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Health Care Reform

Health Care Reform

Health Care Reform / Affordable Care Act (ACA)

Welcome to the School District of Philadelphia's “Health Care Reform / Affordable Care Act” page!

 

General Information

Please click on the links below for more information on how this program:

General Information

In March 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (ACA), into law. The law makes preventive care-including family planning and related services-more accessible and affordable for many Americans.  While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years.

What happened so far?

So far, the following benefit enhancements have been made to the SDP's medical coverage:

July 2011

  • Eligible dependents covered until age 26, regardless of student status.
  • Plans added 100 % coverage for designated preventive care from in-network providers.

January 2013

  • We voluntarily included on your 2012 W-2, the cost of your employer-provided health care coverage.
  • Effective for tax years beginning after December 31, 2012, employees' maximum annual pretax contribution into a health care FSA is capped at $2,500.

July 2013

  • Women's Preventive Services, including Birth Control coverage with No Cost-Sharing.
  • Published Uniform Summary of Benefits and Coverage (SBC).  These are available through your ibxpress.com login.  A printed copy can be obtained from the site or by calling 1-800-ASK-BLUE 

What's Next?

  • Open enrollment in the Health Insurance Marketplace begins on October 1, 2013.
  • Starting in 2014, if you are not eligible for insurance from the SDP, you will be able to buy it directly in the Health Insurance Marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards.
  • In 2014, the District must automatically enroll newly hired eligible and newly eligible full-time employees into a default health plan that provides "affordable" coverage.

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What's Happening Now?

In anticipation of the Health Insurance Marketplace Open Enrollment, the SDP is providing employees with an "Exchange Notice" that explains your benefits eligibility.  You'll find the following on our website:

  • An exchange notice about your benefits eligibility based on your position.
  • Links to your plan's Summary of Benefits.
  • Information on the any premium you may pay for your coverage.

This information is provided to help you evaluate options for you and your family.  If you are enrolled in the SDP Sponsored Keystone HMO, Personal Choice or the 32BJ sponsored Keystone POS plan, these plans currently meet the "minimum value" and "affordability"* requirements set forth in the Affordable Care Act.  

* It seems unlikely that an individual covered under our current plan would be paying 9.5% of his salary for single only coverage.

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Where is my Exchange Notice?

Under the Affordable Care Act (also known as the ACA and federal healthcare reform), The School District of Philadelphia, as your employer, is required by the U.S. Department of Labor to provide you with an Exchange notice.

As you read the federally required notice, keep in mind that, under the ACA, any employee who has access to affordable coverage (as the law defines it) is not eligible for subsidized coverage through a state health insurance marketplace. 

Because all employees eligible for coverage are offered the Keystone HMO15 a little or no cost, all such employees have access to affordable coverage under the law and thus (i) do not qualify for subsidized coverage through an exchange and (ii) will not be eligible for a tax credit.

To view your Exchange Notice, click on this link Exchange Notice

Email us at Benefits@philasd.org or visit our office during walk-in Customer Service Hours: Monday through Thursday: 9AM to 5PM if you need a printed copy.  

If you have general questions about healthcare reform or the operation of state health insurance marketplaces, we encourage you to check the following resources:

HealthCare.gov

Toll Free Call Center Available 24/7 1-800-318-2596

Visit the Healthcare Reform FAQ page

  

Am I Eligible for Coverage?

Currently employees classified as the following are not eligible for medical coverage provided by the SDP:

  • Hourly or Daily Employees
  • PFT Support of Services Assistants (SSA)
  • Noon Time Aides (unless assigned to Early childhood location for 5 or more hours)
  • Food Service Workers appointed to less than 5 hours

Based on job classifications and the Collective Bargaining Agreements in which the School District of Philadelphia participates, the following employees are eligible for medical coverage after any applicable probationary period.

  • Food Service Workers appointed to 5 or more hours
  • 5 hour Early Childhood Noon Time Aides
  • Non-represented Employees
  • Employees represented by CASA, the Commonwealth Association of School Administrators
  • Employees represented by 32BJ SEIU / District 1201
  • Employees represented by SPAP, the School Police Association of Philadelphia
  • Appointed Employees represented by PFT, the Philadelphia Federation of Teachers

What are the premiums for coverage?

FAQs

What are my Benefits?  Click on your plan below:

Personal Choice® PPO

Keystone Health Plan East HMO

Keystone Health Plan Direct POS (32BJ)

If you have questions or need help, please contact the Employee Benefits Office at 215 400-4630 or email Benefits@philasd.org

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Where can I learn more?

HealthCare.gov

Independence Blue Cross

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