Are part-time employees considered for participation requirements if not offered coverage?

No.

What if an employee wants to pick a plan in a different metal tier than the employer has chosen?

Starting with coverage effective October 1st, employers may offer Covered California for Small Business plans from two adjacent metal tiers. The two tiers will not be available for existing groups until they come up for renewal. No exceptions for mid-year contract plan changes.

What are valid waivers?

Valid waivers include enrollment in coverage through:

• Another employer
• An employee’s union
• Medicaid
• Medicare
• The military

Can employers choose to offer coverage to some 20-29 hour part-time employees and not others – or do they have to offer to all if they elect to cover any 20-29 hour part-time employees?

If employers choose to offer coverage to part-time employees that work between 20 and 29 hours a week, they must offer coverage to all those part-time employees.

Our office consists of 1 owner and 4 full time employees. 2 of us have coverage through our spouse’s union. Are the remaining 2 the only ones that have to be offered coverage?

The Affordable Care Act, does not require small employers to offer health care coverage. If the small employer chooses to offer coverage, in order to be eligible for SHOP the employer has to elect to offer, at a minimum, all full-time employees coverage in a Covered California Health Insurance Plan through the SHOP and meet a minimum employee participation rate of 70%. The employees who are covered through their spouse’s union would be counted as valid waivers.
See pages 4-5 in the Eligibility and Enrollment for the Small Business Health Options Program participant guide for the eligibility requirements for SHOP.

What if dependents want to pay for family coverage on an employee-only plan?

The dependents would not be eligible to join an employee-only group plan.

Will multiple plan tiers be available in Covered California for Small Business?

Starting with coverage effective October 1st, employers may offer Covered California for Small Business plans from two adjacent metal tiers. The two tiers will not be available for existing groups until they come up for renewal. No exceptions for mid-year contract plan changes.

What documents will be required to be submitted?

See document checklist on page 1 of the employer application:

https://www.coveredca.com/PDFs/paper_application/SHOP-Employer-Application.pdf

Will the employer application require the State Employer Identification Number (SEIN)?

Yes.

What is the special open enrollment period?

In the small group market, for one month each year, a health insurance issuer must offer coverage to employers who do not meet contribution or participation requirements.  This special enrollment period (SEP) starts on November 15 and continues through December 15 for coverage effective January 1.