No matter how many times it is repeated, there are many people who don’t realize that small businesses with fewer than 50 employees (or the “full-time equivalency” of 50 employees) are NOT required to purchase health insurance coverage for their employees. However, if you DO choose to provide insurance to employees, you can purchase it through a local insurance agent or there is a marketplace in which to purchase coverage. Such marketplaces can are run by either states or the federal government and are called the SHOP marketplace. (Individuals do not have access to SHOP marketplaces, only small group organizations.) Here are some frequently asked questions about SHOP marketplaces. Below the FAQ, you can find a glossary of terms found on the website Healthcare.Gov.

Do I have to provide my employees with health coverage if I have fewer than 50 employees? No!

You do not have 50 or more full-time equivalent (FTE) employees, you do not have to provide health insurance. However, you can choose to offer insurance through the SHOP Marketplace in your state or through any other source. But you don’t have to, and you don’t face a penalty if you don’t.

If you have 50 or more employees, you may have to offer health coverage meeting certain standards or make a payment. Learn about the Employer Shared Responsibility Payment.

What if I’m self-employed?

If you’re self-employed with no employees, here are your options:

You can enroll in coverage through the Health Insurance Marketplace for Individuals & Families.

You cannot enroll in a SHOP plan.

Learn more about how self-employment is defined. If you have at least one full-time employee other than yourself, a spouse, a family member, or another owner, you can enroll in a SHOP plan.

How do I make payments for my SHOP plan?

You make your premium payments to the SHOP Marketplace, not your insurance company.

Learn more about paying your SHOP premiums (PDF).

Where can I get a list of agents and brokers in my area?

  • After you create a SHOP Marketplace account, log in and you’ll see a list of agents and brokers searchable by ZIP code. All of them have signed privacy and security agreements with the SHOP Marketplace that allow them to sell SHOP plans.
  • See how to create a SHOP Marketplace account and log in.
  • You can work with any agent or broker who’s signed the SHOP agreement. Ask any agent or broker you want to work with if they’ve signed it.

Healthcare.Gov Glossary

Are you confused by any of the terms mentioned in the questions or answers above? Click on any of these terms and you can find out what they mean. (Note: These links leave SmallBusiness.com and will take you to the Healthcare.gov website.)

A G P
Accountable Care Organization Generic Drugs Patient Protection and Affordable Care Act
Accreditation Gold Health Plan Patient-Centered Outcomes Research
Actuarial Value Grandfathered Payment Bundling
Advance Premium Tax Credit (APTC) Grandfathered Health Plan Penalty
Affordable Care Act (ACA) Grievance Pension (Retirement Benefit)
Affordable coverage Group Health Plan Physician Services
Agent Guaranteed Issue Plan
Alimony Guaranteed Renewal Plan ID
Allowed Amount H Plan Year
Annual Deductible Combined HIPAA Eligible Individual Platinum Health Plan
Annual Limit Habilitative/Habilitation Services Point of Service (POS) Plans
Appeal Hardship Exemption Policy Year
Application ID Health Care Workforce Incentive Pre-Existing Condition
Attest/Attestation Health Coverage Pre-Existing Condition (Job-based Coverage)
Authorized Representative Health Insurance Pre-Existing Condition Exclusion Period (Individual Policy)
B Health Insurance Marketplace Pre-Existing Condition Exclusion Period (Job-based Coverage)
Balance Billing Health Maintenance Organization (HMO) Pre-existing Condition Insurance Plan (PCIP)
Benefit Year Health Plan Categories Preauthorization
Benefits Health Reimbursement Account (HRA) Preferred Provider
Biosimilar Biological Products Health Savings Account (HSA) Preferred Provider Organization (PPO)
Brand Name (Drugs) Health Status Premium
Broker High Deductible Health Plan (HDHP) Premium Tax Credit
Bronze Health Plan High-Cost Excise Tax Prescription Drug Coverage
C High-Risk Pool Plan (State) Prescription Drugs
COBRA Home Health Care Prevention
Cancelled Debts Home and Community-Based Services (HCBS) Preventive Services
Capital Gains Hospice Services Primary Care
Care Coordination Hospital Outpatient Care Primary Care Physician
Catastrophic Health Plan Hospital Readmissions Primary Care Provider
Centers for Medicare & Medicaid Services (CMS) Hospitalization Prior Authorization
Certified Application Counselor Household Public Health
Children’s Health Insurance Program (CHIP) I Q
Chronic Disease Management In Person Assistance Personnel Program Qualified Health Plan
Claim In-network Coinsurance Qualifying Health Coverage
Co-op In-network Copayment Qualifying Life Event (QLE)
Coinsurance Inconsistency (Data Matching Issue) R
Community Rating Individual Health Insurance Policy Rate Review
Competitive Bidding Inpatient Care Reconcile
Complication of Pregnancy Insurance Co-Op Reconstructive Surgery
Conversion Interest Referral
Coordination of Benefits Investment Income Rehabilitative/Rehabilitation Services
Copayment J Reinsurance
Cost Sharing Job-based Health Plan Rental or Royalty Income
Cost Sharing Reduction (CSR) L Rescission
Court Awards Large Group Health Plan Retirement Benefit (Pension)
Creditable Coverage Lawfully Present Rider (exclusionary rider)
D Lifetime Limit Risk Adjustment
Data Matching Issue (Inconsistency) Limited cost sharing plan S
Deductible Long-Term Care Same-Sex Marriage
Dental Coverage M Second Lowest Cost Silver Plan (SLCSP)
Department of Health and Human Services (HHS) Marketplace Self-Employment Income
Dependent Medicaid Self-Employment Ledger
Dependent Coverage Medical Loss Ratio (MLR) Self-Insured Plan
Disability Medical Underwriting Service Area
Dividend Medically Necessary Silver Health Plan
Domestic Partnership Medicare Skilled Nursing Care
Donut Hole, Medicare Prescription Drug Medicare Advantage (Medicare Part C) Skilled Nursing Facility Care
Drug List Medicare Hospital Insurance Tax Social Security
Durable Medical Equipment (DME) Medicare Part D Social Security Benefits
E Medicare Prescription Drug Donut Hole Social Security Survivors Benefits
Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT) Member Survey Results Special Enrollment Period (SEP)
Eligibility Assessment Minimum Essential Coverage (MEC) Special Health Care Need
Eligible Immigration Status Minimum value Specialist
Emergency Medical Condition Modified Adjusted Gross Income (MAGI) Spousal Abandonment
Emergency Medical Transportation Multi-Employer Plan Stand-alone dental plan
Emergency Room Care Multi-State Plan State Continuation Coverage
Emergency Services N State Health Insurance Assistance Program (SHIP)
Employer Shared Responsibility Payment (ESRP) Navigator State Insurance Department
Employer or Union Retiree Plans Net Capital Gains State Medical Assistance Office
Essential Health Benefits Net Rental Income Subsidized Coverage
Exchange Network Summary of Benefits and Coverage (SBC)
Excluded Services Network Plan Supplemental Security Income (SSI)
Exclusive Provider Organization (EPO) Plan New Plan T
Exemption Non-preferred provider TRICARE
Exemption Certificate Number (ECN) Nondiscrimination TTY
External Review Not Yet Accredited (Health Plan) Tax Household
Notice Tax filing requirement (for dependents)
F Total Cost Estimate (for health coverage)
Family and Medical Leave Act (FMLA) O Transgender People
Federal Poverty Level (FPL) Obamacare U
Federally Qualified Health Center (FQHC) Open Enrollment Period UCR (Usual, Customary, and Reasonable)
Federally Recognized Tribe Original Medicare Uncompensated Care
Fee Out-of-Network Coinsurance Urgent Care
Fee For Service Out-of-Network Copayment V
Flexible Benefits Plan Out-of-Pocket Costs Value-Based Purchasing (VBP)
Flexible Spending Account (FSA) Out-of-Pocket Estimate Vision Coverage
Formulary Out-of-pocket maximum/limit W
Full-Time Employee (FTE)   Waiting Period (Job-based coverage)
Fully Insured Job-based Plan Well-baby and Well-child Visits
Wellness Programs
Worker’s Compensation
Z
    Zero cost sharing plan

 

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