Small Business Employers

To offer SHOP coverage to your employees, you must:
    •  Have 1–50 full-time equivalent (FTE) employees.
    •  Offer health coverage to all full-time employees.
    •  Enroll at least 70% of the employees you offer insurance to.
    •  Have an office or employee work site in Virginia.
    •  Complete and submit the Small Employer Self-Attestation Form.

To qualify for SHOP, your business must have a main address in Virginia. You must have 1 to 50 full-time equivalent employees. You must offer coverage to all full-time employees. 

Note: If your business grows above 50 employees, you can still stay in SHOP. You remain eligible until you no longer meet the rules or choose to leave. 

SHOP insurance gives you choice and flexibility. You can:
    •  Offer your employees one plan or let them choose from multiple.
    •  Offer only health coverage, only dental coverage, or both.
    •  Choose how much you pay toward your employees' premiums and whether to offer coverage to their dependents.
    •  Decide how long new employees must wait before enrolling.

When you're ready to enroll, you have two options:
    •  Contact your carrier and enroll directly.
    •  Enroll with the assistance of a SHOP-registered agent.

1. Can I enroll in the same SHOP coverage that I offer my employees?

Yes. You can enroll if at least one employee joins the plan. That person cannot be an owner, partner, or family member. 

2. Do I have to provide insurance to my employees?

If you have 1–50 FTE employees, you're not required to provide insurance to your employees. You can choose to offer insurance through SHOP or any other source. But you don't have to, and there's no penalty if you don't.

3. If my only employee is my spouse or a family member, can I use SHOP to cover us both?

Spouses and family members do not count when deciding if your business can use SHOP.

4. Can my employees enroll in SHOP coverage after the initial enrollment period?

Yes, but only if they qualify for a special enrollment period due to a life event, such as having a baby, adopting a child, or getting married. For new employees hired after your initial enrollment, you can set a waiting period before coverage starts.

5. How do I appeal a SHOP decision?

Based on information you provided on the self-attestation form, if your form shows you are not eligible for SHOP, you will be notified. To be reconsidered, please resubmit the employer attestation form. Contact the SHOP via email at ShopEmployer@scc.virginia.gov.

6. How does an employer claim the Small Business Health Care Tax Credit?   

Information regarding filing the Small Business Health Care Tax Credit can be found on the IRS’s website. 

7. If I operate a business with employees in more than one state, can they enroll in SHOP coverage?  

If you operate a business with employees in more than one state, you'll enroll in a Small Business Health Options Program (SHOP) plan in the state where your primary business site is located. You can then offer your employees SHOP coverage in 2 ways: 

Option 1: Choose a single health plan for all employees. Be sure to choose a plan with a multi-state or national provider network. Offer it to all full-time employees in each business location. 

• If you choose this option, all employees across your locations will be counted to determine participation and eligibility. 

Option 2: Offer different SHOP plans in each state where your employees work. As long as your business meets all requirements to participate in SHOP, you can offer coverage even if you have just one employee in a location. You'll still need to offer coverage to all your full-time employees in each state.

• Employees at each location are counted separately to determine participation. 
• You must verify eligibility for each state separately.
• If you have locations in a state with its own SHOP, you can get coverage through that state's SHOP. 

8. Which carriers offer vision coverage to small business employers?

There are over a dozen carriers that offer approved vision plans in Virginia and can be found using this list. Contact the carrier for availability in your area and for more information.

Use these steps to see if you have 1 to 50 full-time equivalent (FTE) employees. Generally, only businesses with 1–50 FTEs are eligible for SHOP.
    •  Full-time employees that work at least 30 hours per week in any month are counted as one full-time employee.
    •  Part-time employees are those who worked an average of less than 30 hours per week. 
        •  To calculate the number of “FTEs” in your business based on part-time employees:
        •  To find FTEs from part-time staff, add up all their weekly hours. Then divide by 30. 
        •  (Example:  2 part-time employees working 20 hours per week = 40 hours/30 = 1.333. Count this as equivalent to 1 FTE.)
    •  Seasonal workers are counted if they work over 120 days in a year.

When calculating the number of full-time or part-time employees:
Include:
    •  All full-time workers in your business group. This includes related companies with common ownership or control.
    •  Employees under a common group in other states – even if you’re enrolling in separate state SHOPs.

Don't Include:
    •  Partners.
    •  Shareholders owning more than 2% of an S corporation.
    •  Owners of more than 5% of other businesses.
    •  Family members or members of the household who qualify as dependents.
    •  Seasonal workers working 120 days or less in a year.
    •  Independent contractors (Form 1099 workers).
    •  COBRA and retired enrollees.

Virginia uses the Federal FTE Method to count employees: Full-time Equivalent (FTE) Employee Calculator