Monday, November 15, 2010

2010年3月23日法案頒布/ Upon enactment March 23, 2010

2010年3月23日法案頒布/ Upon enactment March 23, 2010
自動投保流程- 員工人數超過200人的雇主,必須在任何新進全職員工符合承保資格時,盡快未其投保,而員工不得選擇不參加承保。Automatic enrollment* process - Employers with more than 200 employees must
automatically enroll all new full-time employees as soon as they are eligible for
coverage, and employees may opt out of coverage.

2010年3月23日法案頒布後90天/ 90 days following enactment on March 23, 2010

•退休人員暫時再保方案/Temporary retiree reinsurance program
•高分險分攤/High risk pool

2010年9月23日當天或之後/ On or after September 23, 2010 

成人子女承保上限為26歲/Adult children coverage to age 26
年度上限僅適用非基本福利(待定義)/Annual limits only allowed on non-essential benefits (to be defined)
基本福利不得規定終身上線/No lifetime limits on essential benefits
不得有未滿19歲計畫參加者的寄有病況排除規定/ No pre-existing condition exclusions for enrollees under age 19
不得撤銷承保(主要針對個人承保及小型團體承保)No rescissions (primarily individual and small group coverage)
特定預防照護享有全額承保/ First dollar coverage for certain defined preventive care**
須有外部上訴流程/ External appeal process required**
不歧視規則擴大適用於被保計畫/ Non-discrimination rules extended to insured plans**
急診服務不需事先授權/ 視為網絡內治療/Emergency services without prior authorization/treated as in-network**
可選擇子女的小兒科醫師為其主治醫師/ Child's pediatrician may be chosen as the primary care physician**
女性可選擇其產科/婦科醫師,不需轉介或事先授權/A woman can choose her OB-GYN without referral or preauthorization**

2011年1月1日/ January 1, 2011

• 除非是醫師開立處方,否則不透過FSA補償非處方藥費用/No reimbursement through the FSA for over-the-counter drugs unless prescribed
• W-2表格申報福利價值 (適用與2011繳稅年度相關且於2102發給的W-2表格)/ Form W-2 reporting of value of benefits (for W-2 issued in January 2012 with
respect to tax year 2011)
• 提高非醫療HSA提款的罰則(從20% 調升為30%)/Increased penalty for non-medical HSA withdrawals (from 20 to 30 percent)

2012年3月23日/ March 23, 2012

• 統一的承保說明/ Uniform explanation of coverage

• 寄發篇幅為四頁的投保前承保說明文件,概述說明福利和排除規定/ 4 page pre-enrollment coverage document sent outlining benefits and exclusions
• 重大修改前60天的通知/60-day notice in advance of material modifications

2013年1月1日/ March 1, 2013

提升高所得者的Medicare稅/ Medicare tax increase for high-earners
退銷人員要物補助無減免/ No deduction for retiree drug subsidy
薪資扣除健保FSA提撥最高限額(上限為美金2500元)/ Cap on salary reduction health FSA contributions ($2,500 limit)
比較效益費(於2012年11月30日後終止的保單年度)/ Comparative effectiveness fee (policy years ending after November 30, 2012)

2013年3月1日/ March 1, 2013

• 有關保險交易機構的雇主通知/ Employer notification regarding exchanges

2014年1月1日/ January 1, 2014

各州設置的保險交易機構/ State-based exchanges
投機者罰款/Free rider penalty
禁止規定既有病況排除項目/No pre-existing condition exclusions
雇主承保證明/ Employer certification of coverage
提高保健方案獎勵(從20% to 30%)/ Increased wellness program incentives (from 20% to 30%)
個人強制險/Individual mandate
自由選擇憑證/ Free choice vouchers
禁止規定年度上限/ No annual limits
對危及生命疾病的臨床試驗必須提供承保/ Required coverage for clinical trials for life-threatening diseases
等待期間最長90天/90-day limit on waiting periods
退休人員再保方案終止(如尚有剩餘資金)Retiree reinsurance program ends if money has not already run out

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