New SHOP Eligibility Determination Form

SHOP is for small employers who want to provide health and/or dental insurance to their employees. To verify that your small business is eligible for SHOP insurance, use the new SHOP Eligibility Determination Form.

Already enrolled in a SHOP plan that began in 2017? You do not need to complete the SHOP Eligibility Determination Form.

Follow these simple steps to get your instant SHOP eligibility determination:

• Get started. Visit forms.cms.gov/shop-eligibility-determination-form/ and click on “Start” to begin.

• Provide some information about your business. You will need to enter some basic information about your business and the anticipated start date for the SHOP coverage desired.

• Certify that your business qualifies. You will need to certify that your business meets the SHOP eligibility requirements.

• Review your information and submit. Once you have filled out all the required fields, click “Preview” to review your responses. You can update your information by clicking “Edit submission” on the preview page. When you’ve confirmed that all information is correct, click “Submit.”

• Save the eligibility determination decision for your records. Once you’ve submitted your Eligibility Determination Form, you will receive an email confirmation. If you did not provide an email address, you can use your internet browser to print your results from the preview page. Save the eligibility determination decision for your records, as you may need to provide this to your insurance company to enroll in coverage.

If your small business is eligible for SHOP insurance, find a SHOP-registered agent or broker near you who can help you explore SHOP plans and prices and enroll.

Questions? Contact the SHOP Call Center at 1-800-706-7893 (TTY: 711) weekdays from 9 a.m. to 7 p.m. Eastern Time.

Thank you,

The SHOP Team