State and Federal Health Care Reform - FJG …：州政府和联邦政府的医疗改革图….pptVIP

What does it take to “Play?”  If you employ 50 FTE, to avoid “Pay” …. Must offer plan to any FTEs (30+ hr/wk) with HH incomes 100-400% of FPL No min. employer contribution required Coverage must pay 60% of actuarial value Coverage must be “affordable” ( 9.5% of hh income) Play or Pay in 2014 24 Play or Pay 2014 - continued When do you Pay? You will pay if any employee applies for coverage thru Exchange AND If employer does not offer at all: penalty = $2000/FTE in excess of 30 ees If employer does offer some coverage, but it doesn’t meet the 60% and 9.5% of income rules for employee who goes to Exchange: penalty = lesser of $3000/employee covered by Exchange or $2000/FTE 25 General Design: 2014 Exchange State-based Exchanges with a federal fallback plan for states who fail to establish an Exchange on their own. Available to eligible individuals and small employers under 100 States can opt to limit to 50 and under until 2016 Federal subsidies for individuals and tax credits for employers available ONLY thru Exchange Maintain internet website that allows Americans to “shop” for insurance easily 26 Timeline for Health Insurance Exchanges 27 2011 2012 2013 2014 2015 2016 2017 March Exchange grants May Final regulations March Employer notice requirements due to employees Sept. - Oct. Plans begin marketing Website active Nov. - Dec. Initial enrollment Exchanges operational 51 employees 100 employees 100 employees Develop Plansof Operations States Issue RFPs (e.g.,IT, Enrollment) 28 Bronze $2,000 Deductible* Silver Gold Platinum: $500 deductible* Richest coverage Catastrophic Lowest coverage Covers 90% of Benefit Costs Covers 80% of Benefit Costs Covers 70% of Benefit Costs Covers 60% of Benefit Costs 3 PCP visits and deductable level set at HSA level Qualified high Deductible plans will still exist under these parameters 2014: Products in the Exchange *Estimated Decisions the State of Vermont Will Need to Make RE Exchanges Who will adm