Affordable Care Act

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IRS Reporting Under the Affordable Care Act

1. What is this 1095-C form I’m receiving from UT?

A 1095 form is a little bit like a W-2 form. UT sends one copy to the Internal Revenue Service (IRS) and one copy to you. A W-2 form reports your annual earnings. A 1095 form reports your health care coverage throughout the year for yourself and for any of your participating dependents. Learn more about the Individual Shared Responsibility Provision.

2. Why are you sending it to me?

The 1095-C forms show information about health insurance coverage for you and your family members during each month of the past year. Because of the Affordable Care Act, every person must obtain health insurance or pay a penalty to the IRS, and this form shows your health insurance coverage under UT SELECT.

3. What if I get more than one 1095 form?

Someone who had health insurance through more than one source during the year may receive more than one 1095. Someone who was enrolled in a Marketplace plan will get a 1095-A. Certain insurance companies and Medicare send the information on a 1095-B. UT SELECT members will receive a 1095-C.

4. What am I supposed to do with the 1095 forms?

If you enrolled in coverage through the Marketplace you will need the information on Form 1095-A to complete Form 8962 to reconcile any advance payments of the premium tax credit or claim the premium tax credit, and to file a complete and accurate tax return. If you need a copy of your Form 1095-A, you should go to HealthCare.gov or your state Marketplace website and log into your Marketplace account, or call your Marketplace call center. Although information from the Form 1095-C – information about an offer of employer provided coverage -  can assist you in determining eligibility for the premium tax credit, it is not necessary to have Form 1095-C to file your return. See Publication 974 for additional information on claiming the premium tax credit. 

If you and your entire family were covered for the entire year, you may check the full-year coverage box on your return.  

You will not need to send the IRS proof of your health coverage. However, you should keep any documentation with your other tax records. This includes records of your family’s employer-provided coverage, premiums paid, and type of coverage.

You do not have to wait for either Form 1095-B or 1095-C from your coverage provider or employer to file your individual income tax return. You can use other forms of documentation, in lieu of the Form 1095 information returns to prepare your tax return. Other forms of documentation that would provide proof of your insurance coverage include:

  • insurance cards,
  • explanation of benefits
  • statements from your insurer,
  • W-2 or payroll statements reflecting health insurance deductions,
  • records of advance payments of the premium tax credit and
  • other statements indicating that you, or a member of your family, had health care coverage.

5. What if I did not get a Form 1095-B or a 1095-C?

The deadline for you to receive the UT SELECT 1095-C is March 31, 2016. If you were covered under UT SELECT and do not receive a 1095-C by the deadline, please contact your institution’s HR/Benefits Office.

6. I have more questions—who do I contact?

For more information about Form 1095-C and your tax return, please visit the IRS website called  Questions and Answers about Health Care Information Forms for Individuals (Forms 1095-A, 1095-B, and 1095-C ).  For questions about your health coverage, please contact your institution’s HR/Benefits Office.

 

UT SELECT Medical Plan Coverage and the Affordable Care Act Marketplace

As part of the Affordable Care Act (ACA, also known as Healthcare Reform) effective October 1 uninsured individuals, or people who would like to explore health care options can begin to shop for medical insurance through a newly created Health Insurance Marketplace.

About the UT SELECT Medical Plan

Benefits eligible UT employees who decide to shop for medical insurance in the Marketplace should know that full-time employees and all retirees pay  no monthly premium  for the member-only portion of the UT SELECT Medical plan.

In addition, employees and retirees who are currently covered under UT SELECT Medical and drop that coverage to purchase health insurance coverage through the Marketplace, will no longer be eligible for employer contributions (premium sharing) toward the UT SELECT Medical plan while covered through the Marketplace.

If you decide to shop for medical insurance coverage in the Marketplace, visit  www.Healthcare.gov   to be guided through the process; you will be asked to provide the information contained in  Part B  of the  New Health Insurance Marketplace Coverage Options and Your Health Coverage  notice. A list of the  notice by academic and health institutions  is provided for your convenience.

Frequently Asked Questions

1. What is the Marketplace?

The Marketplace, also known as the Exchange, is a way for uninsured individuals or people who would like to explore healthcare options to shop for medical insurance.

2. Will The University of Texas continue to offer the UT SELECT Medical Plan to benefits eligible employees, retirees, and their eligible dependents?

Yes , the UT SELECT Medical plan is still being offered to benefits eligible employees, retirees, and their dependents. Benefits eligibility is explained on the  notice .

3. If I am currently enrolled in the UT SELECT Medical plan, may I keep my medical coverage?

Yes , all benefits-eligible employees, retirees and their dependents may continue their UT SELECT Medical plan coverage.

4. How can I review all the benefits available through the UT SELECT Medical plan?

You may view the Summary of Benefits and Coverage for UT SELECT.

5. How much do I pay each month for my UT SELECT Medical plan?

If you are full-time employee or a retiree, you do not pay for your UT SELECT Medical plan. If you cover eligible dependents, you pay a portion of the dependent premium.

To view your current out-of-pocket cost for medical coverage, log into  My UTBenefits  or access the interactive  cost worksheet .

6. Will I be able to see my same doctor if I purchase coverage through the Marketplace?

Maybe.  Insurance purchased through the Marketplace may have different provider networks than the UT SELECT Medical plan.

7. Will I be eligible for a subsidy if I purchase medical coverage through the Marketplace?

Those without access to qualified healthcare coverage through their employer may be eligible for government subsidies to help pay for health insurance premiums for plans purchased in the Marketplace based on their income level and number of dependents. Due to the high quality of the UT SELECT Medical plan and premium sharing that pays half or full premiums for employee and retiree coverage, most employees and working retirees will not be eligible for these subsidies.

8. If I purchase medical coverage for myself or my dependents through the Marketplace that is effective January 1, 2014, can I drop the UT SELECT Medical plan?

Yes . Gaining other coverage is considered a qualified status change. You will have 31 days from the first date of coverage through the Marketplace (January 1, 2014) to drop the UT SELECT Medical plan.

Remember that if you elect to enroll in medical coverage through the Marketplace instead of remaining enrolled in the UT SELECT Medical Plan, you will no longer receive the employer contribution (premium sharing) currently being applied towards your UT SELECT Medical coverage while covered in the Marketplace. Also, the premium sharing and any premium costs you may pay for the UT SELECT Medical plan are pre-tax (excluded from federal income taxes). Your premium payments for medical coverage through the Marketplace are made on an after-tax basis.

9. What if I purchase coverage through the Marketplace for myself or my dependents and later decide I want to re-enroll in the UT SELECT Medical plan?

If you lose your Marketplace medical coverage due to non-payment, you will not be able to add UT SELECT Medical plan coverage until the next UT Annual Enrollment.

However, you could re-enroll in the UT SELECT Medical Plan within 31 days of the last date of coverage through the Marketplace if you drop the coverage during the specified Marketplace drop period.

10. How do I learn more about the coverage available in the Marketplace?

You may visit  www.Healthcare.gov  to learn more about the Marketplace, the process for enrollment and the premium costs. Enrollment begins October 1, 2013 for coverage beginning January 1, 2014.