Affordable Care Act SHOP

Affordable Care Act: SHOP

A New Small Business Health Options Program (SHOP) For Mississippi Small Employers


New Options for Health Insurance Coverage

The Affordable Care Act (ACA) requires that every State have a health insurance exchange (also called a “Marketplace”) in operation in 2014. A State may operate a Marketplace for individual consumers, small businesses or both. The Mississippi Insurance Department has decided to establish and operate a Health Insurance Marketplace for small businesses called One, Mississippi™. The Marketplace is an easy-to-use, easy-to-understand online tool that assists Mississippi’s small business owners interested in providing quality health insurance to their employees. Small businesses should consider using One, Mississippi because:

  • Offering employees high-quality health insurance is a competitive advantage in the labor market.
  • Providing health insurance to employees helps small businesses recruit and retain the best talent while keeping employees happier, healthier and, therefore, more productive.
  • Through One, Mississippi, small employers have a variety of tools to help select and administer all of their employees’ health insurance benefits.
  • Small employers can determine the type of coverage offered and control how much they contribute toward employee premiums to fit their budget.

Your Health Insurance Marketplace

One, Mississippi simplifies the process of providing private health insurance and is available to small businesses in the State that employ fifty (50) or fewer full-time equivalent employees. The Marketplace is designed to provide a central location where small employers can shop and compare a variety of health insurance plans. Plan comparisons are provided in an easy-to-understand format. An employer may choose one plan for all employees, or allow each employee to choose from multiple plans in order to secure the plan that best meets their needs and the needs of their family.

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Tax Credits for Small Businesses

Employers that meet certain qualifications may be eligible for a Small Business Health Insurance Tax Credit. The amount of the tax credit and what qualifications the employer must meet depend on which taxable year a small employer claims the credit. Some of the qualifications remain the same regardless of when the tax credit is claimed.

The eligibility requirements that small employers must meet are:

  • Employ no more than twenty-five (25) full-time equivalent employees;
  • Pay average annual wages below $50,000; and
  • Pay a uniform percentage for all employees that is equal to at least fifty percent (50%) of the premium cost of individual health insurance for each employee.
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Health insurance plans offered on One, Mississippi are classified into one of four tiers: Bronze, Silver, Gold and Platinum. At each level, premiums and cost sharing requirements change.

One, Mississippi also allows the employer to designate a specific amount to contribute toward each employee’s premium cost, instead of choosing a plan (or plans) for its employees. Employees can use that contribution to choose a health insurance plan that best fits their needs and budgets.

Although the tax credit has been available for eligible small employers for taxable years between 2010 and 2013, important changes begin in taxable year 2014 and beyond, including:

  • The employer’s contribution toward premiums must be made on behalf of each employee enrolled in a Qualified Health Plan (QHP) offered by the employer through a Marketplace;
  • The tax credit amount increases to fifty percent (50%) of premiums paid for eligible small employers and to thirty-five percent (35%) of employer premiums paid for tax-exempt eligible small employers;
  • The credit can only be claimed for two consecutive tax years; and
  • Cost-of-living adjustments are made to the average annual wage phase-out amounts. (The credit is phased out gradually when average annual wages exceed certain amounts).
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A transition policy exists for the 2014 taxable year for eligible small employers that have health plan years that differ from its taxable year. Eligible small employers may take the credit for tax years 2010 through 2013 without those years counting toward the two consecutive taxable year period.



Employers should consult their tax advisors for more information.

Enrollment

One, Mississippi enrollment will begin in 2014. Employers can enroll in the Marketplace online
at www.onemississippi.com, or through a licensed insurance agent or broker.
For more information, please call 1-855-9MS-SHOP or 1-855-967-7467.

Frequently Asked Questions

question Which type of benefits must qualified health plans offer through the SHOP Marketplace?

answer Qualified Health Plans offered through the SHOP must offer the following benefits:
  • Ambulatory services
  • Hospitalization
  • Prescription drugs
  • Rehabilitative services
  • Maternity and newborn care
  • Preventive/Wellness/Chronic disease management
  • Emergency services
  • Mental health and substance use disorder services
  • Laboratory services
  • Pediatric services

question What does a small business need to know about the SHOP Marketplace?

answer Issuers participating in the SHOP Marketplace cannot deny coverage based on the health status of your employees or their dependents, even if they have pre-existing conditions, and they cannot charge higher premiums for women, or increase the group’s premium for employees with high medical costs.

question Does an employer have to offer SHOP Coverage to all employees?

answer If an employer uses the SHOP, the employer must offer coverage to all full-time employees — generally those working an average of 30 or more hours per week.

Note: If you are self-employed with no employees, you may get
coverage through the individual Health Insurance Marketplace, but not through the SHOP.

question Can I make changes to my small employer coverage through the SHOP during the year?

answer No. You can change the plans you’ll offer to your employees and contribution amounts only during your annual enrollment period. However, you may add or remove eligible employees and dependents throughout the year. Your plan year is a 12-month period starting on your effective date of coverage.

question If my business is determined eligible for SHOP, can my spouse and I participate in SHOP coverage?

answer Yes. Once your business is determined to be eligible for coverage in the SHOP Marketplace, business owners and their respective spouses may sign up for SHOP coverage.

question How can my agent/broker help me enroll?

answer A licensed agent can assist with:
  • Applying for insurance for your employees;
  • Reviewing and comparing price, coverage, quality and other important features; and
  • Choosing a plan that works for your budget, business and employees.
Note: You pay the same, with or without an agent, and they are not required.