Health Care Reform

The Affordable Care Act (ACA) of 2010 put in place comprehensive health insurance reforms, including expansion of coverage, reforms to the health care industry, and expansion of the availability of coverage in the Marketplace. As of 2014 individuals are required to have health care coverage or pay a penalty.

 FORM 1095 – “Proof of Insurance” Form You May Need to File Your Taxes

How Does the Affordable Care Act Affect Me at Washington State University?

With coverage being available under the Affordable Care Act (ACA), most individuals are required to have health insurance coverage.

Benefits offered to benefit-eligible Washington State University (WSU) Faculty, Staff, non-student hourly employees, and eligible Graduate Student Assistants, have been determined to meet and/or exceed the standard identified by the ACA including premium affordability and minimum essential benefits.  If you are offered coverage by WSU you may not be eligible to receive tax credits through the Marketplace. Additionally, under the ACA, WSU is required to offer Full Time Employees (by ACA definition) employer sponsored health coverage or pay a penalty. This provision is referred to as the Employer Shared Responsibility.

Employees and students currently not eligible for benefits through WSU may need/want to review the coverage options available through the Marketplace, a way to buy health insurance under the ACA. The Marketplace offers “one-stop shopping” to find and compare private health insurance options or apply for medicaid if you are eligible. Some people may be eligible for a tax subsidy that lowers their monthly premiums and provides cost-sharing reductions.

Employer Notification (including Employer Plan Information documents)

This notice specifically addresses the requirements of the ACA Employer Notification, but will also provide links to additional information individuals and their families may find helpful. This notice serves as a household employer notification and our employees should provide it to their household members as well.

This notice was provided to all existing employees as of September, 2013 and will be provided to all future employees starting October 1, 2013.

Employer Notification – faculty, staff, graduate student assistants, non-student and student hourly employees

 

Key Provisions of the Affordable Care Act

Creates the health insurance marketplaceRequires coverage of pre-existing conditions
Helps you understand the coverage your gettingHolds insurance companies accountable for rate increases
Protects people from insurance companies arbitrarily cancelling coverageAllows parents to cover young adults to age 26
Provides free preventive careEnds lifetime and yearly dollar limits on coverage of essential benefits
Guarantees your right to appealProtects you from employer retaliation
The Requirement to Buy Health Insurance under the ACA 

Along with changes to the health insurance system, the Affordable Care Act includes a requirement that many people be insured or pay a penalty. This is sometimes known as the “individual mandate”. The flowchart below illustrates how this requirement works.

The Health Insurance Marketplace 

Under the ACA, a Marketplace is available to shop for and compare medical insurance options. Some states have created their own Marketplaces and other states are using the federal Marketplace.  The Marketplace also assists individuals and families in determining if they qualify for premium tax credits or other financial assistance, thus giving them the confidence to choose the plan that best fits their needs and budget. Individuals who are not eligible for coverage through their employer will benefit the most from this program and its services.

Each Marketplace will offer:

  • Apples-to-apples comparisons of health insurance plans
  • Financial help to pay for premiums for those who qualify
  • Expert customer support online, by phone, or in-person through a local organization, insurance broker or agent

You will utilize the above referenced “Plan Information” document for assistance in applying for coverage in the marketplace.

State Marketplaces

Washington HealthPlanFinder:    www.wahealthplanfinder.org
Oregon Healthcare:    oregonhealth.gov
Your Health Idaho:     yourhealthidaho.org
Marketplaces Outside of the Northwest:    https://www.healthcare.gov/what-is-the-marketplace-in-my-state/

Washington State University