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Affordable Care Act

 
 
State Moves Ahead with Affordable Care Act

In July, a federal decision delayed until 2015 the implementation of a mandate that employers provide affordable health coverage to employees that work an average of 30 hours per week. However, the state of Florida has announced it plans to continue with its implementation of the ACA in 2014.

The state is currently working with FGCU and other state agencies to establish reporting requirements for the eligible employee populations. Any employee (OPS, students, Adjuncts, etc.) who meet the criteria will be offered an opportunity to enroll in various insurance programs during this fall's Open Enrollment period.

Coverage and plan options—which will take effect Jan. 1, 2014—will be similar to those presently offered to benefits-eligible faculty and staff. The health plan will include both an employer and employee contribution, while supplemental plans will be available at the employee's cost.

Further details regarding eligibility criteria, coverage, etc. will be included in the Open Enrollment materials mailed in the coming weeks.

FAQs for OPS Employees

1. As an OPS employee am I automatically eligible for health insurance coverage?
No. Federal guidelines say that employers must offer coverage to employees who work 30 hours per week or more on average. The guidelines further say that employers have to measure employees to determine their eligibility. If you were employed as of April 1, 2013 in an OPS position, we have been measuring your hours worked per week from April 2nd – October 2nd. If you averaged 30 hours or more per week, you will be eligible to enroll in benefits during the upcoming open enrollment period for January 1st coverage. If you were hired on April 2, 2013, or after and your department reported you would be working 30 or more hours per week, you are automatically eligible for coverage.

2. How will I know if I'm eligible?
If you are eligible for benefits, People First will mail you a package of information with your options, monthly costs, enrollment deadlines and other pertinent information between October 4th and beginning of Open Enrollment on October 21st.

3. What kind of insurance can I get through the State Group Insurance Program?
Eligible OPS employees can enroll in State Group Insurance plans as follows:

  • Health Insurance

    • Standard HMO or PPO - $50 single or $180 family per month

    • Health Investor HMO or PPO - $15 single or $64.30 family per month

    • Spouse Program - $15 per spouse per month (spouses must both be employed by a state employer and eligible for coverage)

  • Tax-favored Accounts

    • Health Savings Account - if enrolled in a Health Investor HMO or PPO, eligible to receive the monthly state contribution of $41.66 single or $83.33 family per month, as well as make your own pretax contributions

    • Dependent Care Reimbursement Account

  • Life Insurance

    • $25,000 Basic life – to participate, you must actively enroll and pay $4.54 per month; coverage is effective the first of the month following a full payroll deduction

  • Dental, vision and other supplemental pretax plans

    • Prices vary based on plan options

4. Where can I find information on the benefits I may be eligible for?
Beginning October 14th, the www.myflorida.com/mybenefits will be updated with Open Enrollment information including OPS eligible benefits.

5. Are there any State sponsored benefits that I am NOT eligible for?
OPS employees will not be able to enroll in a Medical Reimbursement or Limited Purpose Medical Reimbursement Account or Optional Life Insurance.

6. Who will pay for the cost of my benefits?
The employee is responsible for their portion of the premium (see above), and the hiring department is responsible for paying the employer portion of the premium. This applies to the Health Insurance only.

7. When will coverage start if I am eligible to enroll during Open Enrollment?
Coverage will begin on January 1, 2014. If an eligible employee enrolls during Open Enrollment, payroll deductions will begin in December.

8. What are the measurement and stability periods?
The new hire measurement period is 12 consecutive months, beginning the first day of the first month following an OPS employee's hire date for which the average hours worked weekly will be measured to determine eligibility for coverage.

The open enrollment measurement period is also 12 consecutive months, from October 1 through the following September 30 for which the average hours worked weekly will be measured to determine eligibility for coverage for the subsequent plan year (January 1 through December 31).

The stability period is the 12-month period following a measurement period during which eligible employees who enroll in coverage must be covered. Following the OE measurement period, the stability period is January 1 through December 31.

9. Once enrolled in insurance, how long will I get to keep my coverage?

  • Health insurance coverage continues for 12 months (your stability period), as long as you continue working for the state, even if your hours drop below an average of 30.

  • Eligibility to continue coverage for the subsequent plan year will be determined annually by measuring your hours worked during the open enrollment measurement period.

  • If you are determined to be eligible, coverage continues without interruption and you will be guaranteed another 12 months of health insurance coverage.

  • If you are determined to be ineligible, health insurance will end the last day of the twelfth month of coverage. All other plans will end at the same time as health insurance, regardless of the number of months you are enrolled.

  • If you terminate employment, you are covered through the last day of the month following termination, provided premiums are paid in full. You can continue health, dental and vision coverage through COBRA for up to 18 months if you were enrolled in those plans at the time of termination.

10. What happens if I have coverage but I'm determined to be ineligible during the next open enrollment measurement period?
All coverage will terminate at the end of your 12-month health insurance stability period; however, you can continue health, dental and vision coverage through COBRA for up to 18 months if you were enrolled in those plans at the time of your ineligibility. Eligibility for the subsequent plan year will be measured during the next open enrollment measurement period.

11. What will the effective date of coverage for OPS employees be?
Effective dates of health coverage depend on the point in time you are determined to be eligible.

Following are the earliest possible effective dates:

  • Coverage will begin at the earliest for any eligible OPS employee on Jan. 1, 2014

  • New hire expected to work 30 hours or more on average per week: the first day of the third month of employment

  • OPS employee measured for the new hire measurement period and meets the eligibility requirements: first day of the second month that follows the new hire measurement period

  • OPS employee meets the eligibility requirements in the open enrollment measurement period: January 1 of the plan year following the measurement period.

12. Do OPS/variable hour employees have to follow cafeteria plan rules?
Yes. OPS/variable hour employees are required, as cafeteria plan members, to follow all rules of the State Group Insurance Program, including events listed in the QSC Matrix. The Matrix will be revised to account for these employees and their special qualifying events.

13. I have health insurance coverage somewhere else. Can I work 30 hours or more and agree that FGCU does not have to offer me coverage?
No. Under the guidelines of the Affordable Care Act, any employee working an average of 30 hours or more during their measurement period MUST be offered health insurance.

14. I work 30 hours at FGCU but have health insurance already; do I have to take it?
No. Although we are required to offer it to you, you can decline the coverage.

15. I work for another state agency or state university in Florida and was just hired to work at FGCU. I only work 15 hour at XZY University and will now work 20 hours per week at FGCU. Does either university have to offer me benefits?
Yes. The second state agency/university that now puts your average over 30 hours per week is responsible to offer you benefits and cover the employer portion of your premiums.

16. I have another job at XYZ business/retail store etc. off campus and work 29 hours per week. If I also work at FGCU and that puts me at an average of over 30 hours per week, does that qualify me for benefits?
No. The total number of hours worked per week is only at FGCU or other State Universities or State Agencies.

17. I have been working as an OPS/adjunct employee for the past year and have average over 30 hours per week therefore will be offered benefits during open enrollment. If my hours decrease and I am working less than 30 hours per week while I have benefits, will I lose them?
No, you will not lose your benefits for the stability period (January 1 – December 31) if you are working less than 30 hours per week. However, if you do not average more than 30 hours per week during the open enrollment measurement period (October 3 – October 2), you will not be eligible to enroll during next year's open enrollment for the subsequent plan year.

18. I was hired to work 29 hours per week, however I often work more than that. Is FGCU required to offer me benefits?
If you work an average of 30 hours or more during your measurement period, we are required to offer you benefits regardless of how many hours you were hired to work. Your department would then be responsible to cover the employer portion of your premiums.

19. I am not eligible for insurance through FGCU, however I know that I am required to obtain health insurance under the Affordable Care Act by January 1, 2014 or I will receive a tax penalty. What do I do?
The Federal Government has designed the Health Insurance Marketplace to offer "one stop shopping" to find and compare private health insurance options. For information, please visit www.healthcare.gov

Click here for additional questions and answers from the State of Florida regarding the ACA.