Affordable Care Act (ACA) regulations, effective Jan. 1, 2016, introduced changes that apply to all UC employees. New provisions made it easier for employees to maintain UC coverage and expanded eligibility 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 throughout the tax year.

Benefit Eligibility

IRS Reporting Requirements under the ACA

IRS Form 1095

Benefit Eligibility

How did the ACA affect UC's eligibility requirements?

Here is an overview of changes UC made to benefits eligibility requirements effective Jan. 1, 2016. Overall, they made it easier for UC employees to qualify for benefit coverage. For more information about benefits eligibility and coverage, see  A Complete Guide to Your UC Health Benefits.

Item From To
(Beginning Jan. 1, 2016)		 Details
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 2017:
  • Monthly payroll Nov. 1, 2016 – Oct. 31, 2017
  • Biweekly payroll
    Nov. 6, 2016 – Nov. 4, 2017
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.

**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.

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 to pay 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 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 is information be reported to the IRS?

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.

IRS Form 1095

Why am I getting this form?

The Affordable Care Act requires every U.S. Citizen or resident alien to have health insurance coverage. If an individual does not have health insurance, or a health coverage exemption, they will be required to pay an individual shared-responsibility payment or “penalty”. This penalty is assessed and deducted when the individual files his/her income taxes. IRS Form 1095 allows an individual to submit proof of having health insurance coverage, thus eliminating the potential of this penalty. Depending on the type of coverage you have, you may receive one or more of Form 1095-B or 1095-C; all of them accomplish the same purpose.

Why is this mailed form coming from UnifyHR?

You are receiving this form and instructions from UnifyHR, on behalf of the University of California, because our records indicate you were offered coverage based on your status as a full time employee or as a member of one of UC’s self-insured medical plans. UC has engaged Unify HR to produce and mail the Form 1095 from data provided by UC.

Why is Form 1095 important?

IRS Form 1095 includes information that will identify which months an employee and any dependents were offered health coverage and whether that coverage met the ACA requirements. Coverage that meets the ACA requirements is called Minimum Essential Coverage (MEC). The Form 1095 also shows the months for which the individual and enrolled dependents participated in health coverage.

What do I need to do with this form?

When individuals file their federal income tax returns they will be asked to verify that they have the required health coverage. Just as it is critical to keep other important tax documents, you should retain the Form 1095 in the event it is needed to provide proof of coverage in response to any future IRS inquiries. You will not need to submit a copy of the 1095 form with your individual income tax return.

How many of these forms will I receive?

UC employees who worked for more than one campus or more than one employer during the course of the tax year may receive more than one Form 1095-C. Employees who are enrolled in fully insured plans (all plans except Core and UC Care) will also receive a Form 1095-B from their insurance plan. Additionally, if you retired from UC during the tax year and now have retiree coverage, you may receive more than one form. UC retirees with UC retiree insurance who were on Medicare for any part of the tax year may not receive a form for those months, as CMS (Centers of Medicare and Medicaid Services) is the responsible reporting entity for Medicare plans and its reporting will not begin until next year.

Why are my covered family members listed in Part III of Form 1095-C, but my co-worker’s are not?

Part III of the 1095-C is only populated for each month you and/or your dependents were enrolled in UC-sponsored, self-insured health coverage, such as UC Care or Core. Family members of those enrolled in other plans will be listed on Form 1095-B from the insurance plan.

What if I need to make a change to my Form 1095 information or have questions?

If you think information about your UC-sponsored plan on your Form 1095 is incorrect, please contact your location’s Benefits department to find out how to get a corrected Form 1095. If you are a retiree, please contact RASC at 800-888-8267. For more information about Form 1095, you can also visit www.irs.gov

Will UC be filing the 1095 data with the IRS?

UC is required to transmit the 1095 information to the IRS. Therefore, if corrections need to be made, the changes should be made in PPS/UCPath/Retiree Insurance, as well as a new 1095 issued. Going through the correction process for the 1095 will ensure the employee has an accurate form and that the employer transmittal is correct.

Why aren’t my family members listed on my 1095-C?

Family members are only listed on the 1095-C for employees in self-insured plans (UC Care and Core). For those in insured plans (Health Net, Health Savings Plan, Kaiser, WHA) the family members are listed on the 1095-B form which you received from your plan. Therefore, a 1095-C without family members is correct if the employee is enrolled in an “insured” plan.

Why does the 1095 form I received in the mail from UC have a return address in Texas?

The vendor that UC used to print and mail its 1095 forms is called UnifyHR and it is located in Texas. The actual envelopes are being postmarked from St. Louis, Missouri.

I’m a UC retiree in UC Care and I cover my spouse, who is eligible for Medicare and enrolled in the Medicare PPO. Why is (or isn’t) my spouse listed on the 1095-B form I received from UC?

Anyone with Medicare coverage will receive his/her 1095 form from CMS. However, CMS is not reporting to everyone in this first year, as previously shared in the 1095 Tool Kit. Additionally, there were some challenges with reporting those with “split Medicare” coverage from UC; therefore, some Medicare-eligible family members of retirees with split coverage may have been reported on UC’s 1095-B showing enrollment in UC Care and Core (rather than the Medicare PPO plan). This over-reporting should not be a concern, but the form may be corrected if the retiree desires.

I’m a UC retiree and I had coverage all year, but my 1095-B only shows me enrolled in UC Care through March — why is it wrong? I became eligible for Medicare and was in the UC Medicare PPO starting in April through the end of the year.

The 1095-B only reports membership in UC Care. If an individual transitioned to Medicare mid-year, the Medicare plan enrollment should be reported by CMS.