Small Business Employers

Quality Coverage for Your Employees

Offering health benefits is a major decision for businesses. Virginia’s Insurance Marketplace makes it easy for you to find a plan that fits your needs through the Small Business Health Options Program (SHOP).

small business owners

What is SHOP?

SHOP is a resource for small business employers who want to provide health insurance to their employees. If your business is eligible for SHOP, you don’t have to wait for an Open Enrollment Period to enroll in a plan. You can start offering SHOP coverage to your employees anytime. Enrolling in a SHOP plan is the only way a small business or nonprofit can claim the Small Business Health Care Tax Credit. This tax credit can be worth up to 50% of the costs you pay for your employees’ premiums. 

Find Plans That Fit Your Business

SHOP plans are options for small employers to provide health and/or dental insurance to their employees. Explore plans or connect with an agent today to secure coverage.

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SHOP Overview

  • SHOP coverage can be purchased for your employees at any time of the year.
  • Premiums charged cannot be adjusted more frequently than annually, except that the premium rate may be changed to reflect changes to (i) the family composition of the member, (ii) the coverage requested by the member, or (iii) the geographic location of the member.
  • No coverage may be offered only to certain eligible employees or their dependents and no employees or their dependents may be excluded or charged additional premiums because of health status. All products that are approved for sale in the small group market that the health insurance issuer is actively marketing must be offered to all small employers, and the health insurance issuer must accept any employer that applies for any of those products.
  • A health insurance issuer that offers health insurance coverage in a small group market through a network plan may limit the employers that may apply for such coverage to those eligible individuals who live, work, or reside in the service area for such network plan.

  • 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 verify SHOP eligibility, small employers will attest that their small business has a primary business address in Virginia; has 1–50 full FTE employees; and offers SHOP coverage to all full-time employees.

    Note: SHOP must treat a qualified employer that ceases to be a small employer solely by reason of an increase in employees as a qualified employer until the qualified employer otherwise fails to meet the eligibility criteria or elects to no longer purchase coverage for qualified employees through SHOP.

  • 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.

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

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

    Yes, as long as at least one of your employees (who isn't a business owner, partner, or family member) also enrolls in your coverage.

  • 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?

    Generally, no. Spouses and family members don't count when determining if your business is eligible to use SHOP. To be eligible, you must have 1–50 FTE employees who aren’t business owners, partners, or family members.

  • 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 change, like having a baby, adopting a child, or getting married. For new employees hired after your initial SHOP enrollment period, you can decide on a waiting period before coverage can become effective. Waiting periods can't exceed 90 days.

  • 5. How do I appeal a SHOP decision?

    Based on information you provided on the self-attestation form, should the response indicate you are ineligible to purchase coverage through the Virginia SHOP, the SHOP will notify you of this.  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 at https://www.irs.gov/newsroom/small-business-health-care-tax-credit-questions-and-answers-how-to-claim-the-credit. 

  • 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, employees in all your business locations will be counted when calculating your minimum participation rate and eligibility determination.

       

    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.

    • The employees on each location's employee roster will be counted separately when calculating your minimum participation rate.
    • You'll have to verify your eligibility for each state where you offer SHOP coverage separately.
    • If you plan to have other business locations in a state that runs its own SHOP, you can get coverage through that state's SHOP. 

  • Use the FTE employee instructions below to see if your mix of full-time and part-time employees equals between 1–50 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:
            •  Take the number of hours worked by all part-time employees in a week and divide that amount 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 employees of a group if your business is affiliated with another employer, under common ownership, or a part of a controlled group.
        •  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 will continue to follow the Federal FTE Method to count employees: Full-time Equivalent (FTE) Employee Calculator