Affordable Care Act Individual Mandate
The Affordable Care Act requires individuals to obtain “minimum essential coverage.” Beginning with the 2019 tax year, individual will no longer be penalized for failing to obtain acceptable health insurance coverage for themselves and their family members.
Summary of Benefits
|Benefits Provided at No Cost to You||Benefits You Contribute to|
• Tobacco cessation medications
• 24/7 nurse hotline
• Health screenings
• Preventive/Wellness visits
|Health and Prescription Drugs
• UnitedHealthcare Exclusive Provider Organization (EPO) Plan
|Basic Life Insurance|
• 4 x annual salary (reduces with age) up to $500,000 plus $10,000
• UnitedHealthcare Preferred Provider Organization (PPO) Plan
|Basic Accidental Death & Dismemberment (AD&D) Insurance|
• UnitedHealthcare Spectera
• Up to 40% of your base pay, up to a maximum of $6,000 per month
• Additional 10% or 20% available for purchase
• Catalyst Health Network, including Village Health Partners Primary Care- $5
• Village Health Pediatrics - $5
• CVS MinuteClinic - $5
• Doctor on Demand - $5
• Airrosti - $15
|Employee Assistance Program (EAP)|
• Six free confidential counseling sessions per event for you and your family members
• Free online tools and legal documents
• Legal discounts
• Mental health, financial, and legal advice
|Flexible Spending Accounts (FSA)
• Health Care FSA
• Dependent Care FSA
|Medical Case Management/Nurse Navigator|
• Communitas, Inc.
• Certified RN Case Managers
• Major disease and illness
• American Fidelity
• Reimburses you for doctor visits, outpatient treatment, and inpatient visits
Proof of Dependent Eligibility
Employees need to provide proof of eligibility documentation (i.e, birth certificate, marriage license, etc.) when adding new dependents to their benefits coverage (this also applies if dependents are removed from coverage and then re-enrolled at a future date). This requirement ensures legal compliance and aids in the City of Plano’s continuing efforts to control health care costs.
Newborns are not automatically covered by the medical plan. You must contact Human Resources to enroll your child within 31 days of birth to elect coverage for the infant.
You may also cover these eligible dependents:
- Your legal spouse
- Your domestic partner
- Your eligible children up to age 26
“Children” are defined as your natural children, stepchildren, legally adopted children, children for whom you are the legal guardian and domestic partner’s children
- Physically or mentally disabled children of any age who are incapable of self-support
Note that both employee and domestic partners must submit copies of driver’s licenses listing a common address AND at least one document of proof from the list below:
- Proof of the same residency for at least six (6) months naming/listing both partners. Examples: joint deed, mortgage agreement, or rental agreement.
- Bills with at least six (6) months of history naming both partners. If bills only include one partner, additional bills listing the second partner must be submitted. Examples: utility bills, credit card statements, etc.
Qualified Status Change
Modification of Coverage Due to a Qualified Status Change
Once you make your benefit elections, these choices will remain in effect until the next plan year; unless you have a qualified status change or your dependents become eligible for coverage.
If you have a qualified status change or another allowable event, you can make those changes during the plan year.
However, you must make enrollment change within 31 days of the event by completing a Benefits Change Form and returning it to Human Resources. If you do not return your form within 31 days, you will have to wait until the next Open Enrollment to make new elections.
Qualified status changes include, but are not limited to:
- Change in eligible dependents due to birth, adoption, placement for adoption or death
- Gain or loss of dependent status (i.e., your child reaches the age limit for eligibility)
- Change in legal marital status, including marriage, divorce, or death of a spouse
- Change in domestic partnership status
- Change in employment status, such as starting or ending employment, for you, your spouse or your children that includes a gain or loss of coverage
- End of the maximum period for COBRA coverage
The Benefits Change Form can be found at plano.gov/benefits.
Special Enrollment Rules
If you choose not to enroll yourself or your dependents (including your spouse/domestic partner) because you have other coverage, you may be able to enroll yourself and your dependents at a later date if:
- You or your dependents lose Medicaid or Children’s Health Insurance Program (“CHIP”) coverage as a result of a loss of eligibility for such coverage, or
- You or your dependents become eligible for a premium assistance subsidy under Medicaid or CHIP.
You must enroll within 60 days of one of these qualifying events. If your dependent also had other health coverage and lost that coverage in the above situations, they may be added to your plan. However, you may not be able to add yourself or your dependents to this coverage if the other coverage was terminated “for cause” (including failure to pay the required premiums on time). If you have a special enrollment event and want to sign up for health coverage, email [email protected].
Individuals who turn 65 and become Medicare eligible will need to apply for Medicare Part A. The City of Plano will provide your primary insurance coverage and Medicare will be secondary.