Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act (ACA), is known as federal health care reform and includes the Health Insurance Marketplace that opened on October 1, 2013.
The Marketplace is for people who do not have affordable employer-based insurance. Because the State pays 100% of health insurance premiums for full-time state employees, state employees who work at least 30 hours a week are considered to have affordable insurance and therefore wouldn't be eligible to purchase insurance through the Marketplace.
If you have other questions about the ACA, information is available at Healthcare.gov or call (800) 318-2596.
The Employees Retirement System of Texas (ERS) administers insurance benefits for eligible employees, retirees, and their family members through the Texas Employees Group Benefits Program (GBP). All participants must continue to meet state eligibility rules to qualify for GBP coverage. All ACA requirements to date are already part of the GBP.
Nothing in the ACA changes who can participate in the GBP. You are strongly encouraged to independently determine how, if at all, the Affordable Care Act (ACA) and the Marketplace (also known as the "exchange") may affect you and your family.
No, retiree coverage, and that of their GBP-eligible dependents, has not changed due to the Marketplace.
GBP-eligible dependents—those who can receive GBP health coverage—include eligible state and higher education employees' and retirees' spouses, children up to and including age 25 in several categories, and disabled children age 26 and older. See the Dependent Eligibility Chart for more information. GBP-eligible dependents are allowed to participate in GBP health coverage, but are not required to.
For the purposes of health coverage, the ACA considers a dependent to be a child or other individual that an adult or married couple may claim as a dependent for federal income tax purposes. In these questions and answers, we refer to dependents in this context as "federal tax dependents."
Yes, the ACA requires everyone, including children, to have coverage or pay a federal tax, unless they qualify for an exemption.
The ACA requires some employers to offer a minimal level of health insurance coverage to full-time employees and their children under age 26 who are their federal tax dependents. The State of Texas offers eligible full-time employees and their dependents coverage that currently meets the ACA's minimum coverage requirement. The State offers this coverage through ERS and the GBP.
Although your employer is required to offer coverage to eligible full-time employees, and all people - including children - are required to have coverage (unless they qualify for an exemption; see question 6), you are not required to buy dependent coverage through your employer.
Effective January 1, 2019, the Tax Cuts and Jobs Act of 2017 has set the federal tax (or penalty) to zero for those individuals who do not have the minimum level of insurance coverage.
Yes, but if you're thinking about buying dependent health insurance through the Marketplace, please keep the following in mind:
- The State currently pays a portion of dependents' premiums for most GBP-eligible employees (50% for dependents of full-time eligible employees, and 25% for dependents of part-time eligible employees). If you decline GBP dependent coverage and purchase a policy through the Marketplace, you may be paying the full price of the Marketplace coverage.
- You cannot drop any currently covered dependents from GBP insurance before the end of the plan year (August 31), unless you have a qualifying life event (QLE). You can drop a dependent during Annual Enrollment without a QLE.
Not if you remain a full-time employee of a state agency or other organization in the GBP. In some circumstances, you or your dependents might be able to drop coverage when you experience a qualifying life event.
According to the IRS, the availability of Marketplace insurance by itself is not considered a QLE. Employees and their dependents who enroll in GBP coverage need to stay enrolled in the GBP for the entire plan year.
That is considered a GBP qualifying life event. Visit the Life Events section of the website for more information.
You may qualify for coverage on the Marketplace depending on federal eligibility guidelines. Go to www.healthcare.gov for more information.
Nothing about the ACA has changed GBP eligibility for part-time employees. Part-time employees and their dependents can go to the Marketplace if they choose and they are eligible, but they don't have to.
No. The state contribution for employees (and their dependents) will be made only to GBP programs, not to any other insurance program, including any program in the Marketplace.
The Marketplace is intended for people who do not have affordable employer-based insurance. Since the State currently pays 100% of the premium for most GBP-eligible employees, it's important to know that if you decline GBP coverage and purchase a policy through the Marketplace, you will be paying the full price of your Marketplace coverage.
The IRS sets the affordability standard for insurance coverage (IRS 26 CFR Part 1). Starting January 1, 2015, the employee's premium contribution cost for the employer-sponsored health insurance plan (for the employee only, not any other members of his or her family) may not exceed 9.5% of the employee's household income for the year. Full-time employees, for whom the employer pays 100% of the member-only GBP contribution, are considered to have affordable coverage.
Yes. GBP coverage currently meets the minimum coverage requirement under the ACA for employees eligible to receive the 100% employer contribution.