The federal government passed the Affordable Care Act (ACA) on March 23, 2010, to increase access to medical insurance.
This legislation requires:
- Individuals to have minimum essential health coverage through an employer-sponsored health plan, government-sponsored program (Medicare, Medicaid, SHIP, and Tricare), or the Marketplace (October 1 Open Enrollment for January 1 coverage).
- Employers, including Wake Forest University, to track hours for all employees to evaluate benefits eligibility.
Wake Forest has introduced the following Medical Plan enhancements, in conjunction with the ACA:
- Added medical plan coverage for dependent children, up to age 26
- Incorporated out-of-pocket cost-sharing limits
- Expanded coverage for additional preventive care options, clinical trial related services, women’s evidence-informed care and screenings (in-network)
- Removed pre-existing exclusions and lifetime limits on Essential Benefits
- Added a Patient-Centered Outcomes Research Fee of $1 per member per year (ends 2019)
- Began including prescription and office co-pays (office visits, urgent care visits, and emergency room visits) in the out-of-pocket maximum
Employers, including Wake Forest, must offer affordable medical coverage that meets minimum essential value requirements. Low Plan Employee Only coverage fulfills these qualifications; therefore, the majority of University employees are not eligible for Marketplace subsidies.
Wake Forest must offer coverage to any employee (and their spouse and/or dependent children), who averages 30 or more weekly hours, or 130 monthly hours. This is measured: upon hire; after a change in employment status; or during an applicable prior measurement period.
The 2016 employer penalty for non-compliance is 2.5% or $695, whichever is higher. Additionally, there is a tax penalty for individuals who do not have minimum essential health coverage.
If it is determined that a faculty or staff member is ACA-eligible, Human Resources will notify* the individual, offer medical coverage, and send an enrollment form. The individual must complete this form and return it to Human Resources within 10 business days of receiving the notification, even if coverage is waived.
*New hires and individuals with employment changes are notified via email, or certified mail if email is unavailable. Individuals meeting the 30-hour requirement during a prior measurement period are notified via certified mail.
- A higher fringe rate may apply when a faculty or staff member meets the 30-hour requirement.
- Coverage is contingent upon active employment and premium payments.
- Faculty, staff, temporary employees, student employees, and working retirees may receive the 1095-C tax form, with important coverage information. The form will be sent to the home residence, so individuals should ensure Human Resources has their current address on file.
- Departments hiring students are responsible for reviewing all jobs for the individual prior to hiring them. If they have another job, contact Human Resources to review potential hours in the new position.
Frequently Asked Questions
Wake Forest University:
- Health Care Reform and Your Benefits
- New Health Insurance Marketplace Coverage Options and Your Health Coverage
Wake Forest University Human Resources
P.O. Box 7424, Winston-Salem, NC 27109
askHR@wfu.edu | P 336.758.4700 | F 336.758.6127