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 Aetna 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 can 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 or annual essential health benefits.
    • Effective 2019, there is no longer 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 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 for paying the premium subsidy back to the IRS.

    If you choose not 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    .

     

    Information You Need if You Are Not Eligible for PCS Group Medical Plan Coverage:
    You may be eligible for a premium subsidy for coverage available on the federal Marketplace depending on your household income level. For example, a family of four with household income that does not exceed $103,000 (for 2020, adjusted annually), 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):
    Because of the health care law, you will receive some new forms in January or February providing you with information about the health coverage you had or were offered in the prior year. 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 to help me complete my tax return?
    Early in the year, 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 form is Form 1095-C. PCS will provide this form to all full-time employees and all employees who were covered with PCS health insurance during the prior year.

    2.  When will I receive these health care tax forms?
    The deadline for insurers and employers to provide Form 1095-C is January 31, unless the IRS provides an extension, which happens occasionally. PCS typically anticipates delivering 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 Form l095-C to file your tax return. Changes in IRS Form 1040 mean that you are no longer required to provide health plan coverage information.

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

    You should not attach Form 1095-C 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 Forms 1095-C 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 Form 1095-C 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 forms 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 the prior year, you should receive a Form 1095-A (from the Marketplace) or 1095-C (from Pinellas County Schools). In addition, if you were an employee of a different employer that was an applicable large employer for the year, you may receive another Form 1095-C or a Form 1095-B from the insurer. If you don't fall into any of these categories, you will not 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 whether you and your dependents were offered coverage for each month during the year. If you received a premium subsidy for a month during which you and your dependents were offered ACA-compliant coverage, you may have to repay your premium subsidy for the month.

    9.  What should I do if I have a question about the form I received? 
    • For questions about Form 1095-A, contact the Marketplace.
    • For questions about Form 1095-C, contact PCS Risk Management at 727-588-6197

    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:

    Notices: 
    ACA IRS 1095 Tax Forms
    Exchange Notice Information 
    PCS Exchange Notice

    Helpful Links:
    Kaiser Family Foundation- http://kff.org/health-reform/
    US Department of Health & Humana Services - http://www.hhs.gov/healthcare/rights/index.html
    US Department of Labor - http://www.dol.gov/ebsa/healthreform/