Since the Affordable Care Act (ACA) was introduced in 2010, the nation’s health care reform law has had a significant impact on the University of California health benefits programs — requiring coverage of children up to age 26, free preventive care, added fees and taxes. This year’s regulations introduce changes that apply to all UC employees.
New provisions will make it easier for you to maintain your UC coverage, or you may be among the roughly 5,000 employees who are newly eligible for UC-paid Core medical benefits. Also, under a separate part of the ACA, you and your medical coverage providers are now required to report annually to the IRS that you have minimum essential medical coverage.
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. 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.