Health Care Reform (ACA)

The Affordable Care Act (ACA) generally requires that individuals and their dependents have qualifying health care coverage that meets minimum value standards. This requirement is commonly referred to as the “individual mandate.” Swarthmore College’s health plans exceed the required minimum value standards set by ACA.

There are reporting requirements for employers to meet under ACA. A tax form called the 1095-C will be sent to all fulltime employees who are currently enrolled in any of Swarthmore College’s medical plans or who have been offered coverage under Swarthmore’s medical plans. Employers are required to send the 1095-C to employees by early March, however, the College’s forms will be mailed to applicable employees by the end of February.

These forms should be retained as support for the responses required on your individual tax return, however, it is not required that the forms be submitted with your tax filing. For more detailed information regarding the ACA, please see the Frequently Asked Questions below, or contact the Human Resources Office at benefits@swarthmore.edu.

1095-C Form

If I have enrolled mid-month, how is that recorded on the Form 1095-C?

Part III will indicate that you had coverage for each month in which you were enrolled for at least one day.

If I change my health coverage during the year, and I end up with a gap when I am not covered, do I owe any taxes/penalties?

Please check with your tax advisor as to whether you may owe taxes or penalties.

How do I know the health coverage offered by my employer provided minimum value?

Minimum value means that the plan pays at least 60% of the costs of benefits. Swarthmore College’s health plans provide minimum value.

I am a full-time employee and had a prior employer in the same year, what should I be receiving?

You will receive a Form 1095-C from Swarthmore College for the period you were employed at Swarthmore College. Depending on the type of insurance offered by your prior employer, you should also receive a Form 1095 from them.

What documents do I need to keep handy for my income tax return?

You should keep the Form 1095-C as support for your responses on your IRS income tax return. It is not required to be submitted by you to the IRS. Swarthmore College will file Form 1095-C with the IRS. Please consult with your tax advisor as to how long you should retain this information in your files.

What is included on the form?

While each individual’s situation may be different, if you had employer-provided or employer sponsored health coverage for all 12 months of the previous year that met the ACA requirements, essentially the form reports to the IRS that this is the case. Form 1095 may include some of the following:

  • the months during the previous year that you were offered employer provided or employer sponsored health coverage, and,
  • for a full-time employee (as defined in the ACA), the single-only premium for the lowest cost, minimum value coverage option made available to you by your employer during each month of the previous year
    • Note: this may not be the health plan option that you actually enrolled in
    • For example, you may have enrolled in the family coverage option and not the self-only coverage one.

 

About the ACA

What is the ACA employer shared responsibility provision?

Employers decide if they want to offer affordable Minimum Essential Coverage (“MEC”) that provides minimum value to their full-time employees and their dependents, or risk being assessed shared responsibility payments by the IRS. Depending on its decisions about offering MEC to its full-time employees and their dependents, an employer may be subject to one of two potential employer shared responsibility payments.

Are children subject to the individual shared responsibility mandate?

Each child must have Minimum Essential Coverage or qualify for an exemption for each month of the calendar year. If you have any questions concerning the shared responsibility rules pertaining to dependent children please contact your personal tax advisor.

Where can I find Marketplace information?

www.healthcare.gov will provide information and links to the state exchanges.

How do I know the health coverage offered by my employer provides minimum value?

All of Swarthmore College’s health plans provide minimum value. Minimum value means that the plan covers at least 60% of claims.

Can I purchase coverage from the Exchange for a lower price for myself, spouse and/or dependents?

You can purchase healthcare coverage from any source you choose: Swarthmore College, private insurance, from the marketplace, etc. The marketplace or “Exchange” is the Government (Federal/State) website that provides options for purchasing coverage. If you are looking for a lower cost, you would need to compare what is being offered from these different sources. If you are already covered under Swarthmore College health coverage, you can only decline coverage at the next annual open enrollment unless you have a qualifying life event.

Affordability

I don’t think my health coverage is affordable. How was this calculated?

We are required to use the IRS’s methods for determining whether coverage is affordable. Affordability is calculated by starting with the lowest cost of self-only coverage that was offered to you – keep in mind this may not be the coverage that you elected. In order to be affordable, this lowest cost of single only coverage must be 9.5% or less than the wages reported in box 1 of your Form W-2.

My share of premiums is higher for family coverage compared to self-only coverage, does this meet the affordability requirements?

Affordability is determined under ACA rules and is based on the lowest cost self-only coverage, regardless of what coverage you have selected.

The premium that I pay is higher or lower or is more than 9.5% (as indexed for inflation) of my Form W-2 wages, how did you calculate affordability?

Affordability is determined by ACA standards by using the lowest cost self-only premium that is offered to our employees – which may be different than the coverage you selected. Swarthmore College qualified for the Federal Poverty Line safe harbor. Swarthmore College’s lowest cost single-only coverage meets this threshold.

Minimum Essential Coverage

Is my coverage Minimum Essential Coverage? What is MEC?

Yes, Swarthmore College’s coverage provides Minimum Essential Coverage (MEC). MEC is qualifying health coverage. You are considered to have MEC for the entire month as long as you are enrolled in a plan or program that is MEC for at least one day during that month.

MEC includes:

  • Most health insurance coverage provided by an employer,
  • Health insurance purchased through the Health Insurance Marketplace (“Marketplace”),
  • Coverage provided under a government-sponsored program (including Medicare, Medicaid, and health care programs for veterans),
  • Health insurance purchased directly from an insurance company, and
  • Other health insurance coverage that is recognized by the Department of Health & Human Services as MEC.

Other Employee Classifications

I retired last year, what do I do with this Form?

You should keep the Form 1095-C as support for your responses on your IRS income tax return. The Form is backup support, much like a W-2 for your tax return. Please consult with your tax advisor as to how long you should retain this information in your files.

What action needs to be made for a deceased employee?

A deceased employee will receive a Form 1095 from Swarthmore College for the period they were an employee. This will need to be referenced when completing the final tax returns for this individual.

I am a retiree, should I be getting the Form 1095-C?

For the year you retire you will receive a Form 1095-C from Swarthmore College that reports part of the year as an employee.

I am enrolled in COBRA, should I be getting the Form 1095-C?

If you were enrolled in COBRA for any portion of the previous year, you will receive a Form 1095-C from Swarthmore College.