, if 2 of the 8 employees have private health insurance policies they bought themselves, you should include them in the calculation.
- Upon your renewal in 12 months, if you choose to enroll in the same health plan, you’ll need to meet SHOP’s minimum participation rate.
What are my options if I don’t reach the minimum participation rate for the SHOP Marketplace?
You have 3 options:
- You can change your offer of coverage if you want to enroll at any time during the year.
- a. For example, you can increase the amount you contribute to employees’ insurance premiums to encourage more of them to participate. If you change your offer, your current offer will be cancelled. You’ll start the process over using the information from your initial application. You’ll also need to set up a new employee enrollment period.
- You can enroll between November 15 and December 15. The minimum participation requirement doesn’t apply during this annual enrollment period.
- a. Upon your renewal in 12 months, if you choose to enroll in the same health plan, you’ll need to meet SHOP’s minimum participation rate.
- You can completely withdraw your offer of coverage.
When can I enroll my small businesses in the SHOP Marketplace?
To start coverage on January 1, 2014, you must select a plan to offer your employees and your employees must enroll in the plan by December 23, 2013. You submit your employees’ applications along with your completed employer application.
You can apply for coverage any time after that. To get coverage, you must submit your completed application along with your employees’ applications by the 15th of any month for coverage to take effect on the 1st of the following month.
For example, if you enroll by April 15th, coverage will begin May 1st. If you enroll between April 16th and April 30th, coverage will begin June 1st.
How do I apply for the Small Business Health Care Tax Credit?
You can apply for the Small Business Health Care Tax Credit only if you enroll in coverage for your employees through the SHOP marketplace.
In order to have access to the expanded Small Business Health Care Tax Credit in 2014 based on coverage offered through the SHOP, you must receive an eligibility determination from the SHOP by completing a paper application . The agent, broker, or insurance company can also help you complete this form. The SHOP will send you an eligibility determination after it receives a completed application. The SHOP will also send employee enrollment information to the IRS to ensure that, if otherwise eligible, you can claim the tax credit for tax year 2014. You will need to apply and be determined eligible prior to filing your taxes and seeking this tax credit.
If I submit a paper application, by myself or through an agent, broker or insurance company, how will I hear back and when will I know about my eligibility to participate in the SHOP?
The Your Health Idaho SHOP Marketplace facilitated by healthcare.gov will notify employers of their eligibility to participate in the SHOP by phone and e-mail, as well as by mail if requested. Employers who have already submitted an application in October or November should receive an eligibility notification in early December, along with information about next steps. Moving forward, the Your Health Idaho SHOP Marketplace facilitated by healthcare.gov expects to notify employers of their eligibility within 3-5 days of receiving a fully completed application either from the employer or from an agent, broker, or insurance company.
By using enrolling directly with an agent or broker you can opt not to wait for an eligibility determination from the SHOP Marketplace before enrolling in a qualified health plan, although you might not be eligible for the Small Business Health Care Tax Credit if the SHOP marketplace facilitated by healthcare.gov later determines you were not eligible to participate in the SHOP.
What happens if I have eligibility issues when I hear back on my paper application?
If the Your Health Idaho SHOP Marketplace facilitated by healthcare.gov can’t determine whether your business is eligible, it will contact you to resolve any outstanding issues. If the SHOP is still unable to resolve these issues, your application may be rejected and you’ll be invited to apply again. If you’re deemed ineligible for the SHOP Marketplace based on your application, you’ll have an opportunity to apply again or to appeal the decision within 90 days of receiving your ineligibility notification