Patient Protection and Affordable Care Act (PPACA)
The Patient Protection and Affordable Care Act (PPACA), or Health Care Reform law, is federal legislation passed in 2010. The law is complex, multi-faceted, and impacts both employers and individuals. This webpage gives an overview of how the University of Missouri (UM) System is meeting the requirements of the law. Navigate to the information you’re interested in by using these links:
This section describes three steps the UM System is taking to meet the PPACA requirements:
- Offer medical insurance coverage to certain variable-hour employees.
- Establish and administer a measurement system and policies to determine which variable-hour employees are eligible.
- Notify employees of their medical insurance choices, including the federal Health Insurance Marketplace.
In general, the new law requires that employers with 50 or more full-time employees—like the university—offer medical insurance to full-time employees and their children up to age 26. Employers not offering medical insurance may have to pay a penalty to the government.
As you know, the university already offers medical insurance to fully benefit-eligible employees, but the PPACA requires the UM System to also offer medical insurance to some benefit-ineligible, variable-hour employees—specifically those variable-hour employees who work an average of 30 hours or more per week in all jobs over a measurement period (determined by the university in compliance with the PPACA regulations). The UM System began offering medical insurance coverage to variable-hour employees who meet the eligibility criteria during the annual enrollment period for 2015 coverage, which ran from October 20 – October 31, 2014. Eligibility and enrollment information is provided on the medical insurance eligibility webpage.
Of course, the university could not offer coverage without first determining which variable-hour employees fit the eligibility criteria. So, the second step the UM System has taken to meet PPACA requirements has been to set up a measurement system and policies, in compliance with applicable regulations, to determine which variable-hour employees have worked 30 hours per week or more on average during a measurement period. (See the measurement period section of this webpage for a definition.)
Third and finally, the UM System is required by the PPACA to annually notify all employees of their medical insurance options. We notify faculty and staff at the same time they receive information about the university’s annual enrollment process. Which letter you receive depends on whether you are eligible for medical insurance or not. For example, during the enrollment period in October 2014, all employees receive one or the other of these two notices:
- New Health Insurance Marketplace Coverage: Options and Your Health Coverage for fully benefit-eligible and medical-insurance-eligible employees (PDF)
- New Health Insurance Marketplace Coverage: Options and Your Health Coverage for non-benefit-eligible employees (PDF)
The PPACA requires that most Americans have medical insurance coverage. The goal is to ensure that Americans have access to medical insurance they can afford—whether they get it from the university or another employer, a spouse’s or partner’s insurance, an insurance company, or the government. People who are not covered by medical insurance may have to pay a tax penalty. You can access information about the PPACA’s requirements for individuals and families at www.healthcare.gov.
If you are a fully benefit-eligible or medical-insurance-eligible employee of the UM System, the university’s medical plans may offer you the best option for obtaining the required insurance. You may read about our insurance plans on the Benefits homepage, and access tools to help you decide which plan is right for you. Also, keep an eye out for more decision tools in the lead-up to each of the university’s annual enrollment periods. The UM System conducts benefits annual enrollment in the fall of each year, and you will receive many communications to help you prepare for the process.
As explained above, under the PPACA’s requirements, variable-hour employees who work an average of 30 hours or more per week in all university jobs over a measurement period must be offered access to the UM System’s medical plans, although they may decline or waive the coverage. Measurement periods are determined by the university in compliance with PPACA regulations. These measurement periods apply only to variable-hour employees, of course, because fully benefit-eligible employees are eligible for medical insurance by definition. Eligibility and enrollment information is provided on the medical insurance eligibility webpage.
There are two types of measurement periods:
This is a 12-month measurement period that begins on the first day of the month a newly hired, variable-hour employee begins work. For example, if your first day of work was June 16, 2014, your measurement period would run from June 1, 2014, to May 31, 2015.
The UM System measures an employee’s work hours during this period to determine if he or she has averaged 30 hours or more per week. If yes, the university notifies the employee that he or she has become eligible for university medical insurance. The notification explains that the employee will be offered insurance for a full year.
Unlike the ongoing measurement process, which occurs every year, the new-hire measurement process occurs monthly. In other words, every month the university may be offering medical insurance to newly qualified variable-hour employees. Once these newly qualified employees are offered medical insurance once, they join the next ongoing measurement period to see if they will continue to be eligible for medical insurance in future years.
The UM System offers medical insurance to eligible variable-hour employees for 12 months at a time, in accordance with the PPACA. The university re-measures variable-hour employees each year to be sure that these employees should continue to receive insurance in subsequent years.
The university’s ongoing measurement period is the same for everyone, regardless of when each employee was first offered insurance. The period is October 4 of one year to October 3 of the next year (e.g., October 4, 2014, to October 3, 2015).