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Catherine Giles, an Independent Insurance Broker/Agent/Owner
     Schedule today your free 30-minute meeting with Catherine for consultation, policy reviews, recommendations, and quotes; or for enrollment and servicing by: in-person appointment at her home office or your office; virtually via Zoom meeting; or via phone. You may schedule by submitting your contact information in the "Schedule an Appointment" field or by calling Catherine at 940-597-4757 or emailing her at:  [email protected].  














       Catherine can provide you and your business or non-profit organization with high quality *Group Health, *Dental, *Life, and *Short-Term Disability, *Long-Term Disability insurance product options and services (*per Industry, Business, and Employee eligibility guidelines and per carrier eligibility guidelines).  In addition, she can provide (*per Industry, Business, and Employee eligibility guidelines and per carrier eligibility guidelines) supplemental and voluntary*Short-Term Disability, *Accident, *Life, *Hospital, *Cancer, *Critical Care, *Dental, and *Vision product options and services which are personalized for your business' and for your employees' unique needs, with options at no direct cost to you or your business, as your employees and independent workers voluntarily fund their Supplemental insurance through payroll deduction or through employee-direct-bill. 















Summary Information Concerning On the Marketplace SHOP Plan

  • Have a primary business address sitused in the state where you're buying coverage

  • If eligible, you don't have to wait for an Open Enrollment Period. You can start offering SHOP coverage to your employees any time of year.

  • Generally, have from 1 to 50 employees:  Any employee who works an average of at least 30 hours per week for more than 120 days in a year, except employees listed below. (Part-time employees work an average of less than 30 hours per week.)

  • Not counted for full-time equivalent (FTE) employees:

  • Owners of a sole proprietorship;
  • Partners;
  • Shareholders owning more than 2% of an S corporation;
  • Owners of more than 5% of other businesses;
  • Family members or members of the household who qualify as dependents on the individual income tax return of a person listed above, including a spouse, child (or descendant of a child), sibling or step-sibling, and parent (or ancestor of a parent), step parent, niece or nephew, aunt or uncle, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, or sister-in-law;
  • Seasonal workers working 120 days or less in a year;
  • Independent contractors (Form 1099 workers);
  • COBRA and retired enrollees.

  • Important: While these employee types listed above shouldn’t be included in the FTE calculation, they may still qualify for coverage through the SHOP Marketplace.

  • If your business or non-profit organization qualifies for SHOP, to whom can you offer health insurance coverage options:

  • Offer SHOP coverage to all full-time W-2 employees.
  • You don’t have to offer coverage to part-time employees — those averaging less than 30 hours per week — or seasonal workers. (However, you can offer coverage to part-time W-2 employees if you choose.)

  • Minimum SHOP participation rate in Texas at any time; also, during same period per year, the SHOP minimum participation requirements are waived only during initial enrollment in that same time period:

  • Enroll at least 75% of the employees in your Texas business or non-profit organization that you offer insurance to
  • If you don’t meet your minimum participation requirement, you can enroll between November 15 - December 15 any year. During this time, the participation requirement isn't enforced.

  • Workers Who Do Not Count toward the at least 75% participation requirement:

  • Employees with other health coverage aren't counted as rejecting your offer.
  • Use the SHOP Minimum Participation Rate Calculator to see how many of your employees must accept.
  • Some states have different minimum participation requirements. See if this affects you.

  • If you don’t meet your minimum participation requirement, you can enroll between November 15 - December 15 any year. During this time, the participation requirement isn't enforced.

  • If you operate a business with employees in more than one state:

  • You'll enroll in a Small Business Health Options Program (SHOP) plan in the state where your primary business site is located.

  • You can offer your employees SHOP coverage 2 ways:

  • Option 1: Choose a single health plan for all employees. Be sure to choose a plan with a multi-state or national provider network. Offer it to all full-time employees in each business location.
  • If you choose this option, employees in all of your business locations will be counted when calculating your minimum participation rate and eligibility determination.

  • Option 2: Offer different SHOP plans in each state where your employees work. As long as your business meets all requirements to participate in the state's SHOP, you can offer coverage even if you have just one employee in a location. You'll still need to offer coverage to all your full-time employees in each state.
  • The employees on each location's employee roster will be counted separately when calculating your minimum participation rate.
  • You'll have to verify your eligibility for each state where you offer SHOP coverage separately.
  • If you have business locations in a state that runs its own SHOP, you can get coverage through that state's SHOP. Select the state where your business operation is located, and we'll take you to your state’s SHOP website.

  • If you operate multiple businesses in a state or in more than one state under the same EIN:

  • You can establish only one SHOP offer per EIN in each state. Learn more about controlled group rules from the IRS.
  • When you count full-time equivalent employees (FTEs) to determine eligibility for SHOP, you must include FTEs from all your businesses.

  • If you operate multiple businesses in a state or in more than one state with different EINs:

  • You must create unique SHOP offers for each EIN. Controlled group rules apply when establishing the FTE count for your businesses — whether your businesses are all in one state or in multiple states.
  • For each business with its own EIN, you’ll need to:
  • Meet SHOP eligibility criteria independently
  • Count all the FTEs in all your businesses using controlled group rules
  • Create separate SHOP coverage offers
  • If you have remote employees, you can use your primary business address for all your remote employees, or use each of the locations where your remote employees work as a separate business location.
















Summary Benefits of SHOP Marketplace Plans

  • All plans offered through the SHOP must provide a set of Essential Health Benefits. They all cover Pre-existing Conditions and Free Preventive Services. Enrollment will be conducted on the insurance carrier's platform, not on the SHOP website

  • You control the coverage you offer and how much you pay toward employee premiums, with a minimum employer contribution of 50% of more, per participating employee, per employee-only coverage

  • You can choose from 4 levels of coverage to find a plan that meets the needs of your business and employees

  • You can start coverage any time. Enroll by the 15th of the month and coverage can begin on the 1st of the following month
















Summary of SHOP Small Business Tax Credit

     Enrolling in a Small Business Health Options Program (SHOP) plan is generally the only way for a small business or non-profit to claim the Small Business Health Care Tax Credit. To qualify for the tax credit, all of the following must apply:


  • You have fewer than 25 full-time equivalent (FTE) employees
  • Your average employee salary is about $56,000 per year or less
  • You pay at least 50% of your full-time employees' premium costs
  • You offer SHOP coverage to all of your full-time employees. (You don't have to offer it to dependents or employees working fewer than 30 hours per week to qualify for the tax credit.)


Summary of Employer Shared Responsibility Fee


  • The Affordable Care Act requires certain employers with at least 50 full-time employees (or equivalents) to offer health insurance coverage to its full-time employees (and their dependents) that meet certain minimum standards set by the Affordable Care Act or to make a tax payment called the ESRP















Summary of Comparing SHOP Health Plans

  • Your SHOP premium estimates are based upon the zip code of your business domicile, or legal address, the number of full-time equivalent (FTE) W-2 employees working 30 or more hours per week, and their ages or composite, or the average rate of all eligible employees, per employee

  • There are 4 categories of plans in the SHOP Marketplace. They offer similar benefits, but differ based on how enrollees and the plan share the costs of care. SHOP plans are by metallic names: Bronze, Silver, Gold, Platinum

  • As with all group health plans, you and your employees pay a monthly premium. You can decide up front exactly how much to contribute towards your employees’ premium costs, so you have control over your company's health coverage spending.  The minimum employer contribution is 50% of more, per participating employee, per employee-only coverage.  You are not responsible for any spouse or dependent premium costs

  • When comparing plans, just as important as the premium cost is how much your employees have to pay out-of-pocket for covered services. The plan with the lowest premium may not provide you or your employees with the best overall value

  • Premiums are usually lower for plans that pay a smaller share of medical costs when your employees get care. For example, with a Bronze plan, your employees will probably pay a lower monthly premium than they would for a Gold plan. But they'll probably pay more when they go to the doctor. For example, Platinum plans generally have the highest monthly premiums and lowest out-of-pocket costs for services. They will likely provide better financial protection if your employees use a lot of services or have a major health crisis

  • In general, when choosing health coverage for your business, keep this in mind: The lower the premium, the higher the out-of-pocket costs; the higher the premium, the lower the out-of-pocket costs  












Summary Information Concerning Group Plans off the Marketplace

  • Group Health insurance plans off the Marketplace are, generally, not eligible for Small Business Tax Credits, but may be, if no SHOP plans are offered in your area and if your business meets certain guidelines.  The IRS can give more guidance on tax credits at www.irs.gov

  • Plans still offer Essential Health Benefits, cover Pre-existing Conditions, and Free Preventive Services. Many Group Health plans may also offer Group Dental, Life, and Disability, based on industry and employee eligibility guidelines and carrier. For a free consultation with recommendations and quotes, please contact Catherine













Summary Information Concerning Supplemental Insurance off the Marketplace

  • In addition, Catherine can offer your full-time, part-time, and seasonal employees and independent workers Supplemental and Voluntary *Short-Term Disability (*per Industry, Business, and Employee eligibility guidelines and carrier eligibility guidelines), *Accident, *Life, *Hospital, *Cancer, *Critical Care, *Dental, and *Vision insurance options at no direct cost to you or your business, as your employees and independent workers fund their Supplemental and Voluntary insurance through payroll deduction or through eligible employee-direct-bill.  Please contact Catherine to schedule a free consultation for more information

     Schedule today your free 30-minute meeting with Catherine for consultation, policy reviews, recommendations, and quotes; or for enrollment and servicing by: in-person appointment at her home office or your office; virtually via Zoom meeting; or via phone. You may schedule by submitting your contact information in the "Schedule an Appointment" field or by calling Catherine at 940-597-4757 or emailing her at:  [email protected].


Group Health, Dental, Life, and *Short-Term Disability Insurance and Services,
Supplemental *Short-Term Disability, Accident, Life, Hospital, Cancer, Critical Care, Dental, and Vision Insurance and Services
*Disability Insurance Option, per Industry and Employee Eligibility Guidelines and Carrier
Supplemental Insurance Options to Enhance Your Employee Benefits Program: