SHOP - Employee

SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP)
Marketplace

SHOP Marketplace Employee Enrollment
User Guide

Table of Contents
SHOP Marketplace – Employee Enrollment Application.............3
Create a HealthCare.gov account............................................................... 4
Confirm eligibility......................................................................................... 7
Review SHOP Marketplace coverage offer................................................. 14
Enrollment selection for dependents......................................................... 19
Review and select plan(s)............................................................................. 20
Complete enrollment................................................................................... 27

Your Healthcare.gov account......................................................... 31
Account profile................................................................................................ 31
My enrollment................................................................................................. 32
My plans........................................................................................................... 36
Message center............................................................................................... 36

Special Enrollment Period............................................................... 37
Account changes..............................................................................37
Submit an appeal.............................................................................37
Username and password recovery............................................... 38
Forgot username............................................................................................ 38
Forgot password............................................................................................. 38
Unlock your account...................................................................................... 39

Have questions or need help.........................................................39

SHOP Marketplace – Employee Enrollment
Application
In most states, the SHOP Marketplace is open to employers with 1-50 full-time equivalent (FTE)
employees, though small employers with 1-100 FTEs can participate in the SHOP Marketplace
in California, Colorado, New York, Vermont and Virginia. If you already have SHOP Marketplace
coverage through your employer, you’ll need to visit HealthCare.gov to renew or change your
coverage. Learn more about renewing your SHOP Marketplace coverage at marketplace.cms.
gov/outreach-and-education/shop-marketplace-coverage-renewal-user-guide.
If your employer is in one of these states, use this document to guide you through the process of
responding to your employer’s SHOP Marketplace coverage offer on HealthCare.gov.
Alabama
Alaska
Arizona
Delaware
Florida
Georgia
Illinois
Indiana
Iowa
Kansas
Louisiana
Maine
Michigan
Missouri
Montana
Nebraska

Nevada
New Hampshire
New Jersey
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Virginia
West Virginia
Wisconsin
Wyoming

If your employer is in a state that’s not listed above, that means the state is running its own
SHOP Marketplace. You’ll need to follow your state’s application process. To find your state’s
SHOP Marketplace, visit HealthCare.gov/small-businesses/employees and select your state
from the drop down menu, or contact the SHOP Call Center at 1-800-706-7893. TTY users should
call 711 to reach a call center representative.
You can work with your employer’s authorized agent or broker to help you complete the
SHOP Marketplace employee application.
IMPORTANT: You can save your information at any point in the application and return later
to complete it. The system will time out after 30 minutes of inactivity.

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Create a HealthCare.gov account
If your employer is offering coverage through the SHOP Marketplace, you’ll get a notice with a
participation code. You’ll use this information to view your employer’s coverage offer. Before you
view the coverage offer, you must create an account on HealthCare.gov.
Select your state. Visit the small business employee’s page on HealthCare.gov/smallbusinesses and select the state where your employer’s primary business address is located.
Then select SEE HOW TO ACCEPT OR DECLINE.
●● Select “If you don’t have a HealthCare.gov account, create one” if you’ve never
set up an account.
●● Select “If you already have an account, just log in” if you have an account you
created previously to apply for individual and family coverage. Don’t create a
different account for your small business employee actions.
Note: You’ll need your Social Security Number (SSN) and your SHOP participation or “unique”
code to create an account and enroll.
If you think your employer is offering SHOP coverage and you haven’t gotten a notice with
your participation code, contact your employer, not the SHOP Marketplace. Your employer can
provide your participation code.

 

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Answer a few questions. On the Create an account page, you’ll enter your first and
last name, email address, and preferred password.
Next you’ll answer a few security questions. These questions will be helpful in case
you forget your username and/or password and have trouble logging in.
●● Select the box about news and updates if you want us to email information
to you.
●● Check the box stating that you understand and agree with HealthCare.gov’s
privacy policy and select CREATE ACCOUNT.

Note: When you create your account, the information you provide is case sensitive. Remember
to enter the information the same way when you log in.

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Verify your email address. You must verify that the email address you gave for the
account is correct. You’ll get an email with a link that’s unique to you. Select the link and
follow the instructions on the screen. Note: If you don’t see the verification email in
your inbox, check your junk mail.

●● After you finish verifying your email address, you’ll see a page with “Success!” letting
you know that your account has been created. Select Continue to create your
profile and verify your identity.

 

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●● Note: If you don’t verify your email address within 48 hours of getting the email,
the link in the email will expire. You’ll need to get another verification email before
you try to log into your account.
●● If you try to log into your account without verifying your email address, you’ll get
an expiration notice. Select Resend Verification Email and follow the steps on the
previous page to verify your email address.

Confirm eligibility
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Log into your HealthCare.gov account. Enter your new username and password,
select LOG IN, then select I ACCEPT on the Terms & Conditions page.

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Select the employee application. On the WELCOME page, select VISIT EMPLOYEE
MARKETPLACE.

 

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Enter the SHOP participation code. On the My employer page, enter the participation
code that was emailed to you, or your employer gave to you, and your Social Security
Number (SSN). You should do this even if you don’t want coverage now. Select VERIFY.

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●● The system determines your eligibility by comparing the SHOP Marketplace
participation code, your name, and SSN that you entered when you created
your Healthcare.gov account to the information given by your employer on the
employee roster. Make sure the information you provide exactly matches the
information your employer gave.
●● After the information is validated, select YES to add the employer to your
account. If you select NO, you’ll return to the My Employer page where you
entered your participation code and SSN.

 

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●● If you entered the SHOP Marketplace participation code and/or SSN incorrectly,
you’ll get a message asking if you’re sure the employee code and SSN entered
are correct.

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If you select NO, you’ll go back to the My Employer page to re-enter the correct participation
code and SSN.

 

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If you select YES, you’ll get a message letting you know that you’re ineligible for the SHOP
Marketplace. This message also includes a link to the SHOP Marketplace appeals page. Before
you submit an appeal, check with your employer to see if your name and SSN are correct on the
employee roster.

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Review SHOP Marketplace coverage offer
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On the My Employer page, select BEGIN to start reviewing your employer’s
coverage offer.

 

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You’ll see a summary of information for your employer, including:
●● Employer name and address
●● Employer ID
●● Enrollment period
●● Estimated effective date
●● Medical and dental plan categories
●● Percentage employer is contributing towards your premium

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Accept or decline your employer’s coverage offer. The application automatically
defaults to “Yes, I plan to accept coverage through my employer.” You can return
and change your response after viewing health plans.
If you accept the coverage offer, enter employee details, like mailing address and
other contact information. All fields marked with an asterisk are required.
●● Add dependents. If your employer is offering dependent coverage, select ADD
DEPENDENT(S).
Note: Make sure your information is correct before you submit. You may not be
able to make changes after you sign the application and your employer submits
the enrollment application to the SHOP Marketplace.

 

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nn

Sign the enrollment application. Enter your name in the box to sign the application.
After you enter your name, the date will be automatically entered. Select SAVE &
CONTINUE.

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If you decline the coverage offer, select the reason from the drop down menu.
●● Verify your decision to decline coverage. Read and agree with the statements.
●● Sign the enrollment application. Enter your name in the box to sign the
application, then select SUBMIT. If you decline coverage, you don’t need to do
anything else. If you select BACK TO MY EMPLOYERS or CANCEL, you’ll return to
the My Employer page.

 

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Enrollment selection for dependents
If your employer is offering dependent coverage and you have elected to enroll, you can choose
which dependents you want to enroll in health and/or dental coverage.

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Review and select plan(s)
Health plans are put into 4 categories (Bronze, Silver, Gold, and Platinum) based on how you and
the plan can expect to share the costs for health care. The health plan category your employer
chooses determines what you’ll pay for things like deductibles and copayments, and the total
amount you’ll spend out-of-pocket for the year if you need a lot of care. The categories don’t
reflect the quality or amount of care the plans provide.
There are 2 dental plan categories (Low and High) based on how you and the plan can expect to
share the costs of covered services. The dental plan category your employer chooses affects the
total amount you’ll likely spend out-of-pocket for dental benefits during the year.
To learn more about health and dental plans, visit marketplace.cms.gov/outreach-andeducation/things-to-think-about-shop-2016.pdf.
In this section of the employee enrollment application, you can review the plan(s) offered by
your employer. You’ll either see one health and/or dental plan offered by your employer, or your
employer will offer you a choice of health and/or dental plans. If you’re offered a choice of plans,
this is called “Employee Choice.” This means that your employer will select one plan category
and you can choose any health or dental plan (if offered) from any insurance company in that
category.
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Review employer’s health coverage. The plan(s) you’ll see are based on your
employer’s primary business address. Select View plan details to see plan details, like
copayments, laboratory and outpatient services, medical devices, emergency care, and
inpatient hospital services. If your employer is offering you a choice of plans, you’ll see a
list of plans to compare.
●● Compare plans. If you have multiple plans listed, you can select up to 3 plans to
compare side-by-side. Select the Compare checkbox for each plan you want to
compare. Then select Compare plans.
●● Sort plans. Select Sort by on the drop down menu to see your options. You can
sort by:
§ Employer’s monthly share high to low
§ Employer’s monthly share low to high
§ Employee’s monthly share high to low
§ Employee’s monthly share low to high
§ Annual deductible high to low
§ Annual deductible low to high

 

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●● Filter plans. You can use the menu listing on the left side of the page to narrow
your plan search based on certain criteria. You can move the bars on the left to
increase or decrease the dollar amounts. You can filter by:
§ Employee estimated contribution
§ Yearly deductible (per person or per family)
§ Insurance company
§ Plan category
●● Plan details. To view the benefits of the plan, including a list of covered drugs,
select DETAILS.

 

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●● Find covered drugs. Under the details view, select List of covered drugs to view each
plan’s covered drug information.

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Select one health plan and one dental plan (if offered). To choose plan(s) for you and your
dependents, select SELECT next to the health plan information. Then select
SAVE & CONTINUE.
●● If your employer is offering health and dental coverage, you can enroll in health
coverage only, dental coverage only, or both health and dental coverage. You’re not
required to enroll in health coverage to enroll in a dental plan.
●● If your employer offers dependent coverage, you and your dependents must enroll
in the same health and/or dental plan. However, you can choose which dependent
to enroll in your selected plan(s). You must enroll in health and/or dental coverage
if you want to enroll your dependents.
●● If your employer is offering health and dental plans, you can select SAVE &
CONTINUE without selecting a health plan.
●● If you select another health plan, you’ll see a message letting you know that this
selection will replace your current plan selection.
Note: You can choose which dependents you want to enroll in either your health
or dental coverage. You don’t have to enroll all your listed dependents in all your
selected plans. Remember, whatever plan(s) you select for each dependent can’t be
changed after the enrollment is submitted, unless you experience a life change that
qualifies you for a Special Enrollment Period.

 

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Complete enrollment
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Review plan selection(s) and cost. Read the summary of your health and dental plan
(if offered). This includes the total monthly employee premium across all your plans.
Confirm plan choice(s). Select CONFIRM to submit your application.

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Get a confirmation. You’ll get a confirmation letting you know that your application is
complete. It includes a confirmation number that you should keep for your records.

View enrollment. Select RETURN TO MY ENROLLMENT to view the details of your
enrollment.

 

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Don’t want to buy coverage? Select DECLINE.

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On the page that says I’m declining this coverage offer, select the health coverage you
currently have or will have once your employer’s coverage is effective. Then select CONTINUE.

 

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Your HealthCare.gov account
Account profile
Select the My profile tab to view and update your profile information. You can only make
changes to certain fields. When you’re finished, select SAVE.

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My enrollment
Select the My enrollment tab to view the details of your coverage, edit your plan selection(s),
and cancel your enrollment.

 

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nn

Select VIEW DETAILS on the My enrollment page to view your employer, SHOP
Marketplace application number, and enrollment status. The enrollment status lets you
know where you are in the enrollment process (like “Not started” or “Completed”).

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Select EDIT ENROLLMENT on the My enrollment page to make changes to your
coverage. When you see the Edit enrollment message:
●● Select YES to cancel your current application. You’ll return to the My Employer
page to start the application process and select a plan.
●● Select NO to return to the Enrollment Details.

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Select CANCEL ENROLLMENT on the My enrollment page to cancel your coverage
selection. You’ll only see this button if you’re still within an Open Enrollment Period.
When you cancel your coverage, you’re declining your employer’s coverage offer and
must provide other coverage information.

 

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My plans
Select the My plans tab to view the health and dental plans (if offered) you enrolled in.

Message center
Select the Message center tab to view messages about your coverage from the
SHOP Marketplace.

 

EMPLOYEE USER GUIDE | 36

Special Enrollment Period
You and your dependents (if dependent coverage is offered) may have a right to sign up for
employer coverage, or make changes to your coverage choices outside of the employer’s
initial Open Enrollment Period. Job-based plans must provide this Special Enrollment Period
(SEP) of 30 days following certain life events that involve a change in dependent status or loss
of other health coverage. If you don’t make a change during the SEP, you’ll have to wait until
your employer renews coverage. If your employer doesn’t offer dependent coverage, the SEP
applies only to qualified employees. Learn more about the SEP and qualifying life events at
marketplace.cms.gov/outreach-and-education/buying-shop-coverage-2016.pdf.
If you want to report a life event that may qualify you for an SEP, contact your employer as soon
as possible. Your employer or the employer’s agent/broker can report the event by logging into
their HealthCare.gov account, or by calling the SHOP Call Center.

Account changes
You can make some changes to your account, like updating your email or mailing address and
phone number, by logging into your HealthCare.gov account.

Submit an appeal
To submit an appeal, select Submit appeal in the Actions field to get the appeal request form.
Print the appeal request form and mail it to the address on the form. You’ll be notified by mail of
the outcome of the appeal request within 90 days of the date you submit your appeal request.
You have 90 days from the date in your SHOP Marketplace eligibility determination notice to
request an appeal. Learn more about SHOP Marketplace appeals at marketplace.cms.gov/
outreach-and-education/shop-marketplace-appeals-2016.pdf.

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Username and password recovery
Forgot username
If you forget your username:
●● Enter your email address, first name, and last name.
●● Select SEND EMAIL. You’ll get an email with your username.

Forgot password
If you forget your password:
●● Enter your HealthCare.gov username (the email address you entered to create your
account).
●● Select SEND EMAIL. You’ll get an email with directions and a link to a page to create a
new password. Your new password must be at least eight (8) characters, but no more
than 20 characters long, and have a mixture of uppercase and lowercase letters, and
at least one number.

 

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Unlock your account
To unlock your account, contact the SHOP Call Center at 1-800-706-7893 Monday through Friday,
9 a.m. – 7 p.m. ET. TTY users should call 711 to reach a call center representative.

Have questions or need help?

For more information on the SHOP Marketplace, visit HealthCare.gov/small-businesses. You
can also contact the SHOP Call Center at 1-800-706-7893, Monday through Friday, 9 a.m. – 7 p.m.
ET. TTY users should call 711 to reach a call center representative.

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Product No. 11879
December 2015

 

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