The Patient Protection and Affordable Care Act (PPACA), referred to on this 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 (effective January 1, 2019 the Individual Mandate penalty has been reduced to $0). 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, tax reporting requirements were put into place. Large employers, such as the UW System, 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. Below 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
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.
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 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 State Group Health Insurance coverage.
Frequently Asked Questions - General
These are the various names referencing the exact same law. Within this page, the law will be referred to as the ACA.
The law currently remains in effect. UW System will continue to monitor all legislative activity relating to the ACA and will provide updates as necessary.
On December 14, 2018 the Federal District Court issued a ruling finding the ACA unconstitutional in its entirety. While the future of this litigation is unknown, it is important to emphasize that the ACA remains the law.
In 2016, all Applicable Large Employers must offer affordable minimum essential coverage that provides minimum value to 95% of their full-time employees (and dependents) as defined by the ACA. This is also known as the “employer mandate” or the “employer shared responsibility provision.”
Per the ACA, the definition of full-time includes employees paid an average of 130 hours/month (30 hours per week). This includes paid vacation leave, sick leave, jury duty pay, etc. Status as a full-time employee under the ACA does not affect your status as a full-time or part-time employee for any other purpose.
If you have coverage through your employer, you pay your insurance premiums with pre-tax dollars. You will not be able to purchase coverage through the Marketplace with pre-tax dollars. If you have coverage through your employer, you are likely eligible for the employer contribution of your insurance premium. However, if you purchase individual health insurance coverage through the Marketplace, you must pay the entire cost of the insurance premium (there is no employer contribution to coverage through the Marketplace).
The Marketplace offers more choices than most employer plans. If your employer does not provide coverage that meets requirements for minimum value and affordability, and your income is low enough, you may be able to get a tax credit if you buy coverage through the Marketplace. Note: The State of Wisconsin health insurance plans available through the UW System meet the requirements for affordability and minimum value under the ACA.
Frequently Asked Questions - ACA Tax Forms
Form 1095-A is the Health Insurance Marketplace statement. You'll get this statement if you bought health coverage through the "Marketplace" - the web-based insurance markets that the federal government and states set up under the ACA.
Form 1095-B is a statement from your health insurance company verifying that you and other members of your household had insurance coverage that met the requirements of the ACA during the prior year. This for applies to you if your coverage was fully insured with an insurance carrier (includes all health plans except Access Plan and Access HDHP).
Form 1095-C is a statement from your employer providing details about the health coverage offered by your employer and whether or not you chose to participate. Individuals that purchased health insurance coverage through the Health Insurance Marketplace will use the information found on this form to determine if they are eligible for a premium tax credit.
More information: www.irs.gov/Affordable-Care-Act/Individuals-and-Families
Beginning in 2016, employers must file Forms 1095-C with the IRS to report information about the offers of health coverage made to full-time employees during the previous calendar year and provide copies of Forms 1095-C to those employees. Like W-2s, copies of Forms 1095-B and/or 1095-C are provided to you early in the calendar year for the previous year.
You will receive a Form 1095-C if you were a full-time employee (as defined by the ACA) for all or some months of the prior calendar year. You will receive a copy of the Form 1095-C so you know what information was reported to the IRS about the offer of health coverage made to you and your family. More information: www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals.
Beginning in 2016, the insurance carrier must file Form 1095-B with the IRS and furnish a copy to the individual for whom coverage was provided during the previous calendar year. You receive a Form 1095-B because the insurance carrier provided either you and/or your family member(s) with health coverage during the previous calendar year.
The information included on your Form W-2, Box 12, code DD states the total cost (employee & employer share) of the employer-sponsored health insurance you enrolled in during a single calendar year. It does not show the months in which you enrolled in coverage or the lowest cost (employee share), employee-only coverage offered to you.
Forms 1095-B and 1095-C show enrollment information on a monthly basis and include information about the lowest cost (employee share), employee-only coverage offered to you. Thus, your Form W-2 contains different information than Forms 1095-B and 1095-C.
Generally, no. Form 1095-Cs are only required to be provided to full-time employees. As for Form 1095-B, all family members covered through your enrollment (if you elected family coverage) will appear on your Form. This is required to be provided to you as the “responsible individual.” In some instances, a spouse and/or dependent may receive their own copy of Form 1095-B if they independently enroll in COBRA coverage and you do not enroll in COBRA (e.g. divorce).
*If a spouse and/or dependent is also employed full time, they may receive these forms from their employer as well.
Retain your Forms 1095-B and 1095-C with your tax records. The information on these forms may assist in preparing a return; however, they are not required. You do not wait for these forms to file your returns as you normally would.
Review the IRS website for information on what is needed to file your taxes.
If you have any questions regarding your 1095-B, contact your health plan. If you have questions regarding your 1095-C, contact UW-Shared Services, Service Operations at firstname.lastname@example.org or (888) 298-0141 (7:45-4:30 p.m. Monday-Friday).
Frequently Asked Questions - Student Employees
The UW System is statutorily prohibited from offering employer-sponsored health insurance to student help employees. To ensure they are not “full-time” under the ACA, institutions must (1) limit use of lump sum payments and (2) cap hours of service.
Effective January 1, 2016, UW System Administrative Policy 1237 (formerly GEN 20) Student Employment was implemented to limit student help hours worked to 25 hours per week. Per the policy, students may, however, work up to 40 hours per week during weeks when class is not in session provided it is also permitted by the individual institution. Federal Work-Study hours, including the institution match, will not count towards the hours evaluated to determine a full-time employee for purposes of the ACA.
UW System will not count graduate assistant hours towards the student help hour cap. For student help hours, the hours worked in that classification that are not in a job funded by federal work study dollars would still need to be capped at 25, even if the risk is reduced by the employee being dually employed in a benefits eligible position.
Employees who meet the criteria established by the ACA will be treated as full-time employees solely for ACA reporting purposes and the Employer Mandate during the stability period.
Employers subject to the employer shared responsibility provisions of the ACA.
Employees eligible for the Graduate Short-Term Academic Staff or Wisconsin Retirement System benefits package based on their employment at the UW System. Review the General Employee Information page for more information.
Minimum essential coverage is generally any type of employer-sponsored health coverage, certain types of governmental coverage such as Medicare or Medicaid, and other types of health coverage specifically identified by the Department of Health and Human Services.
Minimum value is provided by the plan if it pays at least 60% of the costs of benefits and provides inpatient hospitalization services and physician services.
Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.