Healthcare and Small Business

Under 50 employees

SHOP – Small Business Health Options Program

1. Employers 1-50 FTE’s

   1. ACA fast fact sheet for 1-50 and 50+

   2. https://www.irs.gov/pub/irs-pdf/p5200.pdf

2. Enroll through

   1. Private insurance company

   2. Registered agent/broker

3. Only way to qualify for the Small Business Health Care Tax Credit (SBHCTC)

   • This lowers premium costs

4. Credits Eligibility

   • Cover at least 50% of employee premium cost

   • Employ fewer than 25 FTE’s

   • Average annual wage less than $53k (in 2017)

   • Purchase plan through SHOP Marketplace

5. Requirements

   • Reporting to employees about marketplace (only certain employers)

   • Cannot have waiting period greater than 90 days

   • SBC (Summary of Benefits and Coverage) disclosure

     • What it is and what it costs

   • Additional reporting for being self-insured

   • MLR (Medical Loss Ratio) Rebates

     • Very strict rules here so DOCUMENT EVERY CALCULATION AND REASON

     • For fully-insured Medical plans with MLR below 80% (goes to 85% for large group)

       • Guarantees 80% profitability for insurance providers

       • No rebate if MLR is above 80%, in fact you’ll see premium increases

     • Who distributes this?  The insurer.

     • Calculated on a 3-year look-back average