Amagunya eMpilo aNcedo aphikisanayo
Izinzuzo ezigunyaziwe (ezaziwa nangokuthi "iintlawulo ze-inshorensi yempilo" kunye "nezigunyaziso") ziyimfuneko ezifunekayo ukulungiselela unyango lweemeko zempilo ezithile, iintlobo ezithile zabanikezeli bezempilo, kunye nezinye iindidi zabantu abaxhomekeke kuyo, njengabantwana ababekelwe ukuba bamkelwe. Inani leenzuzo zonyango liyakugunyazwa ngumthetho welizwe, umthetho wesigqeba - okanye kwezinye iimeko - zombini.
Phakathi kolawulo lwama-federal kunye namazwe, kukho iinkulungwane zemisebenzi ye-inshorensi yempilo.
Nangona izigunyaziso ziqhubeka zongezwa njengeemfuno ze-inshorensi zempilo, ziphikisana. Abagulisi abagulana bathi amagunya anceda ukuqinisekisa ukhuseleko olufanelekileyo lwe-inshorensi yempilo ngelixa abanye (ingakumbi iinkampani zomshuwalense yezempilo) bakhononda ukuba izigunyaziso zonyusa izindleko zempilo yonyango kunye ne-inshurensi yezempilo.
Imithetho Yenzuzo Yomshuwalense Wezempilo Inqununu
Imithetho ye-inshorensi yempilo emiselweyo kwinqanaba le-federal okanye likarhulumente ngokuqhelekileyo liwela kwelinye leentlobo ezintathu:
- Imfuno yokuba izicwangciso zezempilo zibandakanya iinkonzo ezahlukeneyo zempilo okanye unyango, njengonyango lokusetyenziswa kakubi kweziyobisi, ukukhulelwa kwezilwanyana, ukukhulelwa kwe-in vitro, iinkonzo zokubeleka, iziyobisi kunye nokuyeka ukutshaya.
- Imfuno yokuba izicwangciso zezempilo zibandakanya ukuxhaswa ngonyango ngabanikezeli ngaphandle kwamagqirha, njengabagqirha, ababelethisi, ababelethisi abahlengikazi, oogqirha bezemisebenzi kunye nabasebenzi bezentlalo.
- Imfuno yokuba izicwangciso zezempilo zixhomekeke kwabathengi kunye nabanye abantu abachaphazelekayo, njengabantwana abamukelweyo, abafundi abaxhomekeke kubo, abazukulu, kunye nabalingani basekhaya.
Imithetho yenzuzo enikwe igunya kakhulu isetyenziswa kwi-inshorensi yempilo enikezelwa ngabaqeshi kunye ne-inshurensi yempilo yabucala ezithengwa ngabantu ngabanye, mhlawumbi nge- inshurensi yezempilo okanye ukutshintshiselana .
Kodwa kukho izigunyaziso ezisebenza kwi- Medicare neMedicaid / CHIP .
IiNzuzo zeMshuwarensi eziMiselweyo kunye neNdleko yeNtsholongwane yezeMpilo
Uninzi lwabantu-ingaba okanye malunga nezigunyaziso-ziyavuma ukuba inzuzo yezempilo enikwe igunya ikhulisa iimali-mali ze-inshorensi zempilo. Ngokuxhomekeke kwintlawulo enikwe igunya kunye nendlela leyo inzuzo ichazwa ngayo, iindleko ezongeziweyo ze-premium yenyanga ziyakwanda ukusuka ngaphantsi kwe-1% ukuya kwi-5%.
Ukuzama ukufumanisa indlela inzuzo enikwe igunya iya kuba nefuthe kwi-premium yomshuwalense inzima kakhulu. Imithetho yegunya ihluke kwilizwe ukuya kummandla kwaye kwanegunya elifanayo, imigaqo nemimiselo iyahluka.
Ngokomzekelo, amaninzi amaninzi agunyazisa ukuhanjiswa kweengcali zonyango, kodwa inani leendwendwe ezivumelekileyo lingahluka ukusuka kummandla ukuya kwimeko. Elinye ilizwe linganciphisa inani labavakatyeli be-chiropractors ezine ngonyaka ngamnye ngelixa elinye ilizwe lingavumela ukuvakatyelelwa kwe-chiropractors ezili-12 ngamnye ngonyaka. Ekubeni iinkonzo zonyango ziza kuba zibiza, igalelo kwiimali-mali ze-inshorensi zempilo ziba zikhulu kwilizwe kunye nenzuzo enomdla.
Omnye umzekelo wokungabikho komntwana, ongafunwa phantsi komthetho wesigqeba, kodwa uyafuneka ngamanye amazwe. Kuzo zonke iinkalo, kukho ukuhlukahluka ngokubanzi malunga nokunyangwa kwimeko yokungabikho komntwana, oko kuthetha ukuba impembelelo kwiiprimiyamu zihluke kakhulu kwilizwe ukuya kwilizwe.
Ukongezelela, ukungabikho kwamagunya kunokwandisa iindleko zempilo kunye neeprojeyam zomshuwalense. Ukuba umntu onenkinga yezobugqirha akayidingi ukunakekelwa kwezempilo ngenxa yokuba engagqunywanga yinshurensi yakhe, unokuthi agule kwaye afune iinkonzo ezibiza ngexabiso elizayo kwixesha elizayo. Umzekelo wale nkalo kukuba ukunakekelwa kwamazinyo omdala akuyona enye yeenzuzo zezempilo ezifunekayo phantsi kwe-ACA, kwaye unonophelo lwamazinyo omdala alufunwa ukuba lubekwe phantsi kweMedicaid (ezinye iindawo zibandakanya ukuxhomekeka kwamazinyo kwiinkqubo zabo zeMedicaid, kanti abanye 't). Ukungaphumeleli kokufikelela ekunakekeleni kwamazinyo kunokubangela ubunzima obude bexesha elide.
Izinzuzo zeMpilo eziMiselweyo zeSizwe
Umthetho we-Federal uquka nenani lamatyala ahlobene ne-inshorensi:
Ii-ACA ezibalulekileyo zezempilo (ii-EHB).
Umthetho ononophelo loNonophelo wawungumngcipheko ophawulekayo ngokwemiqathango yempilo enikwe igunya, ukudala umgangatho wendawo yonke ngokwemiqathango yezempilo ebalulekileyo ekufuneka ifakwe kuwo wonke umntu omtsha kunye nesicwangciso sempilo yeqela elincinane kwiphondo. Imfuno yokubandakanya i-EHB isebenza kuzo zonke izicwangciso zeqela kunye namancinci kunye nemihla efanelekileyo yoJanuwari 1, 2014 okanye kamva. Uludwe lwe-EHB luquka:
- Iinkonzo ezixhasayo (ukunakekelwa kwangaphandle)
- Iinkonzo ezingxamisekileyo
- Izibhedlele (ukunakekelwa kwabantwana)
- Ukunakekelwa kwabazali kunye nosana olutsha
- Impilo yengqondo kunye neenkonzo zengxaki yokusetyenziswa kweziyobisi
- Iziyobisi
- Iinkonzo zokuvuselela kunye nezibonelelo kunye nezixhobo
- Iinkonzo zeLebhu
- Ukunyamekela okukhuselweyo kunye nokulawulwa kwezifo ezingapheliyo ( ukunyamekela okuthile okukhuselekileyo kukhululekile kuzo zonke izicwangciso ezintsha, kungakhathaliseki ukuba ilungu lesicwangciso sele lidibene nexabiso elichithwayo).
- Iinkonzo zonyango, kubandakanywa ukunakekelwa komlomo kunye nombono ( ukugqithiswa kwamazinyo omdala kunye nombono wembono akudingeki ukuba kuhlanganiswe , kwaye kukho ukulungelelaniswa ngokwemiqathango yamagqirha wamazinyo).
Ngaphandle kokunakekelwa kokukhusela kunye neenkonzo zokubhedlelelwa esibhedlele, ii-EHB azidingeki zihlanganiswe zicwangciso zeqela elikhulu ("iqela elikhulu" ngokubanzi lithetha iiplani ezibonelelwa ngabaqeshi abangaphezu kwama-50 abasebenzi, nangona kukho iindawo ezine apho "iqela elincinci" liquka abaqeshi kunye nabasebenzi abayi-100 ).
Kodwa izicwangciso zeqela elikhulu zihlala zinamandla, nangona kunjalo. Kwaye ezinye ezinye izigunyaziso (umzekelo, imfuno-echazwe ngezantsi-ukuba zonke izicwangciso ezinikezwa ngabaqeshi abane-15 okanye abasebenzi abangaphezu kweenkonzo zokunakekelwa kwabantwana) zifaka kwiimakethe ezinkulu zeqela.
I-COBRA yokuqhubeka
I-COBRA inikezela abathile abasebenzi bangaphambili kunye nabaxhomekeke kubo ilungelo lokuqhubeka nokuhanjiswa kweenyanga ezili-18 ukuya kwezi-36.
Umyinge wabantwana abasamkelayo
Izicwangciso ezithile zezempilo kufuneka zinikezele ngokubhengezwa kubantwana abafakwe iintsapho ukuba zitholwe phantsi kweemeko eziye zisebenza kubantwana bendalo, nokuba ukutholwa komntwana kuye kwagqitywa okanye kungenjalo.
Iinkonzo zempilo yengqondo
Ukuba isicwangciso sezempilo sibandakanya iinkonzo zempilo yengqondo, imingcele yaminyaka yonke okanye iidola zempilo kufuneka ibe enye okanye iphezulu kunemida yokufumana izibonelelo zonyango rhoqo.
Isibhedlele esincinci sihlala kubantwana abatsha kunye nonina
Ngaphantsi koMthetho woKhuseleko wezeMpilo kaNtsana kaNtsana ka-1996, izicwangciso zempilo zingenakunciphisa izibonelelo kwanoma yisiphi isibhedlele ubude bokuhlala ngokuphathelele ekubelekeni komama okanye umntwana osandula.
Ukuhlinzwa ngokutsha emva kwe-mastectomy
Isicwangciso sezempilo kufuneka sinike umntu ofumana iinzuzo ezinxulumene nesifo somzimba kunye nesigxina sokwakhiwa kwakhona kwesifuba esenziwe ngayo i-mastectomy.
Amalungelo aseMelika akhubazekileyo (ADA)
Abantu abakhubazekileyo nabangenakho abakhubazekileyo kufuneka banikwe iintlobo ezifanayo ngokumalunga nama-premium, ama-deductibles, imingcele yokukhawulela, kunye nexesha elilindelekileyo lokulinda.
UMthetho wezeMpilo kunye noTywala (FMLA)
Kudinga umqeshi ukuba agcine ukufumana ingxelo yezempilo ngexesha lekhefu le-FMLA.
UMthetho weeNkonzo ezingabonakaliyo zeNgqesho kunye neMisebenzi yokuLungisa (USERRA)
Unika umqeshwa ilungelo lokuqhubela phambili kwenkxaso yempilo phantsi kwezicwangciso zezempilo zomqeshi xa engekho emsebenzini ngenxa yenkonzo kwiinkonzo ezifanayo.
UmThetho wokuNyulwa koTywala
Izicwangciso zezempilo ezigcinwe ngabaqeshi abanabasebenzi abali-15 okanye ngaphezulu kufuneka banikele ngezinga elifanayo lokukhutshwa ngokukhulelwa ngokwezinye iimeko.
Izibonelelo zeMpilo eziMiselweyo
Amazwe ahluke kakhulu kwinani kunye nohlobo lwamaxabiso anikwe igunya, kodwa kuwo onke ama-50 athi, kukho ama-2,000 amagosa enzuzo anikezelweyo kunyaka-30 edlulileyo.
Unokufumana ulwazi malunga nezigunyazo zombuso ngamnye ukusuka kwimithombo emininzi:
- Isebe likarhulumente we-inshorensi, ongayifumana kwi-website ye-National Association of Commissioners Insurance
- INgqungquthela kaZwelonke yeeNqununu zeSizwe (NCSL)
- Ukuhlanganiswa kweKaiser Family Foundation yeeNkcazo zeMpilo kaRhulumente
Ngaphantsi kwe-ACA, yonke into entsha (esebenzayo ukususela ngo-2014) izicwangciso zeqela kunye namancinci kuwo wonke amazwe kufuneka zibandakanye ukuhanjiswa kwe-EHB, kufuneka zibe neenethiwekhi ezibonelela ngenkonzo, kwaye kufuneka zikhusele iimeko ezikhoyo kwaye zikhutshwe ngaphandle kokuqwalasela imbali yonyango.
Leyo imilinganiselo esezantsi apho izicwangciso kufuneka zihambelane nazo, kodwa i-state ingaphaya kweemfuno ze-ACA. Eminye imizekelo yokongezwa kwamanye amazwe anikezelwa ngamagunya ancedo, ukungabikho komsebenzi wokungabikho komsebenzi, ukukhutshwa kwe-autism kunye nokunciphisa iindleko ze-pocket kwimigqaliselo.
Kodwa kukho imigaqo efuna izikhundla-kunokuba i-insurers-ukuhlawula iindleko zamagunya enzuzo ezihamba ngaphaya kweemfuneko ze-ACA, oko kuthetha ukuba ezinye iindawo ziye zakhetha ukufaka izigunyaziso ezintsha kwiiplani zeqela elikhulu, ezingekho phantsi kolawulo Iimfuneko zezempilo ze-ACA eziyimfuneko (ke kunjalo, phawula ukuba izicwangciso zobuqhophololo zilawulwa phantsi kwemithetho yombuso kunokuba zibhekiselele kwiinkqubo zengamela, ngoko azixhomekeke kwiimfuno ezintsha ezichaza ukunyanzelisa;
> Imithombo:
> Kaiser Family Foundation. Iinkcukacha zeMpilo kaRhulumente
> Inkomfa yeSizwe yeeNqununu zeSizwe. I-Autism kunye noMgangatho we-Intshumo, iMithetho kaRhulumente. NgoJuni 7, 2017.
> Inkomfa yeSizwe yeeNqununu zeSizwe. U-2011-2014 Uhlaziyo lwe-inshurensi yempilo eyenziwe ngemithetho kaMbuso ehambelana noMthetho ononophelo loNonophelo. Juni 17, 2014.
> Inkomfa yeSizwe yeeNqununu zeSizwe. Amagunya e-Intshuwalense kaRhulumente kunye ne-ACA Essential Benefits Provision. Matshi 8, 2017.