Answers to Health Insurance Questions if Your Business Has Less than 50 Employees

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No matter how many times it is repeated, there are many people who don't realize that small businesses with fewer than 50 employees (or the “full-time equivalency” of 50 employees) are NOT required to purchase health insurance coverage for their employees. However, if you DO choose to provide insurance to employees, you can purchase it through a local insurance agent or there is a marketplace in which to purchase coverage. Such marketplaces can are run by either states or the federal government and are called the SHOP marketplace. (Individuals do not have access to SHOP marketplaces, only small group organizations.) Here are some frequently asked questions about SHOP marketplaces. Below the FAQ, you can find a glossary of terms found on the website Healthcare.Gov.

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Do I have to provide my employees with health coverage if I have fewer than 50 employees? No!

You do not have 50 or more full-time equivalent (FTE) employees, you do not have to provide health insurance. However, you can choose to offer insurance through the SHOP Marketplace in your state or through any other source. But you don't have to, and you don't face a penalty if you don't.

If you have 50 or more employees, you may have to offer health coverage meeting certain standards or make a payment. Learn about the Employer Shared Responsibility Payment.

What if I'm self-employed?

If you're self-employed with no employees, here are your options:

You can enroll in coverage through the Health Insurance Marketplace for Individuals & Families.

You cannot enroll in a SHOP plan.

Learn more about how self-employment is defined. If you have at least one full-time employee other than yourself, a spouse, a family member, or another owner, you can enroll in a SHOP plan.

How do I make payments for my SHOP plan?

You make your premium payments to the SHOP Marketplace, not your insurance company.

Learn more about paying your SHOP premiums (PDF).

Where can I get a list of agents and brokers in my area?

• After you create a SHOP Marketplace account, log in and you'll see a list of agents and brokers searchable by ZIP code. All of them have signed privacy and security agreements with the SHOP Marketplace that allow them to sell SHOP plans.


• See how to create a SHOP Marketplace account and log in.


• You can work with any agent or broker who's signed the SHOP agreement. Ask any agent or broker you want to work with if they've signed it.

Healthcare.Gov Glossary

Are you confused by any of the terms mentioned in the questions or answers above? Click on any of these terms and you can find out what they mean. (Note: These links leave SmallBusiness.com and will take you to the Healthcare.gov website.)

A	G	P
Accountable Care Organization	Generic Drugs	Patient Protection and Affordable Care Act
Accreditation	Gold Health Plan	Patient-Centered Outcomes Research
Actuarial Value	Grandfathered	Payment Bundling
Advance Premium Tax Credit (APTC)	Grandfathered Health Plan	Penalty
Affordable Care Act (ACA)	Grievance	Pension (Retirement Benefit)
Affordable coverage	Group Health Plan	Physician Services
Agent	Guaranteed Issue	Plan
Alimony	Guaranteed Renewal	Plan ID
Allowed Amount	H	Plan Year
Annual Deductible Combined	HIPAA Eligible Individual	Platinum Health Plan
Annual Limit	Habilitative/Habilitation Services	Point of Service (POS) Plans
Appeal	Hardship Exemption	Policy Year
Application ID	Health Care Workforce Incentive	Pre-Existing Condition
Attest/Attestation	Health Coverage	Pre-Existing Condition (Job-based Coverage)
Authorized Representative	Health Insurance	Pre-Existing Condition Exclusion Period (Individual Policy)
B	Health Insurance Marketplace	Pre-Existing Condition Exclusion Period (Job-based Coverage)
Balance Billing	Health Maintenance Organization (HMO)	Pre-existing Condition Insurance Plan (PCIP)
Benefit Year	Health Plan Categories	Preauthorization
Benefits	Health Reimbursement Account (HRA)	Preferred Provider
Biosimilar Biological Products	Health Savings Account (HSA)	Preferred Provider Organization (PPO)
Brand Name (Drugs)	Health Status	Premium
Broker	High Deductible Health Plan (HDHP)	Premium Tax Credit
Bronze Health Plan	High-Cost Excise Tax	Prescription Drug Coverage
C	High-Risk Pool Plan (State)	Prescription Drugs
COBRA	Home Health Care	Prevention
Cancelled Debts	Home and Community-Based Services (HCBS)	Preventive Services
Capital Gains	Hospice Services	Primary Care
Care Coordination	Hospital Outpatient Care	Primary Care Physician
Catastrophic Health Plan	Hospital Readmissions	Primary Care Provider
Centers for Medicare & Medicaid Services (CMS)	Hospitalization	Prior Authorization
Certified Application Counselor	Household	Public Health
Children's Health Insurance Program (CHIP)	I	Q
Chronic Disease Management	In Person Assistance Personnel Program	Qualified Health Plan
Claim	In-network Coinsurance	Qualifying Health Coverage
Co-op	In-network Copayment	Qualifying Life Event (QLE)
Coinsurance	Inconsistency (Data Matching Issue)	R
Community Rating	Individual Health Insurance Policy	Rate Review
Competitive Bidding	Inpatient Care	Reconcile
Complication of Pregnancy	Insurance Co-Op	Reconstructive Surgery
Conversion	Interest	Referral
Coordination of Benefits	Investment Income	Rehabilitative/Rehabilitation Services
Copayment	J	Reinsurance
Cost Sharing	Job-based Health Plan	Rental or Royalty Income
Cost Sharing Reduction (CSR)	L	Rescission
Court Awards	Large Group Health Plan	Retirement Benefit (Pension)
Creditable Coverage	Lawfully Present	Rider (exclusionary rider)
D	Lifetime Limit	Risk Adjustment
Data Matching Issue (Inconsistency)	Limited cost sharing plan	S
Deductible	Long-Term Care	Same-Sex Marriage
Dental Coverage	M	Second Lowest Cost Silver Plan (SLCSP)
Department of Health and Human Services (HHS)	Marketplace	Self-Employment Income
Dependent	Medicaid	Self-Employment Ledger
Dependent Coverage	Medical Loss Ratio (MLR)	Self-Insured Plan
Disability	Medical Underwriting	Service Area
Dividend	Medically Necessary	Silver Health Plan
Domestic Partnership	Medicare	Skilled Nursing Care
Donut Hole, Medicare Prescription Drug	Medicare Advantage (Medicare Part C)	Skilled Nursing Facility Care
Drug List	Medicare Hospital Insurance Tax	Social Security
Durable Medical Equipment (DME)	Medicare Part D	Social Security Benefits
E	Medicare Prescription Drug Donut Hole	Social Security Survivors Benefits
Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)	Member Survey Results	Special Enrollment Period (SEP)
Eligibility Assessment	Minimum Essential Coverage (MEC)	Special Health Care Need
Eligible Immigration Status	Minimum value	Specialist
Emergency Medical Condition	Modified Adjusted Gross Income (MAGI)	Spousal Abandonment
Emergency Medical Transportation	Multi-Employer Plan	Stand-alone dental plan
Emergency Room Care	Multi-State Plan	State Continuation Coverage
Emergency Services	N	State Health Insurance Assistance Program (SHIP)
Employer Shared Responsibility Payment (ESRP)	Navigator	State Insurance Department
Employer or Union Retiree Plans	Net Capital Gains	State Medical Assistance Office
Essential Health Benefits	Net Rental Income	Subsidized Coverage
Exchange	Network	Summary of Benefits and Coverage (SBC)
Excluded Services	Network Plan	Supplemental Security Income (SSI)
Exclusive Provider Organization (EPO) Plan	New Plan	T
Exemption	Non-preferred provider	TRICARE
Exemption Certificate Number (ECN)	Nondiscrimination	TTY
External Review	Not Yet Accredited (Health Plan)	Tax Household
	Notice	Tax filing requirement (for dependents)
F		Total Cost Estimate (for health coverage)
Family and Medical Leave Act (FMLA)	O	Transgender People
Federal Poverty Level (FPL)	Obamacare	U
Federally Qualified Health Center (FQHC)	Open Enrollment Period	UCR (Usual, Customary, and Reasonable)
Federally Recognized Tribe	Original Medicare	Uncompensated Care
Fee	Out-of-Network Coinsurance	Urgent Care
Fee For Service	Out-of-Network Copayment	V
Flexible Benefits Plan	Out-of-Pocket Costs	Value-Based Purchasing (VBP)
Flexible Spending Account (FSA)	Out-of-Pocket Estimate	Vision Coverage
Formulary	Out-of-pocket maximum/limit	W
Full-Time Employee (FTE)		Waiting Period (Job-based coverage)
Fully Insured Job-based Plan		Well-baby and Well-child Visits
		Wellness Programs
		Worker's Compensation
		Z
		Zero cost sharing plan