Patient Protection and Affordable Care Act (PPACA)
Patient Protection and Affordable Care Act (PPACA)
PPACA Frequently Asked Questions
Q: What’s the difference between the Health Care Reform Act, the Affordable Care Act, PPACA and Obamacare?
A: There is no difference. These are the different names for the same law.
Q: What is the Affordable Care Act (ACA) going to do in 2014?
A: One of the main goals of the ACA is to limit the number of Americans without health insurance coverage. This is being done by:
- Requiring most Americans to some type of health insurance coverage or pay a penalty, and
- Making it easier for individuals to obtain coverage by:
- Creating insurance exchanges
- Encouraging larger employers to provide coverage to all full-time employees
- Making it easier for people who have medical problems to get insurance
Q: What is the requirement to have health insurance?
A: Most Americans and other people legally in the US must have “minimum essential” coverage, or they will have to pay a penalty with their federal income tax. This is otherwise known as the “individual mandate.”
Q: What is “Minimum Essential Coverage”?
A: Minimum Essential Coverage is basic medical coverage. It can be provided by:
- An employer
- The government (Medicare, Medicaid, CHIP, TRICARE, VA, etc.)
- An individual policy (which can be purchased through or outside the insurance exchange)
Q: What happens if I don’t have minimum essential coverage?
A: People who don’t have the needed coverage will have to pay a penalty with their federal income tax return. For 2014, the penalty will be one percent of the person’s household income (with a minimum penalty of $95).
Q: What if my family doesn’t have coverage?
A: The penalty will apply to each adult in the household who does not have coverage. One-half of the penalty applies to dependent children under age 18 who don’t have coverage. The maximum penalty per family is three times the individual penalty.
Q: What if I can’t afford coverage?
A: No penalty will apply if the cost of the least expensive health plan through your employer is more than eight percent (8%) of you household income. Other types of assistance, such as Medicaid, may be available to employees with low incomes.
Q: What kinds of employer-provided coverage will meet the health coverage requirement?
A: Most employer-provided medical coverage will meet the requirement. This includes PPOs, HMOs, and high deductible health plans, whether they are insured or self-funded.
Grandfathered plans will meet the requirement. Plans that provide limited coverage, like dental only, vision only, hospital indemnity, accident only, certain diseased only, standalone HRAs and plan with lifetime or annual dollar limits will not meet the requirement.
You can be covered as an employee, spouse, retiree, or COBRA participant under the employer-provided coverage.
Q: I currently have coverage through the College through the Public Employees Benefits Program (PEBP). Does this coverage meet the health coverage requirement?
A: Yes, this coverage meets the health coverage requirement and the cost of this coverage to you is intended to be affordable, based on employee wages. For more information on this coverage, check the PEBP Master Plan Document or the HMO Summary of Plan Description or contact the Public Employees Benefits Program at 775-684-7000 to 800-326-5496.
Q: Do my spouse and children have to be covered under the same plan or policy that covers me?
A: No, you may be covered under different plans or policies.
Q: What if I only have coverage for part of the year?
A: You will not owe a penalty if you go without coverage for less than three consecutive months during the year. (if you have coverage for even one day in a month, that will count as coverage for that month.)
Q: What’s a Health Insurance Marketplace?
A: A Health Insurance Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.
Q: Does the State of Nevada have an Insurance Marketplace?
A: Yes, the state’s health insurance marketplace is managed by the Silver State Health Insurance Exchange. If you decide to shop for coverage in the Marketplace, you can access information through nevadahealthlink.com.
Q: Who can buy coverage through a Health Insurance Marketplace?
A: Although most people who can buy insurance through their employer or Medicare are expected to keep that coverage, you and your family members will be able to buy coverage through the Health Insurance Marketplace if you prefer.
Q: Are there any advantages to having coverage through my employer instead of the Health Insurance Marketplace?
A: You will not be able to buy coverage through the Health Insurance Marketplace with pre-tax dollars. It is also unlikely that your employer will contribute to a Health Insurance Marketplace plan as it does for its own plan.
Q: Are there any advantages to having coverage through the Health Insurance Marketplace instead of my employer?
A: The Health Insurance Marketplaces may offer more choices than most employer plans. If your employer does not provide coverage that meets requirements for minimum value and affordability, and your income is low enough, you may be able to get a tax credit if you buy coverage through the Health Insurance Marketplace.
Q: Are there limits on stopping and starting coverage in a Health Insurance Marketplace?
A: People may only enroll in a Health Insurance Marketplace during open enrollment or if they have a special enrollment event.
The first open enrollment will be from October 1, 2013 to March 31, 2014. Coverage will begin on January 1, 2014 for those enrolling by December 15, 2013. Coverage will begin on the first of the following month for those enrolling between late December 2013 and end of March 2014.
People who have a special enrollment event (marriage, birth, adoption, loss of coverage under an employer plan, loss of coverage that was affordable and met the minimum value requirements) will have a 60 day special enrollment period in which they can elect coverage through a Health Insurance Marketplace, or change plans within the Health Insurance Marketplace.
Guidelines for Who Qualifies for Benefits
Below are guidelines on the employee classification groups whose benefits eligibility is changing due to the Affordable Care Act. Please note that this is an evolving situation, and this page will be updated as more guidelines are issued and the rules are clarified.
- They are covered by student health insurance, satisfying the students’ coverage obligation under the individual mandate, but the University still needs to meet the shared responsibility requirements.
- Student employees must be treated as any other temporary employee for this purpose under the ACA, since the ACA does NOT provide any special exemption or treatment of student employees at this time
- Medical benefits will need to be offered within 90 days to students working an average of 30 hours a week.
- Hours will need to be tracked to prove that they are working less than an average of 30 hours a week.
- It is legally permissible to indicate via a job description that hours are not to exceed some amount below 30 hours, but the hours would still need to be tracked.
*(includes Thousand Hour Employees, Casual employees, temporary, and seasonal employees)
- This is a work in progress, and further research will need to be done before rules are finalized.
- Hours will need to be tracked for this population, and if the intent at their date of hire is to have them work 30 hours or more per week, they need to be offered medical benefits within 90 days.
- This is done through a measurement, or look back, period – as of now, a 12-month look back period is being proposed. If the temporary employee was found to have worked 30 hours or more per week on average during that time, the employee is considered a full time employee under ACA and needs to be offered medical benefits during the subsequent stability period, which will last the same amount of time as the look back period.
- There are special rules if the number of hours a temporary employee will work is uncertain at the time of hire:
- Using an initial measurement period (IMP) between 3-12 months, an employer can exclude a variable hour or seasonal employee from coverage during the IMP with no penalty.
- If the variable hour or seasonal employee completes an average of 30 hours of service or more per week during the IMP, the employee would be treated as a full-time employee beginning with the subsequent stability period.
- If they work less than 30 hours a week on average during the IMP, they would not be considered full-time employees and would not have to be offered health benefits during the IMP or the subsequent stability period.
Letter of Appointments (LOA)
- Until further guidance is issued, the University must use a reasonable method for calculating hours of service for LOAs, which must include all hours worked (including preparation for class, grading papers, and other activities outside the classroom)
- One proposal for tracking their hours us to assume a 3:1 ratio – every credit hour they teach equals three hours of work.
- Currently, LOAs whose contracts are over 90 days and whose FTE is at least 50% are considered benefits eligible and are enrolled in the University’s health insurance plan through the Public Employees Benefits Program (PEBP).
- Classified employees who work 80 hours or more per month are currently considered benefits eligible and are enrolled in the University’s health insurance plan through the Public Employees Benefits Program (PEBP) following a 90 day waiting period.
Academic and Administrative Faculty
- Academic and Administrative Faculty with at least 50% FTE are considered benefits eligible and are enrolled in the University’s health insurance plan through the Public Employees Benefits Program (PEBP) on the first of the month concurrent with or following their hire date.
This notice is provided to you in accordance with the requirements of the Patient Protection and Affordable Care Act (PPACA).
For Employees Eligible for Public Employee Benefit Program (PEBP)
The Nevada System of Higher Education currently offers Health Insurance coverage to employees in the following categories:
- Classified employees at 50% FTE working at least 80 hours per month
- Academic and Administrative Faculty at 50% FTE
- Employees on a Letter of Appointment with Benefits who are working at 50% FTE.
For Employees Eligible for Other Vendor Coverage
The Nevada System of Higher Education currently offers Health Insurance coverage through non PEBP vendors to employees in the following categories:
- Graduate Assistants with a 20-hour or half time appointment (50% FTE or more)
- Medical Resident Physicians
All Employer sponsored plans meet the Federal Affordable Minimum Essential Coverage (AMEC). Under the AMEC requirement, health insurance is affordable in an employee's share of the health insurance offered only to the employee doesn't include family plans) is less than 9.5% of the employee's taxable income. However depending on affordability, the employee may qualify for additional subsidized insurance through Nevada Health Link.
For Employees Not Eligible for Coverage
For those Nevada System of Higher Education employees who do not meet eligibility requirements and do not have coverage through Public Employees Benefits Program can purchase affordable health insurance through the Nevada Health Link.
These employees include:
- Casual, Temporary, Seasonal employees
- Student employees
- Event center employees
- Employee on a Letter of Appointment
Nevada Health Link can help ineligible employees select a qualified health plan, determine if you and your family are eligible for a health insurance premium tax credit, reduced cost sharing as well as assist in calculating the net amount of any premiums that you may be required to by, should you choose a plan through Nevada Health Link.
In Nevada, the Health Insurance Marketplace is called Nevada Health Link and is operated by the Silver State Health Insurance Exchange. For questions regarding the Health Insurance Marketplace, the plans that are offered on the Marketplace and the cost of those plans, please contact the Nevada Health Link at:
Nevada Health Link
c/o State Health Insurance Exchange
2310 S. Carson Street, Suite 2
Carson City, NV 89701
Note: Employees who purchase coverage through the Nevada Health Link Marketplace (instead of PEBP coverage) will not receive an Employer premium contribution (subsidy) towards that coverage. Also, the PEBP subsidy contribution and the employee's premium contribution are excluded from Federal income tax. Premium payments for coverage through the Marketplace are made on an after-tax basis.
PPACA: Notice Part A: General Information
When key parts of the health care law took effect in 2014, there was a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you are eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.*
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, (i.e., declining PEBP coverage) you will lose your employer contribution for your employer-offered coverage. Also, this employer contribution as well as your employee contribution to employer-offered coverage is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about coverage offered by your employer, check the PEBP Master Plan Document or the HMO Summary of Plan Description or contact the Public Employees' Benefits Program at 775-684-7000 or 800-326-5496. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit Nevadahealthlink.com for more information including an online application for health insurance coverage or contact the Nevada Health Link at 855-768-5464.
* An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.
Human Resources information contained on the World Wide Web is in no way to be interpreted as a contract between the College of Southern Nevada and any of its employees. This information is provided as a service to the CSN community and will change as CSN changes. From time to time, CSN must modify its policies. Information is current as of the time of its presentation and may be subject to change or repeal at any time, with or without notice, at the discretion of CSN.