Iziganeko zokuQinisekisa eziQalisa ixesha lokuBhalisa okhethekileyo
Ithuba lokubhalisa elikhethekileyo lixesha apho uvunyelwe ukwenza utshintsho kwisicwangciso sakho se-inshurensi yezempilo nangona kungengona ixesha lokubhalisa elivulekile .
Ngokuqhelekileyo, awuvumelekanga ukuba ubhalisele i-inshurensi yezempilo okanye wenze nayiphi na isicwangciso sezempilo ngaphandle kwexesha lokubhalisa. Nangona kunjalo, iziganeko ezithile ezifanelekileyo ziza kubangela ixesha lokubhalisa elikhethekileyo elikuvumela ukuba wenze utshintsho ixesha elifutshane emva kwesiganeko esishukumisayo.
Ukuba awuyi kuyenza utshintsho olufunekayo kwi-inshurensi yakho yempilo ngexesha lokubhalisa okhethekileyo, kuya kufuneka ulinde kuze kube yithuba elilandelayo lokubhalisa elivulekile ukwenza nayiphi na inguqu.
Amaxesha okubhalisa okukhethekileyo anokunika imihla engama-30 ukuba ubhalise kwisicwangciso esinikezwa ngumqeshi wakho (okanye ukongeza izixhomekeke kwisicwangciso sakho esixhaswe ngumqeshi). Kodwa kwizicwangciso kumarhwebo ngamnye, ixesha lokubhalisa elikhethekileyo lihlala ixesha elide kwiintsuku ezingama-60, nangona ezinye zihlala iintsuku ezingama-60 zombili ngaphambi nangemva kwesiganeko esifanelekileyo.
Ziziphi iziganeko zokuQinisekisa eziQalisa ixesha lokuBhalisa ngokuKhethekileyo?
Izinto ezitshintsha ubukhulu bentsapho yakho okanye zenza ukuba ulahlekelwe ngenye i-inshorensi yempilo yonyango kungenzeka ukuba uqalise ixesha lokubhalisa okhethekileyo. Imizekelo ibandakanya:
- Ukwahlukana kukushiya ungaxhaswanga
- Umtshato
- Ukuzalwa komntwana
- Ukwamukelwa komntwana
- Ukufa kweqabane lakho kukushiya uncedured
- Ukulahlekelwa yinshorensi yempilo yengqabane yakho
- Ukulahlekelwa yinshurensi yempilo yakho esekelwe kwimisebenzi
- Ukunciphisa kwiiyure zomsebenzi kwenza ukuba ungenakufaneleka kwi-inshurensi yezempilo
- Umyalelo weNkxaso yoNyango oNyango oNyango
- Uhamba ngaphandle kwendawo ye- HMO
Iziganeko zokuQinisekisa zifana noko kodwa akungafani nakwiimarike ngamnye
Ngaphambi kuka-2014, iziganeko ezifanelekileyo nezibhengezo ezizodwa ezisetyenziselwa kwikharityhulam yeqela (oko kukuthi, i-inshorensi-based job) kunye ne-Medicare, kodwa kungekhona kwimarike nganye.
Kwakungabikho ukubhaliswa okuvulekileyo kwimarike nganye ngaphambi ko-2014, kuba izicwangciso zezempilo zazingenakuqinisekiswa kwimeko nawuphi na unyaka kumazwe amaninzi-ngoko kwakungekho mfuneko yokuba kufikelelwe ixesha lokubhalisa olulodwa; abantu basebenzise nje, kwaye bamkelwe okanye banqatshelwe ngabathwali bomshuwalense.
Kodwa oko kwatshintsha ngoMthetho wezoKhathalelo ongenakunciphisa. Iimarike zomntu ngoku sele inezihlandlo ezizodwa zobhaliso njengemakethe yomshuwalense exhaswe ngumqeshi . Ziyafana kakhulu neziganeko ezifanelekileyo ezibangela ixesha lokubhalisa okhethekileyo kwi-inshurensi exhaswe ngumqeshi kunye nokuxhaswa kweMediare, kodwa kukho ukungafani. Ukuba uthengisa i-inshorensi yempilo kwiimarike nganye (okanye ukutshintshiselana), qiniseka ukuba uyaqonda ukuba iziganeko ezifanelekileyo zisebenza njani kwizicwangciso ezithile .
Kwaye njengoko kuphawuliwe ngasentla, khumbula ukuba iziganeko ezifanelekileyo ziyakunika iintsuku ezingama-60 ukuba ubhalise okanye wenze utshintsho kwisicwangciso semarike nganye, kodwa ngokuqhelekileyo kuphela iintsuku ezingama-30 zokubhalisa okanye ukwenza utshintsho kwisicwangciso esinikezwa ngumqeshi.
Ixesha lokuBhalisa eliKhethekileyo lisebenza njani?
Nasi umzekelo:
- UMelissa, uKen, kunye nabantwana babo abahlanu banomshuwalense wezempilo ngemisebenzi kaKen. UMelissa usebenza. Umsebenzi wakhe unikezela i-inshurensi yezempilo kuye kodwa kungabikho kuxhomekeke kuye. Ngexesha lokugqibela lokubhalisa, uMelissa waphekisa ithuba lokufumana i-inshurensi yempilo ngomsebenzi wakhe ngenxa yokuba kungabizi ukuzibandakanya kunye nesicwangciso seentsapho ngokusebenzisa umsebenzi kaKen.
- Iiyure zikaKeni zinqunywe kwixesha elithile. Abasebenzi bexesha lexeshana abafumananga ne-inshorensi yempilo apho uKen esebenza khona. Yonke intsapho ilahlekelwa ngumshuwalense wezempilo. Oku kubangela ixesha lokubhalisa okhethekileyo kwi-inshurensi yempilo yenkampani yase-Melissa kunye nexesha lokubhalisa okhethekileyo kwi- inshurensi yempilo eMelissa naseKen.
- UMelissa unethuba lokubhalisa olukhethekileyo lweentsuku ezingama-30 ukuze azisayinele kwi-inshurensi yezempilo kwimisebenzi yakhe nangona wayesekhokhele loo inshorensi. Ukuba akayi kuthatha isenzo kule mihla engama-30, akayi kukwazi ukubhalisa emsebenzini wakhe kude kube yithuba lokugqibela lokubhalisa lomqeshi.
- Umqeshi kaMelissa akaboneleli ngentsapho, ngoko uKen kunye nabantwana baya kufumana i-inshurensi yezempilo kwishishini lomshuwalense wezempilo. Bafumana ixesha lokubhalisa elikhethekileyo leentsuku ezingama-60 ukuze babhalise kule inshurensi yezempilo. Ukuba ababhalisanga ngethuba leentsuku ezingama-60, abayi kuba nelinye ithuba lokubhalisa kwi-inshorensi yezempilo ngokusebenzisa utshintsho lwempilo yomshuwalense welizwe kuze kube yonyaka ozayo wokubhalisa ovulekileyo.
Xa uKen kunye nabantwana babhalisa i-inshurensi yezempilo kwintsebenziswano yabo yelizwe, banokufaka isicelo sokufumana inkxaso-mali ye-premium . Ukuba bafanelekile, inkxaso iya kuhlawula inxalenye yee-premium zabo zee-inshorensi zempilo. Kwaye kuba bengenakufanelekela ukufumana ingxelo ngomqeshi kaMelissa, intsapho ye-glitch ayisebenzisi (phawula ukuba ukuba uMelissa wayesebenza ixesha elipheleleyo kumqeshi nabasebenzi abangama-50 okanye ngaphezulu, ukuxhaswa kwakhe kunokuba kuvumeleke ukuba baxhomekeke kuye, kodwa akukho mfuneko yokuba abaqeshi banoma yiphina isayizi banikezela ngokukhawuleza kumtshato).
> Imithombo:
> ISikole soMthetho weeYunivesithi yaseConell, iSiko leNgcaciso soLwazi; 29 CFR 2590.701-6 - Izihlandlo ezizodwa zobhaliso.
> ISikole soMthetho weeYunivesithi yaseConell, iSiko leNgcaciso soLwazi; 45 CFR 155.420 - Izihlandlo ezizodwa zobhaliso .