The Patient Protection and Affordable Care Act (PPACA), referred to on our website 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, or Individual Mandate, requires most people to obtain qualified health insurance or pay a penalty. The Employer Shared Responsibility provision of the law, or Employer Mandate, requires large employers to provide health insurance coverage that meets minimum standards to all full time employees or else incur a penalty.
- Health Insurance Marketplace: Also known as the “Exchange,” this is a new “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 and/or employers are subject to penalties under the ACA’s individual and employer mandates, a few new tax reporting requirements have been put into place. Large employers, such as the UW, are required to file a new form with the IRS (called a Form 1095-C) to report information about the health coverage that was 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 will also need to be filed with the IRS by the insurance carrier and a copy provided to the employee. Finally, individuals who received coverage through the Health Insurance Marketplace will receive a Form 1095-A (a Health Insurance Marketplace statement) from the Marketplace.
- Other provisions of the ACA: The ACA is a very complex law with many different components. Here are a select few of the other provisions of the ACA:
- 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 Notice
The 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 notice of the availability of the Health Insurance Marketplace. In addition to information about the Health Insurance Marketplace, the Notice also includes required information on health insurance coverage available through your employment at the UW System.
Please take a few moments to review your Marketplace Notice. You may request a paper copy of the Notice, free of charge, from your human resources office. (A Spanish version of the Notice is also available on the U.S. Department of Labor website| en español)
If you have State Group Health Insurance through your employment at the UW System, you do not need to enroll through the Marketplace or take any action, unless you choose to do so. If you have questions about your eligibility for health insurance through your employment, contact your human resources office.
Important Note: If you are covered by the State Group Health (SGH) Insurance program through your UW System employment, there are limitations on when you can cancel your coverage outside of the Annual Benefits Enrollment period. Contact your human resources office before enrolling in other health insurance to confirm that you can cancel your SGH coverage.
Disclaimer: The information provided is only intended to be general summary information for UW System employees. It is not intended to provide legal or professional advice, or take the place of either the written law or regulations. Detailed information about the new Health Insurance Marketplaces can be found at healthcare.gov or at 1-800-318-2596.
Last updated: 1/18/2017