Affordable Care Act (ACA) regulations, effective Jan. 1, 2016, 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 the Core Benefits Package (including the UC-paid Core medical plan).
Under a separate part of the ACA, you and your medical coverage providers are now required to report to the IRS, confirming that you have had minimum essential medical coverage for yourself and your dependents during 2015. You can read the details on UCnet and follow up with these FAQs.
- How are eligibility requirements changing?
- Do the new eligibility requirements mean that I may be able to stay eligible for benefits longer in 2016?
- What happens if I no longer qualify for benefits from UC?
- Are we changing the way we determine eligibility for the UC Retirement Plan (UCRP)?
Newly Eligible for UC Benefits in 2016
- How will I know if I become eligible for UC benefits?
- What if I am in one of these jobs, but I am ineligible for benefits right now because I work fewer than 30 hours a week?
- What do I need to do to enroll?
- What benefits am I eligible for?
IRS Reporting Requirements under the ACA
- Why does the IRS need to verify my medical coverage?
- What information is reportable to the IRS?
- How will the University of California use Social Security numbers for ACA reporting?
- How will my information be reported to the IRS for 2015?
- Is this information secure?
- Are children subject to the individual mandate?
- Are there any exceptions to the requirement to have health insurance?
Is UC changing our benefit program because of the ACA?
All existing UC medical plans will be available in 2016, and UC will still offer all three benefits packages — Full, Mid-level and Core.
How are eligibility requirements changing?
Here is an overview of the changes. Overall, they make it easier for UC employees to qualify for benefit coverage.
(Beginning Jan. 1, 2016)
|Hours included for benefit eligibility||Average regular paid time||Average weekly hours of service||Hours of service refer
to any and all paid time* plus special unpaid time.**
|Measurement method||Average regular paid time calculated monthly using a rolling 12-month period||Average weekly hours of service calculated annually using a 12-month look-back period||Look-back period will begin and end about the same time each year. Example for 2015:
|Measurement frequency||Month-to-month||Year-to-year||If your hours of service after the 12-month look-back qualify you to continue coverage, it will continue through the entire next calendar year; otherwise, it will end and in most cases you won’t be eligible until you are next measured.|
*Paid time includes all time for which you are granted pay. In addition to work hours, it includes sick time, vacation, holidays, paid leave of absence, paid jury duty and paid military duty.
**There are four types of special unpaid time: Unpaid Family and Medical Leave Act (FMLA) leave, unpaid Uniformed Services Employment and Reemployment Rights Act (USERRA) leave, unpaid jury duty and unpaid hours during “special employment breaks” of at least 4 weeks.
Do the new eligibility requirements mean that I may be able to stay eligible for benefits longer in 2016?
Yes. All paid hours and even some unpaid hours now count toward eligibility. Since more types of time count and your hours are averaged over an entire 12-month period, it is now easier to qualify for benefits and stay qualified. Plus, as long as you remain employed, you can generally become ineligible only once a year (as a result of the annual look-back measurement) instead of facing the possibility every month (the frequency that eligibility is calculated now).
What happens if I no longer qualify for benefits from UC?
Your benefits from UC will end at the end of the current coverage period (called the “stability” period — generally, Dec. 31). You will become eligible for COBRA health benefits continuation coverage. Or, you may enroll in an individual medical plan, including on the public exchange (CoveredCA.com). Plans may offer conversion to an individual plan.
Are we changing the way we determine eligibility for the UC Retirement Plan (UCRP)?
No. The ACA does not impact retirement benefits.
Newly Eligible for UC Benefits in 2016
How will I know if I become eligible for UC benefits?
If you have one of the following types of job appointments and are expected to work 75 percent time (30 hours) a week for three months, UC will determine whether you qualify for health insurance and notify you.
- Students in “casual/restricted” appointments
- Per diem employees
- Employees paid “by agreement” (flat-dollar compensation)
- Seasonal workers
What if I am in one of these jobs, but I am ineligible for benefits right now because I work fewer than 30 hours a week?
You can become eligible if you qualify in the next occurring 12-month look-back period, which will typically begin and end around the same time. For 2015, these are the dates:
- For those on monthly payroll Nov. 1–Oct. 31
- For those on biweekly payroll Nov. 9–Nov. 7 (of subsequent year)
What do I need to do to enroll?
If you are eligible, we will contact you by Dec. 31 to enroll during a special enrollment period in January 2016.
What benefits am I eligible for?
You and your dependents will be eligible for the UC-paid Core catastrophic medical plan. Additionally, UC has decided to offer you the entire Core benefit package which includes the Core medical plan and these options:, Legal, Core Life insurance, AD&D, Dependent Care and Health Flexible Spending Accounts, Business Travel Accident insurance and Family Care Resources.
IRS Reporting Requirements under the ACA
Why does the IRS need to verify my medical coverage?
The Affordable Care Act (ACA) calls for each individual to have qualifying health care coverage known as minimum essential coverage unless he/she qualifies for a health coverage exemption, or pays a penalty when filing his or her federal income tax return. This is called the ACA “individual mandate.” In order to verify that individuals are complying with the law, the IRS requires health care plans to report member information to the IRS.
What information is reportable to the IRS?
All of UC’s medical plans are required to report name, address, Social Security number and coverage dates for each plan member, including covered dependents. Additionally, under the Act’s employer shared responsibility provisions, the University of California must also report this information to the IRS to verify that it offered coverage to all “full-time” (those having, on average, 30 or more hours of service). This verification process applies to 2015 coverage and will continue as long as the regulations are in effect.
How will the University of California use Social Security numbers for ACA reporting?
We will use your Social Security number to:
- Report to the IRS that you have medical coverage with the University of California.
- Send you a Health Coverage Statement, which you’ll need for reporting your health coverage information (and, if applicable, your dependents’) when you file your federal income tax return next year.
How will my information be reported to the IRS for 2015?
The University of California has engaged UnifyHR to file the required forms with the IRS on its behalf. UnifyHR is a nationally recognized ACA compliance company focused on assisting employers that are required to comply with the new employer mandates as defined by the ACA. Their headquarters is based in Irving, Texas, with a field office in Sacramento. UnifyHR stores and processes all data in the U.S.
Is this information secure?
Yes. Your personal information will be stored in a fully secure data center.
Are children subject to the individual mandate?
Yes. Each child must have minimum essential coverage or qualify for a coverage exemption. Otherwise, the adult or married couple who can claim the child as a dependent for federal income tax purposes will generally pay a penalty for the child who does not have health insurance.
Are there any exceptions to the requirement to have health insurance?
Yes. Certain individuals are exempt from the requirement. To see a list of exemptions, go to Q/A 6 of the IRS Questions and Answers on the Individual Shared Responsibility Provision.