The federal Affordable Care Act ("ACA") requires that nearly all individuals (who are above the threshold for filing income tax) must obtain health insurance for themselves and any of their dependent family members. The following plans will satisfy this individual responsibility requirement:

• State of Illinois health insurance plans offered through the Department of Central Management Services ("CMS") based on University employment, which include:
  • Aetna HMO
  • Blue Advantage HMO
  • Health Alliance HMO
  • HMO Illinois
  • Aetna OAP
  • HealthLink OAP
  • Quality Care Health Plan (QCHP/Aetna)
• RSL BasicCare Program, Essential Plan
• Student Health Insurance plan offered based on student enrollment, which include:
  • Urbana: UnitedHealthcare
  • Chicago: Campus Care
  • Springfield: Academic Health Plans

The following types of health insurance coverage will also satisfy the individual responsibility requirement as long as the insurance qualifies as "minimum essential coverage" under ACA (contact the plan directly to find out if it qualifies):

• Health insurance provided by a parent/guardian, spouse, or other family member who claims you as a dependent
• Another employer-provided health insurance plan, if your primary employment is somewhere other than the University
• Private health insurance coverage purchased independent of employment

If you have questions about your employment status, please contact your university HR office.

If you have questions about your health insurance coverage offered through CMS, please contact University Payroll & Benefits.

FAQs

Where can I read the Notice?

You can find the Insurance Marketplace Notice online.

Why am I, as a new University employee, receiving this notice?

ACA requires the University, as your employer, to provide you with information relating to the Health Insurance Marketplace ("Marketplace"). The notice provides basic information about the Marketplace and how it may relate to coverage that is offered to eligible employees.

Why does ACA require me to purchase coverage or pay a fee if I don’t have coverage?

The rationale for requiring nearly all individuals to purchase coverage is that having a larger pool of individuals (both healthy and sick people) will reduce the overall cost of providing health care in this country. Other ACA requirements, such as prohibiting denial of coverage based on pre-existing conditions and removing annual and lifetime limits on coverage, provide increased protections to those who might otherwise not be able to obtain coverage. ACA attempts to create incentives for healthy individuals to obtain coverage and to guard against the adverse financial consequences of unexpected health care costs resulting from significant illness or injury.

If you choose not to obtain coverage for yourself and/or any dependents despite the individual responsibility requirement, you must pay a fee when filing your income taxes. The IRS administers the fee, which increases every year.

What if I already have insurance?

If you participate in a State of Illinois health plan offered through CMS, through University student insurance, or you have coverage that meets the minimum essential coverage requirements through another employer, a spouse, parent, or other family member, then you do not need to take any action as long as you and your dependents maintain health insurance coverage.

What if I already have health insurance, but I would rather purchase coverage through the Marketplace?

You may be able to change to Marketplace coverage if you desire to do so. However, if you are eligible for coverage offered through CMS and choose to purchase a health plan through the Marketplace instead, then you will lose vision and dental coverage provided through CMS, and you will also lose any employer contribution for CMS coverage. In addition, while both the employer contribution and your employee contribution to CMS coverage are typically excluded from income for Federal and State income tax purposes, your payments for coverage through the Marketplace will be made on an after-tax basis.

If you are eligible for the University’s RSL plan and choose to purchase through the Marketplace instead, then you will lose the employer-paid premium for employee only coverage.

Am I required to give up my current coverage?

No. If you have coverage that qualifies as minimum essential coverage under ACA, then you satisfy the individual responsibility requirements for yourself. State of Illinois health plans offered through CMS and the University’s RSL BasicCare Program, Essential Plan qualify as minimum essential coverage.

What if I don’t have coverage?

ACA requires nearly all individuals who are above the threshold for filing income tax to obtain minimum essential coverage for themselves and any of their dependent family members or pay a fee when filing income tax returns. If you are not eligible for CMS coverage  or the RSL BasicCare Program based on your University employment or student status, and you do not otherwise have coverage through a spouse or other family member, then you should carefully review the Insurance Marketplace Notice and understand your option to purchase health insurance through the Marketplace.

If you were eligible for health insurance coverage through CMS or the RSL BasicCare Program but declined or opted-out of that coverage and do not have any other health coverage through a spouse or family member, then you can elect coverage through the respective open enrollment period for each program to satisfy your individual responsibility requirement under ACA:

• CMS during the May Benefit Choice period (or when experiencing a qualifying event)
• RSL BasicCare during the November open enrollment period

Please note that the individual responsibility requirement under ACA is NOT a qualifying event for these health plans.

If you decide to remain uninsured, you and any uninsured dependents will be required to pay a fee when filing your income taxes. The IRS administers the fee, which increases every year.

See also – Student FAQ: What if I don’t have insurance?

I work at the University but I’m not eligible for health plan coverage. Does this mean I’m now eligible?

Not necessarily. The State of Illinois Group Insurance Act establishes eligibility for CMS health plans; the University established eligibility for RSL BasicCare Program based on ACA requirements. If you are unsure whether you are eligible for health insurance coverage based on your University employment, please contact your supervisor or your unit’s hiring manager with questions. If you have questions about your employment status, please contact your campus/central HR office at the number noted above.

I waived CMS insurance as a part-time employee and now I want to reinstate coverage. When can I elect it - do I have to wait until I experience a qualifying event or until the next annual Benefit Choice period?

If you are a part-time employee (working 50% to 99% of a normal work period) who declined health insurance through CMS previously, you can elect coverage through CMS during the Benefit Choice period, typically held in May, or earlier if you experience a qualifying event, to meet your individual responsibility requirement under ACA. Please note that the ACA individual responsibility requirement is NOT a qualifying event for CMS health plans.

What happens if I do not comply with ACA’s individual responsibility requirement?

If you do not have coverage in 2018, you must pay a fee when you file your income taxes. Final 2018 fee rates are not yet available; 2017 fees were $695 per adult ($347.50 per child) or 2.5% of yearly household income, whichever is higher. The maximum fee for a family is $2,085, or the amount of total yearly premium for the national average price of a Bronze plan sold through the Marketplace. These fees will increase annually.

I am already covered by a CMS health plan or another healthcare plan that meets the minimum essential coverage requirements. Do I have to do something with the Marketplace to prove I have insurance?

According to the Internal Revenue Service (IRS), you will not have to prove coverage (or pay any fees) until you file your 2018 federal income tax return in 2019. For more information, please visit the IRS website. For the tax filing thresholds for most taxpayers, see this chart. Please consult with your tax advisor regarding your tax filing status.

What are the deadlines for enrolling family members and/or me in insurance?

Not Eligible for CMS: If you are not eligible for coverage through CMS or the University’s RSL BasicCare Program based on your University employment and you do not otherwise have health insurance coverage through another employer, a spouse, parent, or other family member, then you have the option to purchase health insurance through the Marketplace during the annual open enrollment period that typically begins each November.  If you have life changes, like losing health coverage or having a baby/adopting a child, or qualify for Medicaid or CHIP, you may qualify for a special enrollment period.

Eligible for CMS: If you were eligible for coverage through CMS, but declined or opted-out of that coverage and do not have any other health coverage through a spouse or family member, then you are required to have coverage. To satisfy your individual responsibility requirement under ACA, you can elect coverage through CMS during the Benefits Choice period, typically held in May, for coverage effective July 1, or earlier if you experience a qualifying event. For example, if you are a part-time employee (working 50% to 99% of a normal work period) who declined health insurance through CMS previously, then you can elect coverage through CMS during the Benefit Choice period, typically held in May, to meet your individual responsibility requirement under ACA. Please note that the ACA individual responsibility requirement is NOT a qualifying event for CMS health plans.

Eligible for RSL BasicCare Program: If you were eligible for coverage under the RSL BasicCare Program but declined that coverage and do not have any other health coverage through a spouse or family member, you can elect coverage during the annual open enrollment period that typically occurs in November. If you experience a qualifying event, you may elect coverage earlier than the open enrollment period. Please not that the ACA individual responsibility requirement is NOT a qualifying event for RSL BasicCare Program.

Eligible for Student Insurance: If you are a student who plans to continue academic enrollment at the University, then you may have until August 2018 to elect health coverage under the student insurance plan. Please see the Student FAQ for more information.

Can my dependents be covered through the Marketplace if I am not getting insurance through the Marketplace?

Based on the currently available information, health insurance plans will be available through the Marketplace for you to cover your dependent family members. Please contact the Marketplace at HealthCare.gov for coverage in any state or go directly to GetCoveredIllinois.gov for coverage in the State of Illinois for more information.