The Patient Protection and Affordable Care Act (PPACA), referred to as the Affordable Care Act (ACA), is the health care reform legislation signed into law by President Obama in March 2010. Many of the key provisions of the law were designed to extend health insurance coverage to the uninsured, improve the quality and affordability of health insurance and reduce health care costs. Some provisions of the law include:
- Health Insurance Requirement:
The Individual Shared Responsibility provision of the law (Individual Mandate) requires individuals to obtain qualified health insurance or pay a penalty (reduced to $0 effective January 1, 2019). The Employer Shared Responsibility provision of the law (Employer Mandate) requires large employers to offer health insurance coverage that meets minimum standards to all full time employees or incur a penalty.
- Health Insurance Marketplace:
Also known as the “Exchange.” This is a “one-stop shop” designed to help people find and compare health insurance costs and coverage. Premium subsidies in the form of a tax credit are available to qualifying individuals.
- Health Insurance Reporting:
In order for the IRS to determine whether individuals or employers are subject to penalties under the individual and employer mandates, tax reporting requirements were put into place. Large employers, such as the UW System, are required to file Form 1095-C with the IRS to report information about the health coverage offered to their employees during the previous calendar year. Employers are also required to provide a copy of the Form 1095-C to each corresponding employee. If an employee participated in coverage through a fully-insured health plan, then a Form 1095-B is filed with the IRS by the insurance carrier and a copy provided to the employee. Finally, individuals who received coverage through the Marketplace will receive a Form 1095-A (Health Insurance Marketplace statement) from the Marketplace.
- Other provisions of the ACA:
The ACA is a complex law with many different components. Below are a select few of the other provisions:
- Elimination of pre-existing condition limitations
- Increase in adult dependent eligibility to age 26
- Elimination of life-time dollar limits as well as annual dollar limits on essential health benefits
- Limits on waiting periods
- W-2 reporting of health coverage costs
Health Insurance Marketplace
The Health Insurance Marketplace (also known as the Exchange) is an option for individuals to obtain private health insurance. The UW System is required to provide all employees with a Marketplace Notice and cover letter within 14 days of hire. In addition to information about the Health Insurance Marketplace, the Notice includes required information on health insurance coverage available through their employment at the UW System. A Spanish version of the Notice is also available (en español). Employees may request a paper copy of the Notice, free of charge, from their human resources office.
Cover Letter (word version)
Employees covered by the State Group Health Insurance program through their UW System employment have limitations on when they can cancel their coverage outside of the Annual Benefits Enrollment period. Employees should contact their institution benefits contact before enrolling in other health insurance to confirm that they can cancel their State Group Health Insurance coverage. Since most UW System employees are offered affordable health insurance through their employment with the UW System, they do not need to enroll through the Marketplace.
- UW System Administrative Policy 1260 (formerly HR 12) Health Insurance Marketplace Notice Distribution
- UW System Administrative Policy 1237 (formerly GEN 20) Student Employment
Frequently Asked Questions
- HealthCare.gov | (800) 318-2596
Disclaimer: The information provided is intended to be a general summary. It is not intended to provide legal or professional advice, or take the place of either the written law or regulations.