Patient Protection and Affordable Care Act - Human Resources at Ohio State
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (ACA) put in place comprehensive health insurance reforms designed to expand coverage, control health care costs, and improve the health care delivery system. The ACA includes requirements for employers and individuals.
Under the ACA, Ohio State is required to offer health insurance to certain employees. Many employees are eligible for coverage based on their employment classification and full-time equivalency. Those who are not eligible under the university’s eligibility rules – but who worked an average of 30 or more hours a week during the applicable measurement period – are considered an “ACA-eligible employee.”
These employees receive a notice of eligibility from the Office of Human Resources and may elect coverage under the Faculty and Staff Health Plans. The coverage is for medical and prescription only; it does not include dental or vision benefits.
In previous years, the ACA required all individuals, with a few exceptions, to have health insurance that provides “minimum essential coverage” or potentially pay a penalty for noncompliance. Through December 2018, individuals who could afford health insurance but chose not to buy it were able to pay a fee called the Individual Shared Responsibility Payment when filing federal taxes.
Starting with the 2019 plan year, individuals who don’t have coverage no longer need to pay the Shared Responsibility Payment.
Note: Some states have their own individual health insurance mandate, requiring individuals to have qualifying health coverage or pay a fee with state taxes. If you live in a state that requires you to have health coverage and you don’t have coverage (or an exemption):
- You may be charged a fee when you file your 2019 state taxes.
- You will not owe a fee on your federal tax return.
Check with your state or your tax preparer to find out if there is a fee for not having health coverage. For more information about the individual mandate, visit the HealthCare.gov website.
The Ohio State University Faculty and Staff Health Plans provide minimum essential coverage. An individual who was covered for at least one day during a month is considered to have had coverage for the entire month.
When you return to The Ohio State University following your retirement from Ohio Public Employees Retirement System (OPERS), it is important that you understand the university’s policies, the impact of the ACA on your eligibility for medical coverage and your retirement system’s rules for reemployed retirees.
- Break in service requirements: OPERS and the university require a two-month break in service between retirement and reemployment. You must notify Ohio State upon hire or rehire that you receive an OPERS retirement benefit. If you return to employment during the first two months of your retirement, your OPERS retirement allowance and health coverage and forfeited for each month during which you are employed.
- Medical coverage: At any point that you are reemployed at Ohio State as an OPERS retiree and you are eligible for any level of medical coverage, you are not eligible to participate in OPERS medical coverage.
- Most retirees who return to work within 26 weeks of their retirement are eligible for coverage under The Ohio State University Faculty and Staff Health Plan due to the ACA. Even if you return to work in a position that is not eligible for medical coverage under the university’s eligibility rules, the ACA requires the university to offer you medical coverage if you averaged at least 30 hours per week during a measurement period. When you are eligible for university coverage and do not enroll, you need a source other than OPERS for your medical coverage.
- Refer to the university’s Benefits Eligibility tool to determine your eligibility for medical coverage under the university’s eligibility rules. If you are ineligible under the university’s rules, it is likely you are ACA-eligible after your return to work from retirement.
- Because the university does not provide a subsidy to employees whose medical eligibility is only due to ACA, these employees pay the higher, full-cost rate for medical coverage. See ACA rates.
- If you wish to avoid the impact of ACA medical eligibility, it is suggested you wait more than 26 weeks before returning to work at the university following your retirement. When you return employment, make sure you work less than 30 hours per week.
- Review materials and understand your retirement system’s rules, particularly the impact on your pension and retiree health benefits. More information can be found from OPERS.
For questions, contact the appropriate entity:
An individual employed in a non-benefits-eligible position, such as an IRP, is normally ineligible for non-retirement benefits such as medical, dental, vision, life insurance and other benefits. The exception to this is an employee who transfers to an IRP position from a previous full-time position at Ohio State.
When you transfer from a full-time, benefits-eligible position to a non-benefits-eligible position, your coverage terminates for the non-retirement benefits in which you are enrolled, except for medical coverage. It is likely that you will remain eligible for and enrolled in medical coverage under The Ohio State University Faculty and Staff Health Plan due to the Affordable Care Act (ACA). The ACA requires that the university continue to offer medical coverage to individuals who averaged at least 30 hours per week during a prior measurement period.
Because the university does not provide a subsidy to employees whose medical coverage eligibility is due only to the ACA, you will pay the higher, full-cost rate for your medical coverage as soon as you are employed in the IRP position. See ACA rates.
Unless you waive your current Ohio State medical coverage within 30 days of the effective date of your IRP position, your medical coverage will continue, and you will pay the higher, full-cost rate. After 30 days, no changes can be made to your enrollment until open enrollment for the following plan year, or unless you experience a qualifying status change.