Which of the following individuals will be eligible for coverage on the health insurance Marketplace

Under the Affordable Care Act (ACA), when you complete your tax return, you will be required to indicate whether or not you (and your eligible dependents) had qualifying medical coverage for all of prior calendar year. The University will send you a tax form, Form 1095-C, which includes information about the health coverage offered to you by the University. In some instances, our insurance carriers will be sending you Form 1095-B. You may receive one or both of these forms. 

It is not necessary for you to wait until you receive these forms to file your tax return. While the information on the forms may assist you in preparing your return, the forms are not required. Similar to last year, you can prepare and file your return using other information about your health insurance.

Note: If you are not considered a full-time employee under the ACA rules, you may not receive these forms, or you may only receive one form.

FAQS

What information does Form 1095-C contain?

  • Your name, Social Security number and address
  • Your Employer’s name, Employer Identification Number (EIN) and address, and
  •  Information about health coverage that the University offered you and your dependents during the prior calendar year and that you were enrolled in during that year.
  • For an example form, click here. 

What information does Form 1095-B contain?

  • Your name, Social Security number and address, as well as your dependent’s names and Social Security numbers or date of birth, and
  • Information about the health coverage you and your dependents, if applicable, were enrolled in during the prior calendar year.
  • For an example form, click here. 

Who will receive a Form 1095-C or 1095-B?
The following individuals will receive a Form 1095-C from the University:

  • Employees eligible for health coverage under any of the following health plans offered by the University:
    • Enhanced 80/20 Plan
    • Traditional 70/30 Plan
    • High Deductible Health Plan
  •  Former employees who were eligible and/or enrolled in University-sponsored health coverage during the prior calendar year, either as active employees and/or COBRA participants
  • Other employees determined to be a full-time employee under the ACA rules

The following individuals will receive a Form 1095-C from the State Health Plan:

  • Retirees under age 65 enrolled in the Enhanced 80/20 Plan, or Traditional 70/30 Plan
  • Retirees 65 or older enrolled in the Traditional 70/30 Plan

The following individuals will receive a Form 1095-B from another organization, not UNC:

  • Retirees enrolled in the State Health Plan Medicare Advantage Plan will receive a 1095-B from the Medicare Advantage Insurer (either Humana or United Health Care)  
  • Students enrolled in the UNC Student Health Insurance Plan will receive a 1095-B from Blue Cross / Blue Shield of North Carolina

The following will receive a Form 1095-C from the University and a Form 1095-B from Blue Cross / Blue Shield of North Carolina:

  • Postdoctoral fellows eligible for health coverage under the UNC Postdoc Medical Insurance Plan

When will I receive the forms?
The form(s) will be mailed to your home address at the end of January.

What do I need to do?
When you receive the form(s), save them with your other important tax records. You will not need to attach or file the forms with your federal income tax return.

If you (and your eligible dependents) were enrolled in the health plan provided by the University for all of the prior calendar year, you can indicate on the appropriate line of the IRS Form 1040, 1040A or 1040EZ that you (and your eligible dependents) had qualifying medical coverage.

If you (or your eligible dependents) did not have health coverage for all of the prior calendar year, you may be assessed a tax penalty unless you qualify for an exemption. 

Note: Under passage of tax reform legislation at the end of 2017, the requirement for each individual to obtain health coverage or pay a penalty will no longer be in effect beginning 2019. The individual mandate will continue to apply for 2017 and 2018.

If I cover my dependents under the health plan provided by the University, will they receive a separate Form 1095-C or 1095-B?
Generally no. Coverage for both you and your eligible dependents will be included on the form(s) sent to you.

Note: If your eligible dependents file separate tax returns, they will need to provide information about their medical coverage when completing their tax returns. You can provide a copy of the form(s) to your eligible dependents; however, they do not need the form(s) to complete their individual tax returns. They can prepare and file their returns using other information about their health insurance.

Questions?
More information on Forms 1095-C and 1095-B are available on the IRS website. 

What is eligible insurance?

Conditions that must be met in order for an individual or group to be considered eligible for insurance coverage. Eligible Dependent: A dependent (usually spouse or child) of an insured person who is eligible for insurance coverage.

What plans do not qualify as coverage under the ACA?

What plans are not considered minimum essential coverage? Policies that are not major medical coverage and not regulated by the ACA do not count as minimum essential coverage. This includes discount plans, limited-benefit plans, critical illness plans, accident supplements, and dental/vision plans.

What are five things that would be covered under basic health insurance?

These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.

What is the lowest income to qualify for Obamacare?

Generally, if your household income is 100% to 400% of the federal poverty level, you will qualify for a premium subsidy. This means an eligible single person can earn from $12,880 to $51,520 and qualify for the tax credit. A family of three would qualify with income from $21,960 to $87,840.

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