Affordable Care Act

Affordable Care Act and Health Insurance Marketplace Information

The Patient Protection and Affordable Care Act (“ACA”) was signed into law on March 23, 2010. The following mandates have already been implemented:

The newest mandate requires employers to share information about the new Health Insurance Marketplace with employees by October 1, 2013. Below is a notice from the U.S. Department of Labor with general information about the Health Insurance Marketplace. In California, the Health Insurance Marketplace is called “Covered California”.  Find specific details about Covered California.

The Individual Mandate, effective January 1, 2014, is another provision that may have an impact on you. Individuals must obtain minimum essential health coverage or be subject to a penalty. Our understanding is that individuals will receive notification by the Department of the Treasury or the Internal Revenue Service at a later date. Please keep in mind that this information is based on what we currently understand. Many additional provisions are still pending final regulations. We will provide additional updates as regulations become final.

For more information, see the information posted on the Employee Health Benefits page.

If you have questions, you may contact our staff at tusdhealthbenefits@turlock.k12.ca.us.

• Dependent coverage up to age 26;
• Elimination of lifetime limits on essential health benefits;
• No cost sharing for Preventive Health Services;
• The cost of employer health plans reported as an information item on employee W-2 forms (2012 calendar year); and
• Summary of Benefits and Coverage (SBC) is available to employees to compare health plan offerings (see the link on our website) 

Employee Frequently Asked Questions (FAQs) on the Marketplace

• Why was the notice titled “New Health Insurance Marketplace Coverage Options and Your Health Coverage” sent to me?

As a part of the Affordable Care Act (ACA) that was passed in 2010, employers are required to provide this notice to all employees regardless of whether or not they are eligible to participate in Employment-Based Health Plans. This notice of the soon-to-launch Marketplace (also known as Exchanges) must be provided to all employees by October 1, 2013.

• Why is the Marketplace being established?

  Under the ACA, beginning January 1, 2014 individuals will be required to have minimum essential health coverage, or else be subject to a penalty. This is referred to as the “individual mandate.” The Marketplace is intended to help individuals meet the individual mandate requirement by providing another place to purchase coverage, and possibly qualify for federal assistance to do so. Information and details are available at HealthCare.gov

• Do I have to purchase health coverage through the Marketplace?

  No. You may still obtain health coverage from other sources.

• What if I am covered under my employer’s plan? Can I keep it?

  Yes. Most Employment-Based Health Plans will qualify as the coverage required under the individual mandate requirements. You do not need to purchase coverage through the Marketplace in order to avoid the individual mandate penalty.

• Can I drop myself or my dependents from my Employment-Based Health Plan to purchase a plan through the Marketplace or outside of the Marketplace?

  In some cases, yes, but in many cases, no. Employment-Based Health Plans have very specific rules around enrollment. In general, special enrollment and disenrollment are permitted during the year based on events such as marriage, divorce and the birth of a child. Generally, employees may not change unless the employee experiences a change in status allowed by the Employment-Based Health Plan.

• How do I know if I qualify for assistance to purchase my coverage through the Marketplace?

  Individuals who are not offered qualifying healthcare coverage through their employer may be eligible for government subsidies to help pay for health insurance premiums for plans purchased in the Marketplaces. Subsidies are based on the household income level and how many dependents you have. If your employment-based health plan is considered affordable according to government definition and meets minimum value requirements, you won't be eligible for government subsidies on premiums in the Marketplace. This is true regardless of your household income and family size. As state Marketplace sites are launched over the next months, you will be able to get details about a possible subsidy.