Skip to content

Health Care Reform and Your UT Benefits-Updated!

It has been just over six months now since the Patient Protection and Affordable Care Act (PPACA) was signed into law. Discussion of PPACA has been prevalent in the media since it was finalized in March. This coverage has expanded in recent weeks because certain provisions began to take effect for some health plans starting on September 23, 2010 (six months after enactment). Despite these widespread discussions, most people probably still have questions about how and when this complex legislation will affect the health benefits available to you and your family.

As discussed in previous editions of your “A Matter of Health” newsletter, the UT System Office of Employee Benefits (OEB), in consultation with outside health care experts and legal counsel, continues to examine both the short and long-term requirements of PPACA and to analyze how required changes will impact the overall UT Benefits program. Many details will continue to evolve over the coming months and years. During that time, you should continue to pay close attention for the most current details about required changes to your UT Benefits. Below is the latest on how key PPACA provisions impact UT Benefits.   

Required PPACA provisions are on a staggered implementation schedule over the next several years. Certain requirements are structured such that they take effect on different dates depending on the scheduled plan years for affected health plans. For example, some eligibility expansions and minimum benefit levels are required at the start of the plan year beginning after September 23, 2010 for each affected plan (September 1, 2011 for UT Benefits). Other provisions have the same required start date for all affected plans regardless of plan year schedules. The first provision to directly impact your UT Benefits will become required on January 1, 2011 for all applicable plans (see chart below for details).

Some limited changes are expected during upcoming plan years. The following chart details the main PPACA requirements that will impact UT Benefits plans over the next few years based on current information. Further guidance, newly issued regulations, and legislative changes to applicable state and federal statutes may result in additional modifications. If this happens, updated information will be communicated to all plan participants as soon as it becomes available.

Expected Effective Date

Affected Plan
Specific Change

January 1, 2011

UT FLEX Medical Expense Reimbursement Account

Elimination of qualifying expense status for over-the-counter (OTC) medications unless purchased with a prescription (except OTC insulin)

September 1, 2011

UT SELECT Medical Plan

Coverage for young adult dependents until the age of 26

September 1, 2011

UT SELECT Medical Plan

Evidence of Insurability no longer required when adding coverage for eligible participants under the age of 19

September 1, 2011

UT SELECT Medical Plan

No out-of-pocket costs for certain preventive health services

September 1, 2012

UT FLEX Medical Expense Reimbursement Account

Maximum limit for annual contributions capped at $2500 (down from existing UT System limit of $5000)

September 1, 2014

UT SELECT Medical Plan

Reduction of state mandated waiting period from potential up to 120 days to a maximum of 90 days

Prevention and wellness will continue to be an important focus. Because prevention and wellness have been priorities for UT Benefits and are also key areas of focus within PPACA, several preventive services will continue to be available with little or no out-of-pocket costs. UT SELECT already includes a number of preventive services with no cost-sharing required, including: office and outpatient labs and x-rays, mammograms, and preventive colonoscopies. Other preventive services will be added  at no out-of-pocket costs based on pending regulations. Additionally, increased incentives for participation in prevention and wellness activities have been authorized and may be offered through the UT System Living Well: Make it a Priority program.

Some annual limits on specific benefits may be reduced or eliminated. UT SELECT has always offered robust coverage, regardless of any pre-existing health issues, with only a small subset of medical services subject to annual or lifetime limits. Provisions within PPACA require the elimination of annual and lifetime limits on certain essential services, which must still be fully defined. Depending on the final regulations, some additional services may be available through UT SELECT without annual or lifetime limits.

Your UT Benefits team is working to ensure that all requirements are met and that you have up to date information about any changes being made to the UT Benefits program. Although differing opinions remain about the provisions of PPACA, it is the job of the OEB Benefits team (with support from the HR and Benefits staff at your specific UT Institution) to ensure that your benefits are administered in full compliance with all applicable laws and regulations. In addition to implementing required changes, OEB will be continually working to provide clear, comprehensive, and up-to-date information to all plan participants on a regular basis. You can continue to get the most value from your UT Benefits by staying informed and by remaining actively involved in managing your own health and wellness.

Contact Us

If you would like a specific topic discussed or have a question you would like answered in a future issue of this newsletter, please send your suggestions to benefits@utsystem.edu.

UT System Employee Benefits Web site: www.utsystem.edu/benefits/
UT System Retirement Programs Web site: www.utretirement.utsystem.edu
Your Local Benefits Office: www.utsystem.edu/benefits/contacts/#1