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Participation Requirements

What Businesses can Use MNsure SHOP?

Small businesses must meet these four criteria to be eligible to offer coverage to their employees through MNsure SHOP.

  1. Have a principal business address within the state of Minnesota or offer coverage to each eligible employee through SHOP serving that employee's primary work site.
  2. Have at least one common-law employee, not including a sole proprietor or spouse, who is enrolling in coverage.
  3. Offer health care coverage to all full-time employees--those working on average 30 or more hours weekly.
    • For the purpose of MNsure SHOP eligibility, employers are not required to offer coverage to employees working between 20 and 29 hours each week.
    • Employers may also choose whether to offer coverage to family members of employees, including spouses, domestic partners, and children.
    • Non-Minnesota residents: employees that live outside of Minnesota can still obtain insurance through the MNsure SHOP marketplace.
      • Employers should make sure that at least one plan option chosen through SHOP offers coverage to employees out-of-state (either the provider networks include coverage in the employee areas or the plan offers out-of-state coverage).
      • You may enroll in multiple state SHOPs to offer coverage to those employees whose primary worksite is in the SHOP's service area.
  4. Employ 50 or fewer full-time equivalent employees (FTEs), not including a sole proprietor (January-December).
    • To calculate the number of FTEs, use the most recent year as a baseline and follow these steps:
      • Count the number of people who worked an average of 30 or more hours per week.
      • Add to this amount the number of hours worked per week by non-full time employees (who may or may not be eligible for health benefits) divided by 30.
      • Employee count does not include temporary, seasonal, substitute-basis employees, retirees, disabled former employees or individuals on COBRA or State continuation (people who worked less than 120 days the preceding year).
    • This FTE calculator at healthcare.gov can also provide an estimate.

Requirements for Participation

Businesses must offer coverage through MNsure to all employees working at least 30 hours per week, and who meet the minimum contribution and participation rates:

  • Contribution: A small business employer's minimum contribution requirement is 50% of the plan premium for all employees offered coverage.
  • Participation: A minimum of 75% of employees must purchase group coverage after eligible waivers. Eligible waivers are for other group coverage (for example, the employee is covered under a spouse's employee-offered coverage), government-sponsored plans (such as Medicare and Medical Assistance (Medicaid)) or military sponsored coverage (Tricare or VA). Individual coverage is not an eligible waiver.
    • Eligible waivers include coverage under another employer-offered plan, government-sponsored plans and military-sponsored plans (such as Tricare/VA). Individual coverage and MinnesotaCare are not eligible waivers.
    • Employers who cannot satisfy minimum participation and/or minimum contribution requirements will be able to enroll during a special annual enrollment period from November 15 through December 15 for a coverage effective date of January 1.
  • Full-time employees: The Affordable Care Act requires that all full-time employees (working on average 30 hours or more each week) must be offered coverage. Employers are not required to offer coverage to employees working between 20 and 29 hours each week.
  • Which employees are not counted? Employers must offer coverage to all full-time employees who worked an average of 30 hours per week. Employers can choose to offer coverage to other employees including part-time employees and choose whether or not to offer coverage to family members of employees, including spouse and children. Count all common law employees. We do not enroll independent contractors, sole proprietors without any employees, partners in a partnership or a shareholder who owns 2% or more of an S corporation.
    • Seasonal workers are generally not considered.
    • Owners and family members are excluded and should not be counted as full-time employees. However, if the owner is going to purchase insurance, they should be added to the employer roster.
    • Non-Minnesota resident employees (who live outside of Minnesota) can still obtain insurance through the MNsure SHOP marketplace.
      • Employers should make sure that at least one plan option chosen through SHOP offers coverage to employees out-of-state (either the provider networks include coverage in the employee areas or the plan offers out-of-state coverage).
      • You may enroll in multiple state SHOPs as long as you have a business location in each state.
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