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Frequently Asked Questions for University Employees

The federal Patient Protection and Affordable Care Act ("PPACA") requires that nearly all individuals (who are above the threshold for filing income tax) must obtain health insurance for themselves and any of their dependent family members. The following plans will satisfy this individual responsibility requirement:

  • State of Illinois health insurance plans offered through the Department of Central Management Services ("CMS") based on University employment, which include:
    • Blue Advantage HMO
    • Coventry Health Care HMO
    • Health Alliance HMO
    • HMO Illinois
    • Coventry Health Care OAP
    • HealthLink OAP
    • Quality Care Health Plan (QCHP)
  • Student Health Insurance plan offered based on student enrollment, which include:
    • UIC: Campus Care
    • UIUC: UnitedHealthcare
    • UIS: Academic Health Plans

The following types of health insurance coverage will also satisfy the individual responsibility requirement as long as the insurance qualifies as "minimum essential coverage" under PPACA (contact the plan directly to find out if it qualifies):

  • Health insurance provided by a parent/guardian, spouse, or other family member who claims you as a dependent
  • Another employer-provided health insurance plan, if your primary employment is somewhere other than the University
  • Private health insurance coverage purchased independent of employment

If you have questions about your employment status, please contact your campus/central HR office:

If you have questions about your health insurance coverage offered through CMS, please contact the UPB-Benefits Services office:

FAQs

  1. Where can I read the Notice?
    You can find the Insurance Marketplace Notice online in NESSIE.


  2. Why am I, as a University employee, receiving this notice?
    PPACA requires the University, as your employer, to provide you with information relating to the Health Insurance Marketplace ("Marketplace"). The notice provides basic information about the Marketplace and how it may relate to coverage that is offered to eligible employees through CMS.

    For further explanation regarding the notice, please see the emails sent to employees:

  3. Why does PPACA require me to purchase health insurance coverage or pay a fee if I remain uninsured?
    The rationale for requiring nearly all individuals to purchase health insurance coverage is that having a larger pool of insured individuals (both healthy and sick people) will reduce the overall cost of providing health care in this country. Other PPACA requirements, such as prohibiting denial of coverage based on pre-existing conditions and removing annual and lifetime limits on coverage, provide increased protections to those who might otherwise not be able to obtain insurance. PPACA attempts to create incentives for healthy individuals to obtain insurance and to guard against the adverse financial consequences of unexpected health care costs resulting from significant illness or injury.

    If you choose not to obtain insurance for yourself and/or any dependents despite the individual responsibility requirement, you must pay a fee when filing your income taxes. The IRS administers the fee, which increases every year.


  4. What if I already have insurance?
    If you participate in a State of Illinois health plan offered through CMS, through University student insurance, or you have coverage that meets the minimum essential coverage requirements through another employer, a spouse, parent, or other family member, then you do not need to take any action as long as you and your dependents maintain health insurance coverage.


  5. What if I already have health insurance, but I would rather purchase coverage through the Marketplace?
    You may be able to change to Marketplace coverage if you desire to do so. However, if you are eligible for coverage offered through CMS and choose to purchase a health plan through the Marketplace instead, then you will lose vision and dental coverage provided through CMS, and you will also lose any employer contribution for CMS coverage. In addition, while both the employer contribution and your employee contribution to CMS coverage are typically excluded from income for Federal and State income tax purposes, your payments for coverage through the Marketplace will be made on an after-tax basis.


  6. Am I required to give up my current coverage?
    No. If you have coverage that qualifies as minimum essential coverage under PPACA, then you satisfy the individual responsibility requirements for yourself. State of Illinois health plans offered through CMS qualify as minimum essential coverage.


  7. What if I don’t have insurance?
    PPACA requires nearly all individuals who are above the threshold for filing income tax to obtain health insurance with minimum essential coverage for themselves and any of their dependent family members or pay a fee when filing income tax returns. If you are not eligible for health insurance coverage based on your University employment or student status, and you do not otherwise have health insurance coverage through a spouse or other family member, then you should carefully review the Insurance Marketplace Notice and understand your option to purchase health insurance through the Marketplace.

    If you were eligible for health insurance coverage through CMS, but declined or opted-out of that coverage and do not have any other health coverage through a spouse or family member, then you can elect coverage through CMS during the May Benefits Choice period for coverage effective July 1, or earlier if you experience a qualifying event, to satisfy your individual responsibility requirement under PPACA. For example, if you are a part-time employee (working 50% to 99% of a normal work period) who declined health insurance through CMS previously, you can elect coverage through CMS during the May Benefits Choice period to fulfill your obligation under PPACA. Please note that the individual responsibility requirement under PPACA is NOT a qualifying event for CMS health plans.

    If you decide to remain uninsured, you and any uninsured dependents will be required to pay a fee when filing your income taxes. The IRS administers the fee, which increases every year.

    See also – Student FAQ: What if I don’t have insurance?


  8. I work at the University but I’m not eligible for health insurance. Does this mean I’m now eligible?
    Not necessarily. The State of Illinois Group Insurance Act establishes eligibility for CMS health plans. If you are unsure whether you are eligible for health insurance coverage based on your University employment, please contact your supervisor or your unit’s hiring manager with questions. If you have questions about your employment status, please contact your campus/central HR office at the number noted above.


  9. I waived insurance as a part-time employee and now I want to reinstate coverage. When can I elect it - do I have to wait until I experience a qualifying event or until the next annual Benefit Choice period?
    If you are a part-time employee (working 50% to 99% of a normal work period) who declined health insurance through CMS previously, you can elect coverage through CMS during the Benefit Choice period, typically held in May, or earlier if you experience a qualifying event, to meet your individual responsibility requirement under PPACA. Please note that the PPACA individual responsibility requirement is NOT a qualifying event for CMS health plans.


  10. What happens if I do not comply with PPACA’s individual responsibility requirement?
    If you do not have coverage in 2014, you must pay a fee when you file your income taxes. In 2014, the fee is $95 per adult ($47.50 per child) or 1% of your income, whichever is higher. The maximum fee for a family is $285. These fees will increase annually.


  11. Why did I receive the Insurance Marketplace Notice from the University, when I no longer work for the University of Illinois?
    The Notice was mailed to any employee whom the University paid in the six months prior to September 2013. If you will not be returning to employment at the University of Illinois, you may disregard the notice. Please note that you may still be subject to the individual responsibility requirement under PPACA regardless of your employment.


  12. I am already covered by a CMS health plan or another healthcare plan that meets the minimum essential coverage requirements. Do I have to do something with the Marketplace to prove I have insurance?
    According to the Internal Revenue Service (IRS), you will not have to prove coverage (or pay any fees) until you file your 2014 federal income tax return in 2015. For more information, please visit the IRS website. For the tax filing thresholds for most taxpayers, see this chart. Please consult with your tax advisor regarding your tax filing status


  13. What are the deadlines for enrolling family members and/or me in insurance?
    Not Eligible for CMS: If you are not eligible for health insurance coverage through CMS based on your University employment and you do not otherwise have health insurance coverage through another employer, a spouse, parent, or other family member, then you have the option to purchase health insurance through the Marketplace during the annual open enrollment period that begins on November 15, 2014 and extends through February 15, 2015. Coverage elected before December 15, 2014 will be effective on January 1, 2015. Coverage elected December 16, 2014 through January 15, 2015 will be effective on February 1, 2015. Coverage elected January 16, 2015 through February 15, 2015 will be effective on March 1, 2015.

    Eligible for CMS: If you were eligible for health insurance coverage through CMS, but declined or opted-out of that coverage and do not have any other health coverage through a spouse or family member, then you are required to have health insurance coverage. To satisfy your individual responsibility requirement under PPACA, you can elect coverage through CMS during the Benefits Choice period, typically held in May, for coverage effective July 1, or earlier if you experience a qualifying event. For example, if you are a part-time employee (working 50% to 99% of a normal work period) who declined health insurance through CMS previously, then you can elect coverage through CMS during the Benefit Choice period, typically held in May, to meet your individual responsibility requirement under PPACA. Please note that the PPACA individual responsibility requirement is NOT a qualifying event for CMS health plans.

    Eligible for Student Insurance: If you are a student who plans to continue academic enrollment at the University, then you may have until August 2014 to elect health coverage under the student insurance plan. Please see the Student FAQ for more information.


  14. Can my dependents be covered through the Marketplace if I am not getting insurance through the Marketplace?
    Based on the currently available information, health insurance plans will be available through the Marketplace for you to cover your dependent family members. Please contact the Marketplace at HealthCare.gov for coverage in any state or go directly to GetCoveredIllinois.gov for coverage in the State of Illinois for more information.

 


Maintained by University Human Resources | Contact Information | Last Update: 21-September-2017 | ID: 4914