Affordable Care Act ("ACA") and how it affects your Flex Plan Participation
If you are covered by any type of group insurance (not just from the Flex Plan),
there are no adverse affects of the ACA. If you have or are considering an
Exchange or Individual Policy, please review the questions and answers
below.
For a comparison of Flex Plan group coverage and an Exchange or Individual
Policy please make sure to review:
www.flexplan.com/aca-compare
Questions and Answers
Does the ACA affect me as a participant in the Flex Plan?
Only participants who choose to be covered by an individual policy
(a policy that you obtain as an individual directly from an insurance
company) or participants who elect coverage through one of the
exchanges created by the ACA. Participants who are enrolled in
"group" coverage under any of the Flex Plan insurance contracts,
covered by their spouse, another employer or union's plan will not be
affected.
If I am covered under "group" health insurance through the Flex
Plan, my spouses employer, another employer or union's plan, will
there be any changes for me?
No.
If I am covered by an individual or exchange policy,
will I have access to my employer contributions posted PRIOR to
01/01/2014?
Participants may use account balances from employer contributions
posted PRIOR TO 01/01/2014 for participant and dependent out-of-pocket
medical expenses provided the participant has current insurance
information (group, individual or exchange) on file with the Plan
(Grandfathered Balance Rule). Individual and Exchange premiums
incurred after 01/01/2014 cannot be reimbursed from any employer
contributions.
If I am covered by an individual policy (one that I or my spouse
purchased directly from an insurance company) will there be any
changes to how I can use the Flex Plan?
Yes. The ACA requires that in order to use contributions made
by your employer to the Flex Plan you must
be enrolled in "group" health coverage. If you are
not enrolled in a "group" health insurance plan, you
will automatically be "opted-out". Employer contributions (if any)
will continue to bank in your account and your account will continue
to be subject to administrative fees. You will have access to the
employer contributions when you resume
"group" coverage. You cannot use employer
contributions for reimbursement of premiums or reimbursement of
out-of-pocket medical expenses when "opted-out" (not covered by
"group" insurance).
If you are covered by an individual policy, effective 1/1/2016 you
are no longer eligible to use voluntary pre-tax payroll withholdings
for premium reimbursement. You cannot
use the contributions made by your employer for premium
reimbursement or reimbursement of out-of-pocket medical expenses.
If I enroll for coverage through one of the exchanges made available
under the ACA, will there be any changes to how I can use the Flex
Plan?
Yes. The ACA requires that in order to use contributions made
by your employer to the Flex Plan you must
be enrolled in "group" health coverage. If you are
not enrolled in a "group" health insurance plan, you
will automatically be "opted-out". Employer contributions (if any)
will continue to bank in your account and your account will continue
to be subject to administrative fees. You will have access to the
employer contributions when you resume
"group" insurance. You cannot use employer
contributions for reimbursement of premiums or reimbursement of
out-of-pocket medical expenses when "opted-out" (not covered by
"group" insurance). In addition, you cannot use voluntary
pre-tax payroll withholdings for reimbursement of premiums for
coverage purchased through an exchange.
If I am covered by Medicare, will there be any changes for me?
No. You will still be able to be reimbursed for your Medicare and
supplemental Medicare Premiums from your Flex Plan account as well as
out-of-pocket medical expenses. Here is a link to the Medicare Q&A
page regarding the ACA:
If I am covered by VA (Veterans Administration), will there be any
changes for me?
No. You will still be able to be reimbursed for out-of-pocket medical
expenses. Here is a link to the Veterans Administrations Q&A page
regarding the ACA:
If I'm covered under a group plan and my spouse and/or children are
covered under an individual policy or a policy through an exchange,
can I get reimbursed for their out-of-pocket medical expenses?
No. In this case you could get reimbursed for your out-of-pocket
expenses, but not theirs. Reimbursement of out-of-pocket expenses is
only available to participants and dependents covered by a group
insurance plan. (See question below)
If I have an individual policy or an exchange policy, but my children
are covered under my spouse's group plan (or they are covered by
another group plan), can I get reimbursed for their out-of-pocket
medical expenses?
Yes. In this case you could get reimbursed for their out-of-pocket
expenses, but not yours. Reimbursement of out-of-pocket expenses is
only available to participants and dependents covered by a group
insurance plan. (See question above)
What happens to employer contributions if I'm enrolled under an
individual or exchange policy?
They may be used for dental, vision or disability premiums (group or
individual) or Flex Plan life insurance premiums (group only). Any
unused employer contributions will roll-over to the next year, they
are not lost.
If I have a balance of less than $500 and satisfy the requirements for
reimbursement under the "no-qualify" rules, can I still be reimbursed
for premiums and out-of pocket expenses?
No. In order for the Flex Plan to reimburse premiums or out-of-pocket
expenses, you must be enrolled under a "group" health insurance plan.
If you are not enrolled under a "group" insurance plan, you will be
"opted-out". Your account will remain with the Flex Plan and will
continue to be subject to administrative fees.
