Determine If Employer-Based Coverage Meets the Affordability Standard

Affordability Standard Calculator

Open Enrollment is now closed. You can make changes to your benefits if you have a "qualified life event." Learn more on the UVA HR Life Changes webpages.

Employees’ spouses who have access to health benefits sponsored by their employer are not eligible for coverage as a dependent on the UVA Health Plan if that coverage meets the Affordable Care Act affordability and minimum value standards. There are two exceptions: 

  • If your spouse’s employer offers affordable health coverage that provides minimum value but ALL of the employer’s health options are HMOs and your spouse lives outside the HMOs’ defined service areas, your spouse is eligible to be a dependent on your UVA health plans. Documentation from the spouse’s employer is required and can be uploaded as an attachment in the View Summary (electronic signature) page of your benefit event in the Attachments section. 
  • If you are a UVA employee or UVA Medical Center team member whose spouse also works in a benefits-eligible position at UVA or UVA Medical Center, he/she is eligible to be a dependent on your UVA health coverage. You may not add a health benefits-eligible UPG spouse to your UVA health coverage. 
  • NOTE: If your spouse does not currently have access to affordable employer sponsored health coverage but later gains it, this is a qualified life event, and your spouse loses eligibility to remain covered on our Plans beyond the end of the month in which other coverage is gained. You are required to drop your spouse within 60 days of the qualified life event by changing your benefit elections in Workday and uploading any required documentation. Any false statements provided by you relating to spousal health information shall be considered grounds for disciplinary action. The Summary Plan Descriptions contain additional information regarding other possible penalties for insurance fraud. 

Use the following calculator to help determine if employer-based coverage meets the affordability standard as derived from the federal Affordable Care Act. Employer-based coverage is considered "affordable" if it does not exceed 9.96% of the employee's income.

 

 

 

 

 

NOTE: The affordability standard calculator only determines if your spouse’s coverage meets the affordability standard. Check with your spouse’s employer to determine if their employer-sponsored coverage meets the minimum value standard. If either the affordability standard OR the minimum value standard is not met, your spouse is eligible for coverage on the UVA Health Plan.