The “Patient Protection and Affordable Care Act” (PPACA), or “Obama Care” legislation contains comprehensive health insurance reforms, and includes tax provisions that affect individuals, families, businesses, insurers, tax-exempt organizations and government entities. The individual shared responsibility provision of this PPACA legislation requires you, your spouse, and certain dependents to have qualifying health insurance for the entire year, report a health coverage exemption, or make a payment when you file your taxes.
The following Q&A’s may help answer many of the questions you may have regarding health care reform and new associated tax reporting requirements.
If you are eligible and enrolled for insurance through Boise State your current coverage is not affected by the PPACA.
In Idaho, the health insurance exchange is called “Your Health Idaho.” The Your Health Idaho health insurance marketplace is where individuals, families and small businesses of up to 50 employees can easily shop for, compare and choose a health insurance plan that is right for them. Idaho residents can find detailed information about Your Health Idaho’s marketplace here: http://www.yourhealthidaho.org. Complete exchange details will be available on or after October 1st. Additional information may be found on the federal site: www.HealthCare.gov.
There are many health insurance plans offered from a variety of Idaho insurance companies on Idaho’s insurance marketplace for qualifying individuals.
Idahoans who are currently uninsured or those that have a plan and want to look for different coverage can shop on Your Health Idaho. While there is a specific annual open enrollment period, individuals experiencing a loss of other coverage or certain life events may be able to obtain coverage at other times during the year.
All of the plans offered through the marketplace cover a required set of “essential benefits.” There are different levels of cost sharing and out-of-pocket expense among the plan offerings, to meet individual needs. Plan details and tools to compare plans offered through the marketplace are available on the Your Health Idaho site.
Summaries of the Blue Cross plans available to eligible employees of the university are available on the Office of Group Insurance website: https://ogi.idaho.gov/
You may compare premium cost information for plans offered through the health insurance exchange with the current Blue Cross employee premiums found on the schedule posted here: https://ogi.idaho.gov/premium-rates/.
Note: Keep in mind that the premiums deducted through Boise State University payroll deduction may be paid on a pre-tax basis, while the premiums for coverage purchased through the exchange will be after-tax, and no university payroll deduction is available.
The open enrollment period is generally between November 1 and January 31 each year.
Premiums for the health insurance exchange may be greater than what you pay for your Blue Cross coverage today for two reasons:
1) Boise State will not provide a contribution towards the cost of coverage purchased through the exchange.
2) Since Boise State coverage meets the “affordability” and “minimum essential coverage” tests of the law, you will not be eligible for premium subsidies through the exchange, regardless of your household income. You will pay the full premium of any coverage you might choose for yourself through the exchange while still eligible for coverage through Boise State.
The eligibility rules for State of Idaho insurance through Blue Cross are not changing at this time. If you are not expected to work at least 20 hours per week for five consecutive months, you will not be eligible for this insurance, but you may select a plan through the health insurance marketplace. If your hours change or you leave the university and return to a position that is not eligible for full benefits, in some circumstances you may be eligible to enroll in health insurance under the provisions of the PAPCA.
No, however, effective January 1, 2014, individuals age 18 or older may be required to enroll in health insurance through their employer, their spouse’s employer, the new health insurance exchange, individual insurance, or through Medicare/Medicaid, if eligible.
No. You can only pay for that insurance directly, with after-tax dollars.
The amount of premium assistance that individuals and families may be eligible for depends on your income, employment status and household size. While the exact amount of premium assistance will vary, some level of premium assistance may be available to individuals, depending on household income and the number of people in the household.
It’s your choice. However, starting in January 2014, federal law will require most Americans 18 and older to have health insurance or pay a penalty.
If you choose not to purchase a health insurance plan with basic minimum standards, you could face a penalty of either $95 a year or 1% of your taxable income, whichever is greater. This penalty will increase over time:
- In 2015, it will be the greater of $325 per adult or 2 percent of taxable income.
- In 2016, it will be the greater of $695 per adult or 2.5 percent of taxable income.
- After 2016, the tax penalty increases annually based on a cost-of-living adjustment.
- The uninsured will not have to pay a penalty if they:
- Are uninsured less than 3 months of the year
- Are determined to be low-income and coverage is considered unaffordable
- Not required to file a tax return because their income is too low
- Are a member of a federally recognized tribe
The adjunct workload for all appointments combined is limited to 11 credits per semester, including summer, starting after the end of the FY14 spring semester.
Currently, no changes have been made to the policies for student work load. The student employment policy is currently under review. Should there be any changes, the campus will be notified.
NEW! 1095-C Statement of Employer-Provided Health Insurance Offer and Coverage Forms
1095-C is a new informational tax form that you will receive from Boise State this year. This form, which will be mailed to your home address, provides information about health insurance coverage offered to employees and their dependents as required by the Affordable Care Act. This form is not required to be attached to the tax return. If you and your dependents have been covered continuously with qualifying health insurance through the university or elsewhere for the entire 2015 calendar year you will indicate this on your tax return by simply checking a box on Form 1040, 1040A or 1040EZ. Please read the filing instructions or consult with your tax advisor for additional information.
These new 1095-C forms will be mailed to employees’ homes by the March 31, 2016 IRS deadline. Additionally, employees may provide consent to receive their 1095-C form from Boise State electronically through a secured web portal. Instructions for this online access are provided here. If you have questions regarding the 1095-C form, please read these Frequently Asked Questions for the Form 1095-C or check out this “1095-C Decoder” to learn more about the information provided on these forms.
Frequently Asked Questions for the Form 1095-C
The Affordable Care Act requires that most Americans have qualifying healthcare coverage or potentially face a fine. Employers with 50 or more full-time equivalent employees are required to offer healthcare coverage to their full-time employees or potentially face a fine. Much like the Form W-2 is used to determine whether or not you owe taxes, the IRS will use the information you reported from your Form 1095-C to determine whether you (or your employer) may have to pay a fine for failing to comply with the Affordable Care Act.
The Form 1095-C contains important information about the healthcare coverage offered or provided to you by your employer. Information from the form may be referenced when filing your tax return and/or to help determine your eligibility for a premium tax credit. Think of the form as your “proof of insurance” for the IRS.
If you or a family member enrolled in healthcare coverage at any time in 2015, you will receive a Form 1095 from the entity that provided the coverage. For example, if you were determined to be a full-time employee or were enrolled in coverage through your employer, you will receive a 1095-C from your employer.
Did you receive a 1095-C and are wondering what the codes mean? Check out this Form 1095-C Decoder.
The forms are very similar. The main difference is who sends the form to you. The entity that provides you with health insurance will be responsible for sending a Form 1095.
- You will receive a 1095-B from your insurance carrier if you are enrolled in a fully-insured employer sponsored plan.
- You will receive a 1095-C if coverage was provided by your employer.
Applicable Large Employers (ALEs), or employers with 50 or more full-time equivalent employees, are required to send Form 1095-Cs to all full-time employees (those who work an average of 30 or more hours per week) as well as any employee who was enrolled in their health insurance plan. So if you were a full-time employee and/or were enrolled in health insurance through your employer at any time during 2015, you should receive a Form 1095-C.
If you were a full-time employee working an average of 30 or more hours per week and/or were enrolled in health insurance through your employer at any time during 2015, you will receive a Form 1095-C.
If you were not full-time (working an average of 30 or more hours per week in any month) and were not enrolled in healthcare coverage through your employer’s self-insured plan at any time during 2015, you should not receive a Form 1095-C. You may also not receive a 1095-C if you were not the primary insured. For example, you should not receive a form if you were listed as a spouse or dependent under another family member’s plan.
Or, if you were not full-time but were enrolled in a fully-insured plan, you will not receive a 1095-C from your employer. Instead, you should receive a 1095-B from your insurer.
If you are eligible to receive a Form 1095-C, your employer is required to send your Form 1095-C for the 2015 tax year on or before March 31, 2016.
Keep your 1095-C for your records with your other important tax documents. While you will not need to attach your 1095-C to your tax return or send it to the IRS, you may use information from your 1095-C to help complete your tax return. Please consult with your tax advisor.
There are three parts to the form:
- Employee and Employer Information (Part 1) reports information about you and your employer.
- Employee Offer and Coverage (Part 2) reports information about the coverage offered to you by your employer, the affordability of the coverage offered, and the reason why you were or were not offered coverage by your employer.
- Covered Individuals (Part 3) reports information about the individuals (including dependents) covered under a self-insured plan. Boise State’s plan is not self-insured, so this section is not completed for our plan participants. Your 1095-B form that you receive from the insurance company will list all individuals covered under the plan.
Part 3 of your 1095-C will be left blank if:
- No one was enrolled in coverage for any month of the year
- The coverage is through a fully-insured plan
- The coverage is through COBRA
No, you do not need to send a copy of your 1095-C to the IRS when filing you tax return. However, you should keep the form with your tax records.
If you have additional questions, please email BENEFITS@BOISESTATE.EDU and we will do our best to help you. Please note that we may cannot provide tax advice.