Izicwangciso zezempilo zempilo (AHPs) ziye zadlulayo iminyaka emininzi, zivela kwi-Employee Retirement Income Security Act (ERISA) ka-1974, kwaye ngokukodwa kuxhomekeke kumgaqo-nkqubo phantsi komthetho omiselweyo ekuqaleni kwawo-1980. Umthetho wokuNakekelwa ongenakuncedo (ACA) unqume imimiselo emitsha eyenzelwe ukubonelela ngokukhusela okungeziwe kumalungu e-AHP.
Kodwa Ulawulo lweTrump lufuna ukukhulula imithetho ye-AHPs, yingakho baqhuba iindaba ezintsha ezintsha nje.
Ngo-Oktobha 2017, uMongameli uTrump "Ukhethelo lwezeMpilo kunye noKhuphiswano" kulandelwa ukuba, phakathi kwezinye izinto, imimiselo emitsha ejoliswe "ekuwandiseni ukufikelela" kuma-AHPs kumashishini amancinci kunye nabasebenzi abaqeshwe ngoku ngokuphantsi kweqela le- ACA kunye nemimiselo yerhwebo nganye .
Kwasekuqaleni kukaJanuwari 2018, iSebe lezeMisebenzi lanyathelisa imimiselo ecetywayo evela kwi-oda kaMongameli we-Oktobha, ukuvula ixesha lokubeka izimvo zikawonke-wonke kwiintsuku ezingama-60 (ungathumela izimvo apha).
Ngokucacileyo: Indlela i-AHPs ingayitshintsha ngayo i-inshurensi yakho yempilo
Ukuba unolwazi oluvela kumqeshi omkhulu, iMedicaid, okanye i-Medicare, imigaqo emitsha ecetywayo ayiyi kuchaphazela ukukhutshwa kwakho. Ukuba unemiyalezo kwiimarike zeqela okanye ezincinci, nangona kunjalo, imimiselo ecetywayo inokuchaphazela ukukhutshwa kwakho, kuxhomekeke apho uhlala khona.
Imithetho ayigqityiwe, kwaye akucaci ukuba ingaba ama-leeway aya kufuneka anqande imigaqo emitsha ukuba kwaye xa iphelile.
Kodwa ukwandisa ukufikelela kwi-AHPs kunokubangela iiphesimali ze-inshurensi zempilo ezincinci kumaqela amancinci kunye nabantu abaqeshwe ngabanye abajoyina imibutho enika ii-AHPs. Nangona kunjalo, kulawo ma-premium angaphantsi angafika ekunciphiseni okunciphisayo kwiinshorensi zezempilo. I-adage "ufumana oko uhlawulayo" kunzima ukuyiphepha.
Ngakolunye uhlangothi, abantu ngabanye kunye namashishini amancinci angabambisani nemibutho kwaye bafumane ukuxhaswa phantsi kwe-AHPs banokubona iiprayimari eziphakamileyo kwiminyaka ezayo, kunye / okanye imarike yomshuwalense engaphantsi, kunye ne-insurers encane yokunika ingxelo. Oku kuya kubangelwa ukuba i-AHPs inokwenziwa ukuba ibheno kumashishini anempilo, abancinci abasebenzi, beshiya i-marketer endala, igugu ye-ACA-ezicwangcisiweyo.
Abo bangabambisani ne-AHPs baza kubandakanya amashishini amancinci kunye nabasebenzi abaqeshwe ngabanye abakhetha ukugcina i-ACA ekhuselekileyo yokukhawulelana, kunye nabantu abangabasebenzi-kwaye ke abafanelekile ukujoyina i-AHP-kuquka nabathathe umhlalaphantsi kwangaphambili .
Ukuba okwangoku usebenza kumqeshi omncinci ongeke unikezele ngempilo kwaye ufumene iifowuni kwintsebenziswano, ukufaneleka kwakho kwezibonelelo ze- premium (credits tax premium) kusekelwe kwingeniso yakho yekhaya. Kodwa ukuba umqeshi wakho ufanele ajoyine inhlangano kwaye anikeze ingxelo ye-AHP ehambelana nencazelo ye-ACA yexabiso elingabizi, awuyi kuphinda unelungelo lokufumana inkxaso-mali ye-premium.
Imimiselo yangoku: Imigaqo yeVary ngokuxhomekeke kubukhulu beqela
Isihloko semiqathango ecetywayo, "Inkcazo 'yoMqeshi' Ngaphantsi kweCandelo 3 (5) ye-ERISA-Plans Plans Plans," uhlawula i-crux yale mbambano: Okubalulekileyo, ngubani ovumelekileyo ukuba ahlangane kunye nokwenza iqela elikhulu, umqeshi isicwangciso esicwangcisiweyo?
Kubalulekile kuba i-ACA ilawula amaqela amakhulu kunye amancinane. "Iqela elincinci" lithetha abasebenzi abangama-50 kwiindawo ezininzi, kodwa kwabasebenzi abayi-100 eCalifornia, eColorado, eNew York naseVermont. Iqela elincinci lilawulwa phantsi kwe-ACA (izicwangciso ezinempumelelo ngoJanuwari 2014 okanye kamva) ngokufanayo zifana nemigaqo yokuthengiswa kwemakethi nganye: Izicwangciso kufuneka zikhutshwe ngokuqinisekileyo, kunye neeprayimari ezihluka kuphela ngokusekelwe kwindawo, abasebenzi beeminyaka ( kwisilinganiso esiphezulu se-3: 1 kubaqeshwa abadala nakwabancinci), nokuba ngaba umsebenzi uxhomekeke kwisicwangciso kunye nokusetyenziswa kwecuba.
Izinto ezifana nobulili, uhlobo lweshishini, kunye nempilo yonke yeqela ayikwazi ukusetyenziswa ukufumana iiprayimari.
Kwaye izicwangciso zeqela elincinci liphunyeziweyo ukususela ngo-2014 kufuneka zijongene neenzuzo zezempilo ze -ACA, kwaye zifikelele kwizinga leziseko ze-ACA (ubhedu, isilivere, igolide, okanye i-platinum), okuyixabiso lexabiso le- actuarial .
Eminye imigaqo ye-ACA isetyenziswa kwizicwangciso zeqela elikhulu kunye nezicwangciso zobuqu ezizimeleyo (ezithandwa kakhulu ngabaqeshi abaninzi kakhulu), kodwa imimiselo ayigcinanga. Iintlawulo zeenqununu ezinkulu kunye nezicwangciso zokhuseleko ezizimeleyo azixhomekeke kwinkqubo efanayo yokuphonononga eyenziwa kwizicwangciso zeqela kunye namancinci, ziyahlukahluka ngokusekelwe kwimbali yebango lezonyango, kwaye akufanele uhambelane ne-3: 1 yobudala bendi umlinganiselo osebenza kwiimakethi yeqela elincinci (oko kukuthi, iiproyamu zabasebenzi abadala zingaphezulu kwamaxesha amaninzi ama-premium ahlawulwa ngabasebenzi abancinci). Kwaye iqela elikhulu kunye nezicwangciso ze-self-insured akudingeki ukuba zibandakanye iingenelo zezempilo ze-ACA ezibalulekileyo.
Ukongezelela, ngelixa ezininzi iimfuno ze-ACA azisebenzi kwiqela elikhulu kunye nezicwangciso zokhuseleko oluzimeleyo, izicwangciso ezizimeleyo zingaphantsi komgaqo-nkqubo. Kunoko, zilawulwa nguRhulumente waseburhulumenteni, phantsi kwesikhokelo se-ERISA. Ngoko unokucinga ngesikhokelo solawulo njengokuba sisigxina kakhulu kwiiplani zeqela kunye nezincinci, ubuncinci kwizicwangciso ezizimeleyo, kunye naphakathi phakathi kwamaqela amakhulu athengisa inkcazo evela kwinkampani yomshuwalense kunokuzimela, kuba iinkampani zomshuwalense ezithengisa ezo zicwangciso ziphantsi komgaqo-nkqubo, nangona imithetho ekhululekile phantsi kwe-ACA xa iqhathaniswa nezicwangciso zeqela kunye namancinci (ngokubanzi, inkulu inhlangano kukuba, banokuthi banokuzibonela ngokuqinisekileyo).
Izikhokelo zoHlelo lwe-AHP ziya kuphucula iMithetho
Ngaphansi kwemithetho ekhoyo, i-AHPs ivumelekile ukuba inikezele iqela elikhulu okanye izicwangciso ezizimeleyo kumalungu azo, kodwa imithetho imele iqinile: Abaqeshi kufuneka bahlangane ngenjongo ngaphandle kokudala i-AHP (oku kuthiwa " inomdla, "ngokuqhelekileyo kuthetha ukuba kufuneka babe kwishishini elifanayo), kufuneka babe nokulawulwa kwe-AHP, kwaye abaqeshi beelungu kufuneka babe nabasebenzi abangaphezu kweyodwa (okt, abanako ukuba ngabanikazi bodwa abangenabaqeshwa).
Imigaqo ecetywayo iya kukhulula loo mithetho. Ukuba kugqityiwe njengoko kucetywayo, imigaqo emitsha iya kubavumela abaqeshi ukuba bahlangane kunye nokwenza i-AHP ngokusekelwe kwimboni ebelwanayo OKANYE nendawo ekwabelwana ngayo indawo, enokuba yindawo okanye indawo ehlala kuyo, njengengingqi okanye kwindawo yesikhulu (ukugcina engqondweni ukuba ezinye iindawo ezikuloo mizi zihlala ngaphaya kwamanye amazwe). Ngoko ezininzi izityalo ezincinci zokulungisa izithuthi kwiindawo ezahlukeneyo zingadibana kunye nokwenza i-AHP, okanye amashishini amancinci amancinci onke afumaneke kwidolophu enye okanye urhulumente angabambisana kunye nokwenza i-AHP.
Ngelixa iqela loomatshini liza kufana nencazelo yangoku yombutho onokuzibandakanya kunye nomntu onomdla, imigaqo emitsha iya kubavumela abaqeshi ukuba baqulunqe umbutho nokuba ngaba indawo yendawo ihlala yintando yesintu kuphela.
Nangona kunjalo, imimiselo ecetywayo iya kufuna iminyano ukuba ibe "imibutho yangempela kunye nesakhiwo sobalulekileyo sokwenza 'ngentshisekelo' yabaqeshi abathathe inxaxheba." Umbutho kuya kufuneka ube nemithetho-mthetho kunye nolawulo kwaye ulawulwe ngamashishini afaka ubulungu bawo. Ngoko ngelixa iqela labaqeshi lidibanisa kunye nenjongo epheleleyo yokufumana iqela elikhulu okanye i-inshurensi yempilo yokhuseleko (kunye nokugwema i-ACA yomntu ngamnye kunye nemimiselo emfutshane yeqela), bekuya kudala umbutho we-bonafide ukuze wenze njalo.
Ngaphantsi kwemithetho ekhoyo, abantu abaqeshwe ngabanye abangenabasebenzi abakwaziyo ukujoyina ii-AHPs ukuze bafumane i-ERISA-ye-health care coverage (ngokuchasene ne-ACA-ehambisanayo yokuthengiswa kwemakethe). Kodwa imiqathango ecetywayo iya kukhulula ukulawula, ukuvumela "abanikazi abasebenza" ukuba bajoyine ii-AHPs nje kuphela ukuba abafanelekanga kwi-inshurensi yezempilo eyongezelelweyo evela kwelinye icebo elixhaswe ngumqeshi, sebenze okungenani iiyure ezingama-120 ngenyanga, kwaye ufumane imali ngokwaneleyo -ngqesho yokufihla indleko yenkcazo enikezelwa ngu-AHP.
Luhlobo luni lwe-AHPs oluza kunika?
Ukuba ulawulo olucetywayo lugqityiwe, i-AHPs entsha ingaqala ukubonakala ngokukhawuleza kungekudala, kwaye kuya kuba nobuninzi obubanzi ngokwemigangatho yemigangatho abayinikezela ngayo. Kodwa ngokubanzi, yonke into yokunyusa i-AHPs kukunciphisa iindleko zempilo. Yaye ekubeni imimiselo ecetywayo ingenzi nto yokunciphisa indleko zempilo yonyango (yintoni eyenza iindleko ze-inshurensi yezempilo), yindlela ephela yokuba babe neeprayimari ezisezantsi kukukhawulwa kwemigangatho ngokwemiqathango enikezelwayo, okanye ukunyanzelisa ubulungu obunempilo kunomlinganiselo.
Imigaqo ecetywayo iya kuthintela i-AHPs ekubeni ikhethe ngokucalucalulo ngokusekelwe kwimeko yempilo, ngoko abayi kukwazi ukukhanyela ishishini okanye umqeshwa ukusuka kubulungu kumbutho (kwaye ke ngoko kuhanjiswa kwe-AHP) ngokusekelwe kwimbali yonyango. Nangona kunjalo, i-AHPs iya kuba nelungelo elibanzi lokuyila i-coverage ngendlela engabonakaliyo kubantu abaneemeko eziphambili. Abatshutshisi babesele benza oku ngezinga elithile ngaphambi kokuba i-ACA-umzekelo, ukubonelela izicwangciso zempilo ezikhuselekileyo izidakamizwa zendalo, okanye oko kungaboneleli ngezempilo yengqondo.
I-ACA imisa ezo zinto, kwaye yonke imigaqo-nkqubo ye-inshorensi yempilo yecandelo ngalinye kunye neyincinci esebenzayo ukususela ngoJanuwari 2014 kuye kwafuneka ihlangabezane nemigangatho emancinci yokujonga. Kodwa ezininzi ze-ACA imithetho ayisebenzisi kwiqela elikhulu kunye nezicwangciso ezizimeleyo, oko kutheni ingcamango yokwandisa ukufikelela kwi-AHPs ibhenela kumashishini amancinci nabasebenzi bezempilo.
I- American Academy ye-Actuaries kunye noMbutho weSizwe we-Arms Commissioners wabonisa ukukhathazeka ngo-2017 (xa ukunyuka kwe-AHP kuqwalaselwa ngabagwebi) malunga nefuthe le-AHPs ekwandisiweyo kwiimarike zeqela kunye namancinane. Le mibini mibutho yathi ii-AHPs ezitsha kunye nezandisiweyo zingabangela ukhetho olubi kwiimarike zeqela kunye namancinci, njengoko i-AHPs ikwazi ukuyila izicwangciso zabo ukuba zibhenele kumashishini amancinci (kunye nabantu abaqeshwe ngabanye) abanempilo , abasebenzi abancinci, beshiya abantu abadala, abagulayo kwicandelo elilawulwa nguRhulumente, ii-ACA ezihambelana neemarike zeqela kunye namancinci.
I-AAA ne-NAIC nayo ibini inqaku lokuba ii-AHPs zeeminyaka ezidlulileyo zihlala zijongene nokungabikho, ukungabikho kwimeko engayi kuvuka kwakhona. Kwaye ekubeni ezi zicwangciso zilawulwa yi-inshorensi yombuso, amalungu ayakuba neyona ndlela yokufumana ukuba i-AHP iphelile ayikwazi ukuhlawula amabango abo.
> Imithombo:
> American Academy of Actuaries. Incwadi kubamthetho ngokubhekiselele kwandiswa kwamalungiselelo ezempilo . Matshi 8, 2017.
> Amasebe e-Medicare kunye neeNkonzo zeMedicaid, iZiko loLwazi loThengi kunye noLawulo lweNtshuwalense. Ixabiso leMakethe liyahlaziywa; Iingqinisiso ezichaziweyo zikaRhulumente.
> Isebe lezeMisebenzi, uLawulo lweZibonelelo zoKhuseleko lweBasebenzi. Inkcazo ye "Umqeshi" phantsi kweCandelo 3 (5) ye-ERISA-Plans Health Plans. Ishicilelwe kwiRejista yaseStar January 4, 2018.
> Keith, Katie. Imiba yezeMpilo. UMbutho wezeMpilo iSicwangciso esiPhakanyisiweyo: Oko Kuthethayo noko Kuya kuyenza. NgoJanuwari 5, 2018.
> Umbutho kaZwelonke weeKomishinari zeeNtshumo Incwadi kubamthetho ngokubhekiselele kwandiswa kwamalungiselelo ezempilo . NgoFebruwari 28, 2017.