Affordable Care Act (ACA)

These are the various names referencing the exact same law. Within this page, the law will be referred to as the ACA.

The law currently remains in effect. Universities of Wisconsin will continue to monitor all legislative activity relating to the ACA and will provide updates as necessary.

On December 14, 2018 the Federal District Court issued a ruling finding the ACA unconstitutional in its entirety. While the future of this litigation is unknown, it is important to emphasize that the ACA remains the law.

Starting in 2016, all Applicable Large Employers must offer affordable minimum essential coverage that provides minimum value to 95% of their full-time employees (and dependents) as defined by the ACA. This is also known as the “employer mandate” or the “employer shared responsibility provision.”

Per the ACA, the definition of full-time includes employees paid an average of 130 hours/month (30 hours per week). This includes paid vacation leave, sick leave, jury duty pay, etc. Status as a full-time employee under the ACA does not affect your status as a full-time or part-time employee for any other purpose.

If you have coverage through your employer, you pay your insurance premiums with pre-tax dollars. You will not be able to purchase coverage through the Marketplace with pre-tax dollars.

If you have coverage through your employer, you are likely eligible for the employer contribution to your insurance premium. If you purchase individual health insurance coverage through the Marketplace, you must pay the entire cost of the insurance premium (there is no employer contribution to coverage through the Marketplace).

The Marketplace offers 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 eligible for a tax credit if you buy coverage through the Marketplace. Note: The plans offered to Universities of Wisconsin employees in the State Group Health Insurance Program meet the requirements for affordability and minimum value under the ACA.

Form 1095-A is the Health Insurance Marketplace statement. You'll get this statement if you enrolled in health insurance coverage through the "Marketplace," the web-based insurance market that the federal government and states set up under the ACA.

Form 1095-B is a statement from your health insurance company verifying that you and other members of your household had health insurance coverage that met the requirements of the ACA during the prior year. This form applies to you if your health insurance coverage was fully insured with an insurance carrier.  

Form 1095-C is a statement from your employer providing details about the health insurance coverage offered by your employer and whether you chose to participate. Individuals that purchased health insurance coverage through the Health Insurance Marketplace will use the information found on this form to determine if they are eligible for a premium tax credit.

More information: www.irs.gov/Affordable-Care-Act/Individuals-and-Families

Beginning in 2016, employers must file Forms 1095-C with the IRS to report information about the offers of health coverage made to full-time employees during the previous calendar year and provide copies of Forms 1095-C to those employees. Like W-2s, copies of Forms 1095-B and/or 1095-C are provided to you early in the calendar year for the previous year. 

You will receive a Form 1095-C if you were a full-time employee (as defined by the ACA) for all or some months of the prior calendar year. You will receive a copy of the Form 1095-C so you know what information was reported to the IRS about the offer of health coverage made to you and your family. More information: www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals.

You may elect to receive your 1095-C electronically. Review the View/Print Form 1095-C tip sheet for more information. If you have questions on consenting to receive your 1095-C electronically contact UW-Shared Services at serviceoperations@support.wisconsin.edu or (888) 298-0141 (Monday-Friday 7:45 a.m. - 4:30 p.m.). 

Beginning in 2016, insurance carriers must file Form 1095-B with the IRS and furnish a copy to the individual for whom coverage was provided during the previous calendar year. You receive a Form 1095-B because the insurance carrier provided either you and/or your family member(s) with health coverage during the previous calendar year.

The information included on your Form W-2, Box 12, code DD states the total cost (employee & employer share) of the employer-sponsored health insurance you enrolled in during a single calendar year. It does not show the months in which you enrolled in coverage or the lowest cost (employee share), employee-only coverage offered to you.

Forms 1095-B and 1095-C show enrollment information on a monthly basis and include information about the lowest cost (employee share), employee-only coverage offered to you. Thus, your Form W-2 contains different information than Forms 1095-B and 1095-C.

Form 1095-C is required to be provided to full-time employees*.

As for Form 1095-B, all family members covered through your enrollment (if you elected family coverage) will appear on your Form. This is required to be provided to you as the “responsible individual”. In some instances, a spouse and/or dependent may receive their own copy of Form 1095-B if they independently enroll in coverage through COBRA.

*If a spouse and/or dependent is also employed full time, they may receive these forms from their employer as well.

Retain your Forms 1095-B and 1095-C with your tax records. The information on these forms may assist in preparing a return but these forms are not required. You should not wait for these forms to file your taxes. Review the IRS website for information on what is needed to file your taxes.

If you have any questions regarding your 1095-B, contact your health plan.

If you have questions regarding your 1095-C, contact UW-Shared Services, Service Operations at serviceoperations@support.wisconsin.edu or (888) 298-0141 (Monday - Friday 7:45-4:30 p.m.).

The Universities of Wisconsin is statutorily prohibited from offering employer-sponsored health insurance to student help employees. To ensure student help employees are not “full-time” under the ACA, institutions must (1) limit use of lump sum payments and (2) cap hours of service.

UW System Administrative Policy 1237 (formerly GEN 20) Student Employment was implemented to limit student help hours worked to 25 hours per week. Per the policy, students may, however, work up to 40 hours per week during weeks when class is not in session provided it is also permitted by the individual institution. Federal Work-Study hours, including the institution match, will not count towards the hours evaluated to determine a full-time employee for purposes of the ACA.

Universities of Wisconsin will not count graduate assistant hours towards the student help hour cap. For student help hours, the hours worked in that classification that are not in a job funded by federal work study dollars would still need to be capped at 25, even if the risk is reduced by the employee being dually employed in a benefits eligible position.  

Employees who meet the criteria established by the ACA will be treated as full-time employees solely for ACA reporting purposes and the Employer Mandate during the stability period.

Employers subject to the employer shared responsibility provisions of the ACA.

Universities of Wisconsin employees eligible for the Wisconsin Retirement System benefits package or Graduate Assistant / Short-Term Academic Staff benefit package. Review the General Employee Information web page for more information.

Minimum essential coverage is generally any type of employer-sponsored health coverage, certain types of governmental coverage such as Medicare or Medicaid, and other types of health coverage specifically identified by the Department of Health and Human Services.

Minimum value is provided by the plan if it pays at least 60% of the costs of benefits and provides inpatient hospitalization services and physician services.