The Federal Affordable Care Act (ACA) requires changes in workforce management and payroll procedures. The ACA redefines "full-time employee" and changes how benefits eligibility is determined. These changes impact nearly every university department. Maintaining compliance requires collaboration between individual departments, Payroll Services, Human Resources, and several other university offices.
The ACA employer mandate applies to all OU employees who meet the Affordable Care Act’s definition of full-time. For ACA purposes, full-time employees are those who work, or are expected to work, an average of 30 or more hours per week. This includes not only OU’s benefits-eligible employees, but also temporary, part-time, and student workers.
All full-time temporary, part-time, and student employees identified as ACA-eligible will only be offered the university’s high-deductible health plan (HDHP). The HDHP provides affordable minimum essential medical coverage (MEC) to eligible employees and their eligible dependents.
Plan design information for the High-Deductible Health Plan can be found on the medical insurance page. Premium rate information can be found on the Insurance Benefits page.
Benefits eligible employees will be given the opportunity to enroll in benefits either at time of hire or during the university’s annual open enrollment period. When a non-benefits eligible employee meets the ACA definition of full-time employee, Payroll Services will notify the HR Benefits department of those employees. HR Benefits will then notify those employees of their eligibility to enroll in the medical plan. Eligible employees will be given 30 days to respond to accept or to decline coverage.
ACA eligibility is based upon worked hours averages during a specific period of review. A new employee will be reviewed two times during their first year of employment, confirmed eligibility lasts one-year unless found to be eligible under a consecutive period, which would extend ACA eligibility by an additional year from the effective date. All employees are subject to the rules and regulations of the Affordable Care Act regardless of their employment type (Full-time or Part-time). Employees will be notified of ACA healthcare eligibility if they average 30+ hours per week during any of the two review periods listed below:
During the Standard Measurement Period (SMP) all University employees are measured for ACA eligibility. The SMP has a static measurement period annually, each period will begin on November 1st of the current year through October 31st of the following year, example: 11/1/2024-10/31/2025.
If an employee averages 30 or more hours per week during this time, they will become eligible for ACA coverage and will be offered January 1st of the following year. The timeline for processing is listed below:
During the Initial Measurement Period (IMP) all new University employees are measured during their first year of employment for ACA eligibility. The IMP is calculated monthly. For example, if an employee is hired during June (2024) the measurement period will be 7/1/2024-6/30/2025, if found eligible the employee will be offered coverage beginning August 1st, 2025.
If an employee averages 30 or more hours per week during this time, they will become eligible for ACA coverage. The timeline for processing is listed below:
Managers, supervisors, and payroll coordinators can help meet these requirements by taking the following actions.
The ACA defines "full-time employee" as any employee who averages 30 hours or more per week. The ACA requires that the university report hours for all employees and offer employee medical insurance to employees who meet the ACA definition of full-time employee. The ACA reporting requirements require new departmental record-keeping procedures for most employees, except full-time benefits eligible employees (0.75-1.0 FTE).
The university continues to provide employer-based insurance to OU benefits-eligible employees. As a key part of the Affordable Care Act (ACA), people can also consider purchasing health insurance in the Health Insurance Marketplace, also called an insurance exchange.
The Marketplace is designed to help you compare different health insurance options. An initial evaluation by the university and Human Resources has determined that the university-provided coverage continues to be a good value for employees with costs that remain low relative to other available options.
If university managers receive ACA documents on behalf of an employee that ask for plan verification, please forward them to the HR Benefits office on your campus.
This federally required document is sent to employees annually. It introduces the Health Insurance Marketplace and provides information to help you compare plans in the Marketplace. Review the Health Insurance Marketplace Notice.
Coverage begins January 1. The enrollment period is planned for October through December. NOTE: OU's employee insurance coverage also begins January 1, with a shorter enrollment period of Nov. 3-21, 2014.
Yes, OU's plans provide the type of coverage an individual needs to meet the individual responsibility requirement under the Affordable Care Act.
To help you compare options, plans in the Marketplace are categorized as Platinum, Gold, Silver, and Bronze based on how much the plan would pay of your out-of-pocket health care costs. If you get sick, Platinum plans would pay, on average, 90% of your out-of-pocket health care costs. Gold plans pay 80%, Silver plans pay 70%, and Bronze plans pay 60%.
Your options depend on what kind of employee you are.
Yes, affordability as defined by the Act means that the employee pays less than 9.5% of their income towards the cost of their own employee only coverage. Under that standard, all full-time OU employees and half-time graduate assistants have affordable coverage.
Yes, affordability as defined by the Affordable Care Act is based only on the employee-only coverage category.
Yes, a health plan meets this standard if it's designed to pay at least 60% of the total cost of medical services for a standard population.
Based on family size and income. Visit HealthCare.gov for more information. However, since all full-time OU employees and half-time graduate assistants have affordable coverage that meets the minimum value standard as defined under the law (see #4 & 6), no full-time OU employees or half-time graduate assistants will be eligible for a subsidy, even if they would otherwise qualify under the income requirements.
Employees could choose to waive OU coverage and purchase from the Marketplace. However, all full-time OU employees have affordable coverage as defined under the Affordable Care Act; therefore, no full-time OU employees would be eligible for a subsidy.
Yes, you can, and depending on your total family income and family size, you may qualify for a subsidy.
There are several things to consider when comparing plans.
No changes are planned for OU retiree medical insurance at this time. However, the proposed federal rate structure in the Marketplace makes rates for 55-65 year olds lower than OU 's current rates. Consequently, retirees may find it advantageous to enroll their spouse in a Marketplace plan. The impact of the Affordable Care Act on retiree medical insurance will continue to be examined over coming years.
Find information about the Health Insurance Marketplace at HealthCare.gov. Plan descriptions and rates are available in the Marketplace. Generalized comparisons between OU plans and Marketplace plans are not available because options in the Marketplace are based on the unique characteristics of each individual seeking coverage. Individuals can review their personal Marketplace options by visiting HealthCare.gov.
