Ngombulelo kwi-ACA, abaninzi abanama-nsurers abanako Ukusebenzisa ixesha elide lokuKhuphela
Ngaphambi koMthetho ononophelo loNonophelo weNtsholongwane yempilo yomshuwalense e-US, imeko ekhoyo ngaphambili idlalwa indima ebalulekileyo kwi-inshorensi yempilo abantu abangakwazi ukuyifumana.
Kuzo zonke ezintandathu kodwa , i-inshorensi yempilo ethengiswa kwikharityhulam nganye ingabandakanyi imeko ekhoyo ngaphambili, iza neeprayimari eziphezulu ezisusela kwimbali yonyango yomfaki sicelo, okanye kungabi maneki naziphi na iindleko ukuba imeko ekhona ngaphambili yayinokwaneleyo.
Kwimakethi exhaswe ngumqeshi, abasebenzi ngabanye ababengenako ukufumana umvuzo womqeshi abazange banqatshelwe okanye bahlawuliswe iiprayimari ezongezelelweyo ezisekelwe kwimbali yabo yezonyango (nangona ama-premium amaqela angase asekelwe kwimbali yezobugqirha yeqela jikelele kwiindawo ezininzi) , kodwa abasebenzi abangenako ukubonisa ukuba babebenokubambisana ngokuqhubekayo babephantsi kwexesha lokukhutshwa kwezimo ezahlukileyo eziye zahluka ngobude kuxhomekeke kwithuba elingakanani umqeshwa ongeke aqiniseke ngaphambili.
Ngoku ukuba i-ACA iphunyeziwe, abaninzi abantu abasayi kuba phantsi kwexesha lokukhutshwa kwezimo zangaphambili. Nangona njengoko kuxoxwa ngezantsi, izicwangciso ezinkulu kunye neentlobo ezinamagama zinemithetho eyahlukileyo.
Iimeko eziPhambi kwexesha elikhoyo zingabandakanywa phambi kwe-ACA
Ngaphambi kuka-2014, xa i-ACA ikhulula ngokugqithiseleyo imboni yomshuwalense wezempilo, ezinye izicwangciso zempilo ziya kwamkela ababhalisile abatsha kodwa ngexesha elide lokukhutshwa (okt, ixesha lokulinda).
Oku kwakuqhelekileyo kwizicwangciso ezixhaswe ngumqeshi kunezicwangciso zeemarike zomntu ngamnye, njengoko izicwangciso zorhwebo nganye zithatha ukuthatha indlela engaphezulu kweemeko ezikhoyo ngaphambili (kungabandakanywa ngonaphakade, ukuhlawula iiprayimari eziphezulu okanye ukunciphisa isicelo ngokupheleleyo). Kodwa ezinye izicwangciso zemakethe zafika kunye neemeko zangaphambili ezikhoyo ngaphandle kwexesha elilinganiselwe.
Ukuba unesithuba sokukhutshwa kwimeko kwangaphambili, ungenayo inkcazo nayiphi na inkathalo okanye iinkonzo ezinxulumene nemeko yakho esele ikhona ngaphambi kwexesha elinqunywe ngaphambili, nangona uhlawula iipriyamu zakho zenyanga . Oku kwakuthetha ukuba nayiphi na imicimbi ephakamileyo yezempilo, engahambelani nempilo ephakanyisiwe ngeli xesha, yayijongwa yinkampani ye-inshorensi yempilo, kodwa nayiphi na imicimbi yempilo enxulumene nemeko esele ikhona yayingagcinwanga de kube sekupheleni kwimeko ebekho ngaphambili. ixesha.
Ngaphansi kwe-HIPAA (uMthetho we- Inshurensi yokuPhathwa kwe-Intshuwalense kunye noXanduva luka-1996 ), izicwangciso ezixhaswe ngumqeshi (iqela) zavunyelwa ukunyanzelisa ixesha elide lokukhutshwa xa umntu obhalisiweyo angenayo ubuncinane ubuncinane beenyanga ezili-12 zokufihla imali (oko kukuthi, ayinakuncediswa ngaphambi kokubhalisa kwisicwangciso seqela) ngaphandle kwezikhala ezingama-63 okanye ngaphezulu (iintsuku ezili-18 zengxelo yokuthenga ngetyala kungadingeka ukuba umntu ubhalise kwisicwangciso seqela emva kwexesha, emva kokuba ifowuni yakhe yokuqala yokubhalisa iphumelele).
Isicwangciso savunyelwa ukuba sibuke emva kweenyanga ezintandathu ezedlule kwimbali yonyango lomntu, kwaye ingabandakanyi imeko ekhoyo ngaphambili eyayiphathwe kwiinyanga ezi ezintandathu, kunye nexesha lokukhutshwa elingapheli kweenyanga ezili-12.
Ubude bexesha lokukhutshwa kwexesha lexesha elide liye lancitshiswa liqela leenyanga umntu obenokubhengezwa ngetyala ngeenyanga ezili-12 ezidlulileyo. Ngako-ke umbhalisi owayengavunyelwanga ngeenyanga ezine angaba neenyanga ezine ezinexesha elide lokukhutshwa kweso siqalo esitsha, esicinga ukuba uphathwe kwimeko esele ikhona kwiinyanga ezintandathu zokugqibela.
Amanye amazwe aphantsi kweemeko zangaphambili ezikhoyo ngaphaya kweemeko ze-HIPAA, kodwa ngokuqhelekileyo kwakukho into abantu ababefanele bayilwe nayo xa befumana isithuba kwi-coverage ngaphambi kokuba babhalise kwisicwangciso esitsha ngaphambi ko-2014.
Kwimakethi nganye, izithintelo ze-HIPAA azizange zisebenzise. Ama-insurers kumazwe amaninzi ahlala ekhangela emva kweminyaka eyi-10 okanye ngaphezulu yembali yezobugqirha, kwaye ingabandakanywa iimeko eziye zangaphambili ezikhoyo.
Isimo esandulelayo
Imeko esele ikhona ngaphambili yinkinga yempilo ekhoyo ngaphambi kokuba ufake isicelo somgaqo-nkqubo we-inshorensi yempilo okanye ubhalise kwisicwangciso esitsha sezempilo.
Ngokukodwa nayiphi na inkcazo yezokwelapha ingawela phantsi kwe-sambulela yimeko esele ikhona ngaphambili kwi-ACA. Iimeko ezikhoyo ngaphambili zizahluka kwizinto eziqhelekileyo njenge-asthma into enzulu njengesifo senhliziyo, umhlaza kunye nesifo sikashukela. Iingxaki zempilo ezingapheliyo ezithintela inxalenye enkulu yabemi zibonwa ziimeko eziphambili.
Umthetho woNonophelo ongenakunciphisa
UMthetho woNonophelo ojongene noTshintsho ungaguqule indlela iimeko ezingaphambili ezikhoyo ziphathwa ngayo eUnited States. Kwimarike yomntu ngamnye, ukususela ngo-2014, abaqinisekisi bempilo abazange bakwazi ukuthatha ingqalelo imbali yakho yempilo xa benquma ukuba okanye akungathengisi umgaqo-nkqubo we-inshorensi yempilo. Akunakukhuphela ngaphandle imeko ekhoyo ngaphambili ukusuka kwirejista, kwaye abanakukuhlawulisa ngakumbi ngenxa yokuba unesimo esasikhona ngaphambili.
Kwakunjalo nakwiimarike ezixhaswe ngumqeshi, kwaye izicwangciso zezempilo zeqela azikho ixesha elide lokukhutshwa kwexesha, kungakhathaliseki ukuba ubhalisile unembali yokuqhubekayo kunye / okanye imeko ekhoyo ngaphambili. Ngokukhawuleza xa ubhaliso lwababhalisi lusebenza kakuhle, uhlanganiswe ngokupheleleyo phantsi kwemiqathango yesicwangciso sempilo, ngaphandle kwemibandela ekhoyo ngaphambili.
Izicwangciso ezikhulu kunye nezicwangciso ezininzi zihlukeneyo. Akumelwe bahambelane nemithetho ye-ACA ngokubhekiselele kwiimeko ezikhoyo ngaphambili, kwaye ziyakwazi ukuqhubeka zingabandakanyi izimo zangaphambili ezikhoyo.
Kwimarike nganye, abantu abazange bakwazi ukubhalisa kwizicwangciso ezininzi ukususela ngo-Matshi 2010, nakwiiplani ezinkulu ekupheleni kuka-2013.
Kodwa kwiimarike ezixhaswe ngumqeshi, abasebenzi abasandula ukufumana (kunye nabo babhalisa ngexesha lokubhalisa kwithuba lwabasebenzi bonyaka ovulekileyo) bangakwazi ukubhalisa kwizicwangciso ezixhaswe ngabaqeshi abanamakhulu amakhulu, oku kuthetha ukuba kukho abanye abantu abatsha kwixesha lokukhutshwa kwezimo zangaphambili. Ukuba unemibuzo malunga nemithetho yecebo lakho kule ndawo, qhagamshelana neSebe lakho le-HR okanye icebo le-inshurensi.
Ulwazi oluthe luvela kuDkt Mike
Izimo eziPhambi kwexesha - Ukuqonda okungabikho kunye neMboleko
> Imithombo:
> Amasebe e-Medicare neeNkonzo zeMedicaid. Umthetho we-Health Insurance and Accountability Act (HIPAA) ka-1996. Iingcebiso ezifanelekileyo .
> Kaiser Family Foundation. Inguqu yeeNtsholongwane yezeMshuwalense yezeMpilo: Ingxaki eqinisekisiwe . Juni 2012.