Affordable Care Act (ACA) basics

In 2010, President Obama signed into law the Affordable Care Act (ACA), also known as health care reform. While there have been other important laws affecting health insurance over the last four decades, the ACA is the most significant change since the 1970s.

Health care reform improves some important aspects of the health care system that, because UC already provides generous medical coverage, you may not have known needed improvement.

  • Everyone can get coverage. You rely on your health insurance, especially when you’re managing a health issue. It might sound strange to you if you’ve been enrolled in a UC plan for a long time, but some Americans were either locked out of buying medical insurance because of an illness — or couldn’t get help paying bills related to that illness for a significant period of time. As of Jan. 1, 2014, all Americans can join any medical plan without any exclusions for pre-existing health issues.
  • Everyone must get coverage. Now that the door is open to everyone, there’s no reason not to get coverage. In fact, starting Jan. 1, 2014, everyone must have medical coverage or pay a fine or tax. There are regulations on the kind of plan you must have — but all of UC’s medical plans meet all regulations. So, as long as you stay in a UC-sponsored medical plan, you’ll meet the minimum requirements for affordable coverage.
  • No more limits. When you’re really sick, bills can add up, and emotional stress can be really high. That’s why UC plans don't have caps on the plan's share of your medical bills. As long as you’re still accessing care, the plan features are still in effect. But now all Americans will have this kind of financial security too. Specifically, there are no annual or lifetime limits on essential health benefits.

What the ACA means for you

New pay categories make it easier to maintain benefits eligibility

UC’s benefits eligibility rules have always required that employees work a certain minimum number of hours to keep their benefits. All “paid time” that you earn will now count toward your benefits eligibility, along with certain types of unpaid time such as time protected by the Family Medical Leave Act (FMLA) or the Uniformed Services Employment and Reemployment Rights Act (USERRA). Specifically, starting in 2016, we will count the full range of paid time hours including sick time, vacation, holidays, paid leave of absence, paid jury duty and paid military duty. Special unpaid time that will also be counted includes unpaid FMLA leave, unpaid USERRA leave, unpaid jury duty and unpaid hours during “special employment breaks” of at least four weeks.

New method for measuring continuing benefits eligibility

UC will now measure your average hours of service once a year, in November, over a 12-month “look-back” period, rather than checking this measurement each month. In other words, once you become eligible for medical benefits coverage, you remain eligible for at least 12 months. “Average Weekly Hours of Service” is the measurement used to calculate your ongoing benefits eligibility. Most employees will remain eligible for benefits coverage if they work an average of 17.5 hours per week during the look-back period.

New types of employees now eligible for UC benefits

While UC currently offers coverage to many employees — both full-time and part-time — starting in 2016, if you are in one of the following job classifications and your appointment involves working 75 percent time (30 hours) a week for three months or more, you also may be eligible for benefits:

  • Students in “casual/restricted” appointments
  • Per diem employees
  • Employees paid “by agreement” (flat-dollar compensation)
  • Seasonal workers

UC will determine the employees who now qualify and will contact you by Dec. 31 to enroll during a special enrollment period in January 2016. These new groups may be offered the Core Benefits Package — including the UC-paid Core catastrophic medical plan as well as Legal, Core Life, Accidental Death & Dismemberment, Dependent Care and Health Flexible Spending Accounts, and Family Care resources. This group will also be measured for ongoing eligibility during the look-back period, but they must work on average 30 hours per week to continue coverage.

New IRS form required to confirm health coverage

In early 2016, you will receive Form 1095, which you’ll use to confirm your health coverage when you file your 2015 federal income taxes. Individuals who submit this information on their income tax returns will satisfy the “individual mandate” to maintain health insurance coverage for the year. Depending on the type of coverage you have, you may receive this form from your medical plan, from UC or from both; UC retirees in Medicare will receive the form from Medicare.

The form(s) will confirm your and your dependents’ coverage for each month of 2015. For the 2015 tax year, you will not need to submit Form 1095 with your income tax return, but you should keep a copy of the form with your important tax documents in the event you need to prove to the IRS that you satisfied the ACA’s “individual mandate” to maintain health insurance coverage for the year.

Similar to other tax forms, Form 1095 will identify you and your dependents by your Social Security numbers (SSNs) so that the IRS can accurately identify covered individuals. As a result, you may be asked to supply UC or your health insurance carrier with any missing SSNs for yourself and/or your covered dependents.

Learn more about Form 1095 »
IRS FAQ about Form 1095 »

What the ACA means to UC

While the ACA improves the health care system, at the same time, this law imposes many new requirements on employers. Health care reform affects UC in three main ways.

  1. UC’s plans will be more heavily regulated. Health care reform puts in place many new rules. Some are one-time changes, but others require annual monitoring and administrative duties.
  2. The university has new costs. New taxes on large employers, as well as indirect taxes levied on insurance companies and medical equipment providers, also mean higher overall costs for UC’s plans.
  3. The health care landscape will keep changing. At the same time health care reform happened, new companies and new ways of providing medical care have emerged to help improve the health care system and help you interact with it in a better way. These shifts will bring new opportunities for UC — especially in our role as one of the largest health care providers in California.

Health Insurance Marketplace — “Exchanges”

In California, the Health Insurance Marketplace is called Covered California. Marketplaces are intended for people who can’t get affordable coverage through their employer and also for small businesses. Anyone can shop in the marketplace, but since benefits-eligible employees have affordable coverage through UC, they are not eligible for the premium tax credits available through the marketplace.

What you can do to help keep costs down

As you learn and think about what the law means to you and your family, your everyday actions matter.

  • Make good choices during UC’s Open Enrollment this year.
  • Take care of yourself and make sure you and your family members get appropriate preventive care, which is now available at no cost to you.
  • Develop a strong relationship with your doctor. He or she has your best interests at heart.
  • Keep learning. Stay curious about ways to better interact with the health care system. When consumers are better informed, change happens. Explore ways to get the most from your benefits.
  • Understand your benefits. Learn more about UC's benefits.