每年第四个季度是大部分公司进行团体健康保险更新的时候,雇主们要注意2021年1月1日开始的福利变化与相关法规变更事项。
2021健康保险重要福利变化
从2021年1月1日之后开始的保险计划中,需要注意的福利变更包括:
• Affordable Care Act (ACA) affordability standard – 可负担式健保法案中规定,2021年员工可负担的百分比为9.83%;意思是公司提供的健康保险中,扣除雇主替员工支付的保费外,按照最低等级计划标准费用,员工自行负担的保费不能超过员工薪资的9.83%。
• Out-of-pocket maximum (OOPM) – 2021年健康保险计划的年度医疗费支出最高限额为:个人为$ 8,550,家庭为$ 17,100。
• High deductible health plan (HDHP) and health savings account (HSA) limits for 2021:
o HSA contribution limits: 个人为$3,600/ 家庭为$7,200
o HDHP minimum deductible最低自付额:个人为$1,400/ 家庭为$2,800
o HDHP OOPM limit年度医疗费支出最高限额:个人 为$7,000/ 家庭为$14,000
雇主应采取的行动
在公司Open Enrollment保险计划更新前,雇主应将2021年度的健康计划福利变更内容通知员工, 还需要将计划变更的信息透过正式的Summary Plan Description (SPD)文档通知公司投保的员工。
需告知员工的其他重要事项
雇主在保险计划Open Enrollment期间必须提供保险计划相关福利通知,最常见的像是保险计划福利和承保范围摘要(Summary of Benefits and Coverage, SBC)。
其他通知包括《妇女健康与癌症权利法》(the Women’s Health and Cancer Rights Act, WHCRA),必须每年告知一次。或许雇主已经在非Open Enrollment的时候公告这些信息,但建议雇主在每年开放期间可以再统一提供给员工。
此外,雇主在每年的开放期都应该再审视一次提供给员工的数据是否正确,必须确保数据皆准确反映了保险条款和费用。
以下清单总结了雇主应提供的福利通知概要,提供给雇主做基本的查看,如需更多信息,欢迎联系美国泛宇健康保险部门。
• Summary of Benefits and Coverage (SBC) – Group health plans and health insurance issuers
• Summary Plan Description (SPD) – Group health plans subject to ERISA
• Medicare Part D notice of creditable or non-creditable coverage – Employers with group health plans that provide prescription drug coverage
• WHCRA notice – Group health plans that provide medical and surgical benefits for mastectomies
• Children’s Health Insurance Program (CHIP) notice – Group health plans that cover residents in a state that provides a premium assistance subsidy under a Medicaid plan or CHIP
• COBRA general notice – Group health plans subject to COBRA
• Grandfathered plan notice – Plans that have grandfathered status under the ACA
• Notice of patient protections – Non-grandfathered group health plans that require designation of a participating primary care provider
• HIPAA privacy notice – Self-insured group health plans
• HIPAA special enrollment notice – All group health plans
• HIPAA Wellness notice – Group health plans with health-contingent wellness programs
• ADA Wellness notice – Wellness programs that collect health information or include medical exams
• Individual coverage HRA (ICHRA) – Employers that sponsor ICHRAs for specific classes of employees (or all employees)