Affordable Care Act

  • Patient Protection and Affordable Care Act

     

    Summary
    The goal of the Patient Protection and Affordable Care Act (PPACA) also referred to as the Affordable Care Act (ACA) is to increase access to health care for all Americans.  It includes provisions for health plans, employers and individuals.  Our current Humana health plan meets or exceeds the provisions of the Affordable Care Act, including limiting the maximum out of pocket expense an individual or family may incur in a plan year.

    Key changes already in effect that you should know about:

    • You can now get preventive services like vaccinations and certain screening through your health plan without a copay or coinsurance when you use an in-network provider.
    • Young adults are now able to stay on your health plan until they turn 26 years old.
    • Dependents younger than 19 years of age with pre-existing health conditions can't be denied healthcare coverage.
    • There is no longer a limit on a health plan's lifetime essential health benefits.
    • The fee in 2017 is 2.5% of household income or $695 per adult and $347.50 per child under 18, whichever is greater, if you are assessed a penalty for not having health insurance coverage.

     

    Information You Need if You Are Eligible for PCS Group Medical Plan Coverage

    The medical plans offered by PCS meet or exceed the affordability and coverage requirements as defined by the ACA

    As a benefits-eligible employee:

     If you enroll in a PCS-sponsored medical plan, you will not pay a penalty.

    • If you are offered health coverage through PCS, you will not be eligible for a premium subsidy through the federal Marketplace.   If you receive a premium subsidy, and you are insurance benefit eligible you may be responsible to pay the premium subsidy back to the IRS.
    • Your spouse and your children must also have health insurance coverage.   If you cannot afford to enroll your spouse and/or child (ren) in a PCS medical plan, there may be cost-effective options through the federal Marketplace and/or Florida KidCare. 

     If you choose to opt out of PCS coverage and buy insurance in the Marketplace, you will:

    • Not receive a contribution from PCS toward the cost of your Marketplace coverage.
    • Not be eligible for a government premium subsidy to help pay for your Marketplace coverage.
    • If you receive a premium subsidy, and you are insurance benefit eligible you may be responsible to pay the premium subsidy back to the IRS.

    Information You Need if You Are Not Eligible for PCS Group Medical Plan Coverage

     
    You (and your spouse and/or child(ren), if applicable) must have medical insurance coverage in  2016 and 2017 or you may be responsible to pay a  penalty.   

    You may be eligible for a premium subsidy depending on your household income level. For example, a family of four with household income that does not exceed $94,200, as explained in the Marketplace application, may be eligible for a premium subsidy.

     

    Questions and Answers about Health Care Information Forms for Individuals (1095-C)

     

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    Because of the health care law, you will receive some new forms in January 2018 providing you with information about the health coverage you had or were offered in 2017.  The information below is intended to help individuals understand these new forms, including who should expect to receive them and what to do with them.    

    The Basics

    1.      Will I receive any new health care tax forms in 2018 to help me complete my tax return?

    Starting early in 2018, (much like Form W-2 and Form 1099), you will receive new health care forms which provide information that you may need when you file your individual income tax return. Also like Forms W-2 and 1099, this information will also be provided to the IRS.  

    The new form is:

    • Form 1095-C, PCS will provide this form to all full time employees, and those employees who were covered with PCS health insurance during 2017.    

    2.      When will I receive these health care tax forms?

    The deadline for insurers and employers to provide Form 1095-C is January 31, 2018.   PCS anticipates delivery of the 1095 C form by late January.    

      3.     Must I wait to file until I receive these forms?

    It is not necessary to wait for Form1095-C in order to file.

    Some taxpayers may not receive a Form 1095-C by the time they are ready to file their 2017 tax return. While the information on these forms may assist in preparing a return, they are not required. Individual taxpayers will generally not be affected by this extension and should file their returns as they normally would.

    Like last year, taxpayers can prepare and file their returns using other information about their health insurance. You should not attach any of these forms to your tax return.

    4.      How will I receive these forms?

    These forms will  be available on employee self-service for active employees who have opted into receiving the form electronically.  Pinellas County Schools will be distributing the 1095 form to your school for employees who have not opted into receiving the form electronically.  If you have terminated or are on a leave of absence, your 1095C form will be mailed to the latest address on file.  

    5.     Can I opt to receive these forms electronically rather than on paper?      

    Yes. Employers and health coverage providers may ask for your consent to receive the form electronically. This is entirely acceptable and may be more convenient for you. Electronic form provide the same information that is provided in the paper form.  The goal of PCS is to obtain electronic approval so that in future years, paper distribution will be minimized.

    6.      Will I get at least one form?

    Maybe.  If you were enrolled in health coverage for 2017, you should receive a Form 1095-A (Marketplace) or 1095-C (Pinellas County Schools).  In addition, if you were an employee of an employer that was an applicable large employer in 2017, you may receive a Form 1095-C.  If you don’t fall in either of these categories, you won’t receive a form.

    7.      Will I get more than one form?

    Maybe.  You are likely to get more than one form if you had coverage from more than one coverage provider or if you worked for more than one employer that offered coverage. You are also likely to get more than one form if you changed coverage or employers during the year or if different members of your family received coverage from different coverage providers.

    8.      What do I need to do with these forms?

    You will use the information on these forms to verify that you, your spouse and any dependents had coverage for each month during the year.

    Like last year, if you and your family members had minimum essential coverage for every month of the year, you will check a box on your return to report that coverage. If you or any family members did not have coverage for the entire year, a coverage exemption may apply for the months without coverage. If you or any family members did not have coverage or an exemption, you may have to make an individual shared responsibility payment.

    9.      What should I do if I have a question about the form I received? 

    • For questions about the Form 1095-A, contact the Marketplace.
    • For questions about the Form 1095-C, contact PCS Risk Management 588-6197 

    10.   Should I attach Form 1095-A or 1095-C to my tax return?

    No. Although you may use the information on the forms to help complete your tax return, these forms should not be attached to your return or sent to the IRS. The issuers of the forms are required to send the information to the IRS separately. You should keep the forms for your records with your other important tax documents.

     

    Required notice and useful information about the Affordable Care Act.

     


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