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Affordable Care Act
Employers are to notify all employees by October 1, 2013 of the new Health Insurance Marketplace (Exchange) as required by the Patient Protection and Affordable Care Act (PPACA). All employees are to receive the notice regardless of full-time/part-time status, health insurance eligibility, temporary or student status. The notice provides basic information about the new Health Insurance Marketplace and health insurance coverage provided by your campus.
Below is a list of frequently asked questions and contacts related to the Affordable Care Act’s Individual Shared Responsibility Provision described in the “New Health Insurance Marketplace Coverage Options and Your Health Coverage” notice being sent to employees.
- How will the Affordable Care Act’s Individual Shared Responsibility Provision and the requirement to maintain Minimum Essential Coverage AFFECT ME?
- Are all individuals living in the United States subject to the individual shared responsibility provision?
- Do I need to do anything right now to get ready for the changes coming in 2014?
- What if I have job-based insurance?
- Does PEBB coverage qualify as minimum essential coverage (MEC) under the Affordable Care Act?
- Does my Graduate Assistant (GRA/GTA), Clinical Fellow, or Postdoctoral Scholar appointment coverage qualify as minimum essential coverage (MEC) under the Affordable Care Act?
- If you are eligible for employee coverage through PEBB (classified and unclassified employees), are not enrolled, and do not have other MEC coverage or do not qualify for an exemption, what should I do?
- If you are eligible for coverage through your campus as a Graduate Assistant (GRA/GTA), Clinical Fellow, or Postdoctoral Scholar and are not enrolled and do not have other MEC coverage or do not qualify for an exemption, what should I do?
- What if I’m a part-time employee without health coverage?
- What is the Health Insurance Marketplace?
- What is the health insurance Marketplace in Oregon?
- I don’t live/work in Oregon, how do I find the Marketplace for my state?
- What if someone doesn't have health coverage in 2014?
- When is the Enrollment Period for the Marketplace?
- What if I'm losing job-based insurance other than retirement?
- What if I'm losing job-based insurance due to retirement?
Under the Patient Protection and Affordable Care Act, Public Law 111-148 and the Health Care and Education Reconciliation Act of 2010, Public Law 111-152 (collectively, the Affordable Care Act), the Federal government, state governments, insurers, employers, and individuals are given shared responsibility to reform and improve the availability, quality, and affordability of health insurance coverage in the United States.
Effective January 1, 2014, the Affordable Care Act’s individual shared responsibility provision requires each individual (including children) to:
- maintain minimum essential health coverage (known as "minimum essential coverage" or "MEC") for each month; or
qualify for an exemption; or
- make a payment when filing his or her Federal income tax return; www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision
All U.S. citizens are subject to the individual shared responsibility provision as are all permanent residents and all foreign nationals who are in the United States long enough during a calendar year to qualify as resident aliens for tax purposes. Foreign nationals who live in the United States for a short enough timeframe that they do not become resident aliens for federal income tax purposes are not subject to the individual shared responsibility payment even though they may have to file a U.S. income tax return. The IRS has more information available on when a foreign national becomes a resident alien for federal income tax purposes. http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision
3. Do I need to do anything right now to get ready for the changes coming in 2014?
You need to learn about the Health Insurance Marketplace by visiting HealthCare.gov and how it applies to you. If you and your family have health care coverage, you may not have to do anything different in 2014. www.irs.gov/aca
4. What if I have job-based insurance?
If you have job-based health insurance you like, you can keep it. You're considered covered. You may be able to change to Marketplace coverage if you want to. Any job-based health plan you currently have qualifies as minimum essential coverage (MEC). You don't need to change to a Marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014. If you'd like to explore Marketplace coverage options you can, but there are several important things to consider.
- With most job-based health insurance plans, your employer pays a portion of your premiums. If you choose a Marketplace plan instead, your employer does not need to make a contribution to your premiums.
- You will not qualify for Marketplace savings if your job-based coverage is considered affordable and meets minimum value, you won't be able to get lower costs on premiums or out-of-pocket costs in the Marketplace. This is true no matter what your income and family size are. https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/
Yes, PEBB coverage is employer-sponsored and all plans meet the definition of MEC.
6. Does my Graduate Assistant (GRA/GTA), Clinical Fellow, or Postdoctoral Scholar appointment coverage qualify as minimum essential coverage (MEC) under the Affordable Care Act?
Yes, all plans offered through these appointments are be considered employer-sponsored meeting the definition of MEC.
7. If you are eligible for employee coverage through PEBB (classified and unclassified employees), are not enrolled, and do not have other MEC coverage or do not qualify for an exemption, what should I do?
You can enroll in PEBB coverage during the PEBB Open Enrollment for 2014 benefits. The 2014 Open Enrollment period runs from September 1, 2013 through October 31, 2013.
8. If you are eligible for coverage through your campus as a Graduate Assistant (GRA/GTA), Clinical Fellow, or Postdoctoral Scholar and are not enrolled and do not have other MEC coverage or do not qualify for an exemption, what should I do?
If you’re a part-time worker without job-based coverage, you may be able to buy health insurance in the Marketplace and get lower costs based on your income. https://www.healthcare.gov/what-if-im-a-part-time-employee-without-health-coverage/
10. What is the Health Insurance Marketplace?
The Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options. With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll. https://www.healthcare.gov/what-is-the-health-insurance-marketplace/
11. What is the health insurance Marketplace in Oregon?
The Marketplace in Oregon is Cover Oregon. For additional information visit: CoverOregon.com
12. I don’t live/work in Oregon, how do I find the Marketplace for my state?
To find the Marketplace for your state, visit: HealthCare.gov
13. What if someone doesn't have health coverage in 2014?
If someone can afford it but doesn't have health coverage in 2014, they may have to pay a fee. They must also pay for all of their care. https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/
14. When is the Enrollment Period for the Marketplace?
The open enrollment period to purchase health care through the new Health Insurance Market place is October 1, 2013 through March 31, 2014. Coverage can begin as early as January 1, 2014. When you get health insurance through the marketplace, you may be able to get the new advance Premium Tax Credit that will immediately help lower your monthly premium, see: https://www.healthcare.gov/glossary/premium-tax-credit/
15. What if I'm losing job-based insurance other than retirement?
If you lose your job-based health insurance, you have 2 primary options for health insurance coverage: a Marketplace plan or COBRA continuation coverage. https://www.healthcare.gov/what-if-i-am-losing-job-based-insurance/
16. What if I'm losing job-based insurance due to retirement?
If you retire and lose your job-based insurance, you have some additional options:
- Marketplace coverage until Medicare eligibility
- PEBB Retiree coverage until age 65 or Medicare eligibility
- PERS Retiree coverage for PERS Tier 1, Tier 2, and OPSRP retirees (non-Medicare & Medicare supplemental plans)
- COBRA continuation coverage
- Coverage through a Spouse/Domestic Partner
- Medicare & Medicare Supplemental Plans
OUS Affordable Care Act (ACA) Campus Contacts
Eastern Oregon University
Art Doherty, Human Resources Director
Oregon Institute of Technology
Vicky Seger, Human Resources Benefits Officer
Oregon State University
Donna Chastain, Human Resources Associate Director, Benefits
Portland State University
Southern Oregon University
Isabel Bauer, Human Resources Benefits Officer
University of Oregon
Western Oregon University
Heather Mercer, Human Resources Benefits Manager
For updates or changes, please contact OUS Human Resources: HR@ous.edu September 2013