Affordable Care Act (ACA)

You may have heard about the Affordable Care Act (ACA), also known as federal health care reform, with the new 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.
No, employees and their GBP-eligible dependents do not have to change their GBP health insurance due to the Marketplace.
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."
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 Texas Employees Group Benefits Program (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.
As of January 1, 2014, anyone who doesn't have health insurance coverage will be required to pay a federal tax unless they qualify for an exemption or for 2013-2014 plan year transition relief. This is sometimes referred to as the "individual shared responsibility payment".

The federal tax filer who can claim a dependent for income tax purposes is responsible for paying the tax if the dependent does not have coverage or can qualify for an exemption. See the Internal Revenue Service (IRS) publication "Facts about Health Coverage Exemptions" for more information about specific exemptions and how to apply for them. We encourage you to consult a personal tax advisor to discuss how these matters may affect your specific situation.

Transition relief was provided to certain individuals who were eligible to enroll in an eligible employer-sponsored health plan with a plan year beginning in 2013 and ending in 2014. In connection with the GBP's plan year that began September 1, 2013 and ended August 31, 2014, IRS guidance provides that selected employees or eligible dependents may have transition relief from liability for the federal tax until the 2013-2014 plan year ends. For more information, please refer to IRS Notice 2013-42.
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.
Probably, but 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.