What to do if you can’t enroll in SHOP coverage due to a qualifying life event
IMPORTANT: The information on this page is for employees who have been offered Small Business Health Options Program (SHOP) coverage through their employer. If you have questions related to Marketplace plans for individuals and families, contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325).
End highlighted textStates using HealthCare.gov for SHOP no longer process employee enrollments, determine employee eligibility, or accept employee appeal requests related to enrollment eligibility. If you:
- Applied for your employer’s SHOP Marketplace coverage and were denied coverage: Contact your employer or insurance company for more information about employee enrollment and eligibility.
- Are eligible for your employer’s SHOP Marketplace coverage, due to a qualifying life event, but couldn’t enroll during a Special Enrollment Period because the insurance company denied you coverage: You can file a SHOP employee complaint. Note: Employee dependents aren't eligible for a Special Enrollment Period if your employer doesn’t offer coverage to dependents.
Ways to report that you could not enroll in SHOP coverage
You can report this information to SHOP by:
- Calling the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).
- Sending an email to shop@cms.hhs.gov documenting the concern and providing supporting evidence. Note: Don’t include Personally Identifiable Information (PII) — like your Social Security Number — in your email. Call the SHOP Call Center at the number above if any PII needs to be provided as a part of your SHOP employee complaint submission.
You have 90 days from the date of your Special Enrollment Period ineligibility notice to submit this information to SHOP.
Note: Keep a copy of your complaint for your records.
After you've contacted SHOP
You'll get a response saying that your complaint was received. It will provide a description of the process and instructions for submitting additional materials, if needed.
Questions?
- An employee should contact their employer or insurance company with questions regarding their SHOP health and/or dental coverage — including plan year start and end dates, payment-related inquiries, life changes, and/or claims-related questions.
- For all other questions related to the SHOP employee complaint process, contact the SHOP Call Center at 1-800-706-7893 (TTY: 1-888-201-6445).