A 1095-C form, also known as Employer-Provided Health Insurance Offer and Coverage Insurance, is an IRS tax form that provides all benefits-eligible employees with information about the health coverage offered by DPS. This form may help you to determine eligibility for tax credits.
Benefit Credits +
Benefit credits are what DPS contributes to offset your cost for premiums for medical, dental and vision plans. Most employees are eligible to receive them. The amount varies by employee association and how many hours you work a week. See the Benefits Enrollment Guide for detailed information.
- If you started working at DPS on or after June 1, 2017, or you are a member of DCTA or FMA and started at DPS on or after June 1, 2018, you must enroll in a DPS major medical plan to receive benefit credits.
- If you started working at DPS before June 1, 2017, or you are a member of DCTA or FMA who started at DPS before June 1, 2018, and you receive benefit credits, you will continue to receive them, even if you waive DPS medical coverage.
- Exception: If you are a member of ATU and started working on or after June 1, 2017, you are eligible to receive benefit credits, even if you waive DPS coverage. However, you will not receive the additional $65.50 subsidy per paycheck toward coverage for dependent children.
Child Subsidy +
Most employees qualify to receive $96.75 per paycheck to offset the cost of premiums for medical plans that cover children. The exception is ATU employee association members who receive $31.25 per paycheck.
After you meet your deductible, coinsurance is when you and your insurance provider share the costs of your medical care. You pay a percentage (usually 20-30%) and your insurance provider pays the remaining amount until you hit your out-of-pocket maximum.
A copay is a fixed payment you pay for a covered service. For example, if you have a DHMO plan, you may pay a $40 copay to see your primary care physician.
Your deductible is the amount you pay out-of-pocket before your insurance provider pays a portion of the bill. If you enroll in a DHMO plan, there are certain benefits (i.e. office visits and prescriptions) where the deductible doesn’t apply.
Dependent Care Flexible Spending Accounts +
Through a Dependent Care FSA, an employee can pay for eligible health care and dependent care expenses (such as child care) with pre-tax dollars. *Allowed if you are enrolled in or not enrolled in an HSA
Embedded and Non-Embedded Deductibles +
An embedded deductible or out-of-pocket maximum applies to all plans except the $1,350 CDHPs. That means:
- If you cover your family (spouse and/or children), all eligible medical costs for each family member will count toward meeting the family deductible. However, an individual will not have to pay more than the individual deductible.
- Your insurance provider begins paying coinsurance for family members covered by your plan who meet their individual deductibles, or when you meet your family deductible.
- The same is true for out-of-pocket maximums: your insurance provider begins paying 100% of your medical care costs for family members who meet their out-of-pocket maximums, or when you meet your family out-of-pocket maximum.
A non-embedded deductible or out-of-pocket maximum only applies to the $1,350 CDHPs. That means:
- If you cover your family (spouse and/or children), the family deductible must be met either by one individual, or by a combination of family members, before the plan begins to pay.
- This means one insured person might hit their $1,350 deductible, but your insurance provider won’t pay coinsurance until you meet your $2,700 family deductible.
- This applies to the out-of-pocket maximum as well: you must meet your total family out-of-pocket maximum ($5,400) before your insurance provider begins paying 100% of your medical care costs.
Employee Association (Union) +
Every team member at DPS is represented by an employee association (also known as a bargaining unit or union). Your role at DPS determines which employee association you belong to. For example, a teacher is part of the DCTA employee association.
Health Savings Account (HSA) +
A Health Savings Account (HSA) is a personal bank account to help pay for qualified expenses not covered by medical, dental or vision insurance plans with pre-tax dollars. Each year, the money in your HSA rolls over. There is no “use it or lose it provision.” In fact, even if you leave DPS, your HSA and the money in it is yours to keep.
Healthcare FSA +
The Healthcare FSA allows you to set aside money from your paycheck, before income taxes are withheld, to pay for eligible out-of-pocket expenses, such as deductibles, copays and other health-related expenses, that are not paid by medical, dental or vision plans. *Not allowed if you are enrolled in an HSA
HSA-Compatible FSA +
An HSA-Compatible FSA can only be used to reimburse dental and vision expenses. Funding an HSA-Compatible FSA may be a good idea if you anticipate significant out-of-pocket dental and vision expenses in the coming year. *Allowed only if you are also enrolled in an HSA
Flexible Savings Account (FSA) +
A Flexible Spending Account (FSA) is a pre-tax benefit account used to pay for eligible medical, dental and vision care expenses that aren’t covered by your insurance plan or elsewhere. You are able to access your full annual election amount starting on the first day of your plan year. You will lose any unused balance, over $500, at the end of the plan year. In most cases, if you leave DPS you will lose your FSA unused balance. DPS offers three FSA options.
Medical Subsidy +
Employees who don’t qualify for benefit credits may qualify for a medical subsidy, which is a discount off the cost of your premiums for medical plans. Please consult the Benefits Guide to determine if your employee associate qualifies for a medical subsidy.
Out-Of-Pocket Maximum +
This is the maximum you pay out-of-pocket for medical care. Any charges above this amount are paid 100% by your insurance provider for the rest of the plan year. Deductibles, coinsurance and copays are all included in our plans’ out-of-pocket maximums.
Pre-Tax Benefit Deductions +
The cost of your benefits is deducted from your paycheck before taxes are calculated, and you are therefore only taxed on your remaining paycheck balance. You pay less taxes with this option.
Post-Tax Benefit Deductions +
The cost of your benefits is deducted from your paycheck after taxes are calculated. You pay more taxes with this option.