Ukuba ulahlekelwe yinshurensi yakho yempilo kwaye ufuna isicwangciso sezempilo esiphezulu, unokutshatyalaliswa ukuba ufunde ukuba utshintshiselwano lwempilo yomshuwalense welizwe (kunye nemakethe yokutshintshiselana kwamanye amazwe ngaphandle kwe-Nevada) ikuvumela ukuba ubhalisele isicwangciso sezempilo ngexesha lokubhalisa ngonyaka. Kodwa kwenzekani ukuba ulahlekelwa yinshurensi yakho yezempilo kwaye unayo inyanga ukuya ngaphambi kwexesha lokubhalisa elizayo?
Unokufumana njani i-inshorensi yempilo kwaye ugweme ukungaqiniseki?
Ixesha lokuBhalisa oluKhethekileyo
Ngokuxhomekeka kwixesha lini kwaye kutheni ulahlekelwe yinshurensi yakho yezempilo, unako ukufumana ithuba lokubhalisa okhethekileyo kwi-Career Affordable Care Act yakho yoshishino lomshuwalense (ininzi imeko, ixesha lokubhalisa olulodwa lisebenzisana ngaphandle kwintengiso). Ixesha elibhaliweyo lokubhalisa likuvumela ukuba ubhalisele i-inshurensi yezempilo nangona kungabhaliswa okuvulekileyo.
Ixesha lokubhalisa elikhethekileyo lilinganiselwe ixesha, ngokuqhelekileyo iintsuku ezingama-60, kwaye zibangelwa iintlobo ezithile zeemeko. Ukuba uhlawula kwaye ungabhalisi kwisicwangciso esitsha ngaphambi kokuphela kwesithuba sakho sokubhalisa esikhethekileyo, kuya kufuneka ulinde kuze kube yithuba elilandelayo lokubhalisa elivulekile ukuba ubhalise. Okwangoku, ungafumanisi nje kuphela uninsuredured kodwa kwaye uxhomekeke kwisigwebo se-ACA sokuba ungenayo inshuwalense yezempilo .
Ngaba Unelungelo Lokubhalisa Okukhethekileyo?
Iziganeko ezithile ezifanelekileyo zizisa ixesha lokubhalisa elikhethekileyo (SEP) eliya kukuvumela ukuba ubhalisele isicwangciso kwi-inshurensi yempilo yomshuwalense, okanye ngokuthe ngqo kwi-inshurensi yempilo kwimakethe yokutshintshiselana.
Ezi ziqhelekileyo izinto ezifana nokulahlekelwa yenye inshorensi yezempilo kunye noshintsho lobukhulu bentsapho. Nayi imimiselo ethile yeziganeko ezibangela ukuba ube nelungelo lokubhalisa ixesha elizodwa:
- Uza kulahlwa kwaye ulahlekelwe yinshorensi yakho yempilo.
- Uqhawula umtshato kwaye ulahlekelwe yinshurensi yempilo yakho yomsebenzi wangaphambili.
- Usukela kuma-26 kwaye awufanelekanga ukufumana ingxelo phantsi kwesicwangciso sezempilo somzali wakho kwakhona.
- Iqabane lakho lifa lenza ukuba ulahlekelwe yinshuwalense yezempilo ayinike yona.
- Uphuma kwindawo yakho yesevisi yendawo yezempilo kwaye ayikukugubungela kwidilesi yakho entsha (inqaku eliya kwindawo entsha yinto efanelekileyo kuphela ukuba sele ufunyenwe yi-inshurensi kwindawo yakho yangaphambili).
- Umqeshi wakho uhlehlisa emva kweeyure zomsebenzi wakho ukwenza ukuba ungafaneleki kwi-inshorensi yempilo.
- Unomntwana okanye utshatile.
Kwiimeko ezimbini, amaxesha abhalisiweyo abhalisiweyo ayisebenzi ngaphandle kweengxoxo. Ngamanye amagama, unokufumana ukutshintshiselana kunye nolu xeshanye lokubhalisa okhethekileyo, kodwa ukuba uya ngqo kwi-inshurensi yempilo yomshuwalense, akufuneki ukuba lwamkele ukubhaliswa kwakho:
- Ukuba ngumthonyama waseMelika (ixesha lokubhalisa olukhethekileyo liqhubeka lonke unyaka)
- Ukufumana ubumi besizwe sase-US okanye ukubeka ngokusemthethweni isimo sokuhlala e-US
Enye into engaqhelekanga ibhalise ixesha elilodwa lokubhalisa lilahlekelwa yinshuwalense yakho yezempilo ngenxa yokuba awuzange uyihlawule iiprayimari zenyanga okanye ngenxa yokuba unqatshelwe ngokukhawuleza ukukhutshwa. Oku kungabandakanywa njengesiganeko esibangela ukuba sivumele abantu ukuba badlale umdlalo kwaye batshintshele kwisicwangciso esitsha sezempilo xa befuna.
Ngokomzekelo, ungathenga isicwangciso sezempilo kunye nokuhlawula ngokungahambi kakuhle kwaye utshintshe kwisicwangciso ngokubhekiselele xa ugula. Oku kuya kunqoba injongo yobhaliso oluvulekile.
Ukulahlekelwa ngumsebenzi kunye / okanye ukuhla kweengeniso akuyiyo isiganeko esifanelekileyo ngaphandle kokuba sele ubhalisile kwisicwangciso ngokutshintshiselana, apho unokuba nethuba lokutshintshela kwisicwangciso esithile. Kodwa ukuba ubhalise kwisicwangciso ngaphandle kokutshintshiselana-ngenxa yokuba awufanelekanga ukufumana inkxaso-mali xa ubhalisile, umzekelo-kwaye ulahlekelwa ngumsebenzi wakho phakathi kweminyaka, awuyi kuba nethuba lokutshintshela kwisicwangciso utshintshiselwano kuloo ndawo.
UkuBhaliswa okuKhethekileyo
Nasi umzekelo.
Unomshuwalense wezempilo ngomsebenzi wakho, kodwa inkampani yakho ayenzi kakuhle kakuhle ngemali. Iinyanga ezimbalwa emva kokuba i-Obamacare ivule ixesha lokubhalisa, uvalelwa kwaye ulahlekelwe yinshurensi yezempilo-based based.
Unokuba uvumelekile ukuqhubeka nesicwangciso sakho sempilo esetyenziswayo ngokusebenzisa i- COBRA , kodwa kunoko, unqumle ukuba unokufumana isicwangciso esitsha sezempilo kwishishini lomshuwalense wezempilo. Uvumelekile ukuba ubhalise ixesha elizodwa ngenxa yokuba ulahlekelwe yinshurensi yonyango-msebenzi ngenxa yokucinywa (qaphela ukuba uvumelekile ukuba ufumane isicwangciso kumashishini-okanye ekutshintshiselwano-nangona ukuba unokhetho lokuqhubela i-inshorensi yomsebenzi wakho nge-COBRA.Unexesha elikhethiweyo lokukhetha unyaka-60 ukukhetha i-COBRA okanye isicwangciso somntu ngamnye, kwaye uvumelekile ukuba utshintshe ingqondo yakho kwimilo yeentsuku ezingama-60, ityala phambi ko-2017).
Uya kwiwebhusayithi ye-intanethi yoshishino lomshuwalense okanye ushayele utshintshiselwano emva kweeveki ezimbalwa uze ubhalise kwisicwangciso esitsha sezempilo. Ukuba isicwangciso sakho somqeshi sasifake iqabane lakho kunye nezingane, ziyakwazi ukufumana ithuba lokubhalisa okhethekileyo, kwakhona. Unokubhalisa ngamnye ngomshuwalense wezempilo okanye unokufumana isicwangciso seentsapho ekutshintshisweni.
Ekubeni umvuzo wakho uthatyathwe ngokugqitywa, unakho ukufumana inkxaso- mali ukuze uncede ukhokhe iindleko zenyanga ze-inshorensi zempilo. Imvume yokuxhaswa isekelwe kwingeniso yakho kwaye ingahlawulwa ngqo kwinkampani yakho yomshuwalense entsha ukwenzela ukunciphisa umrhumo onokuwuhlawula inyanga nganye ukuze ufumane umvuzo. Kukho neenkxaso zokuncedisa ukunciphisa iimbopheleleko zakho zokwabelana ngeendleko ezifana nokuncitshiswa, iipayili, kunye ne-coinsurance. Kwaye, kukho inkxaso yokunciphisa i-out-of-pocket yakho ephezulu .
Incediso eyanciphisa ukwabelana ngeendleko kunye ne-out-of-pocket ephezulu ibizwa ngokuba yintengo yokunciphisa indleko, okanye i-CSR, kwaye ifumaneka kuphela xa unemali engenayo kwaye ukhetha icebo lesilivere . Inkxaso yokunciphisa ama-premium akho angasetyenziswa naluphina iiplani zenqanaba lesinyithi (ubhedu, isilivere, igolide, okanye i-platinum).
Ufaka isicelo sale mali inkxaso nge-inshurensi yakho ye-inshurensi yempilo njengoko uhamba kwinkqubo yokubhaliswa kwe-inshorensi yempilo. Ukuxhaswa kungasetyenziselwa kuphela nge-inshorensi yempilo ethengwe kwi-Care Affordable Care Act. Nangona ixesha lakho lokubhalisa elikhethekileyo liya kukunika ithuba lokubhalisa ngaphandle kokutshintshiselana ukuba ukhetha, awukwazi ukufumana inkxaso-mali ukuze uncedise ukuhlawula i-inshorensi yezempilo engathengiyo ngokuthengisana kwakho (okuquka i-COBRA; ukuba ukhetha ukugcina ingxelo yakho ngokusebenzisa i-COBRA, kufuneka uhlawule i-premium ngokwakho).
Ayikho i-SEP Ukuba Ulahlekelwa Umyinge ongekho mncinane Umthombo
Ukulahlekelwa ngokukhawuleza kwenkcazo yeso siganeko esifanelekileyo esibangela ixesha lokubhalisa elikhethekileyo, kodwa kuphela ukuba i-coverage elahlekelwayo iyabonwa njengeyona nto incinci. Ukuba unemiba engabonakali njengobuncinci bokubhengezwa okubalulekileyo (isicwangciso -sithuba esifutshane , umzekelo, okanye umgaqo-nkqubo wokuhlawulela), ukulahleka kwesi si cwangciso akuyi kubangela ixesha lokubhalisa elilodwa.
Oku kubaluleke ngakumbi ukuqonda ukuba ngaba unikwe ingxelo phantsi kwesicwangciso sexesha elifutshane, njengoko loo migaqo inemihla yokupheliswa kwangaphambili, kwaye ngo-2017, ayikwazi ukuba ngaphezulu kweentsuku ezingama-90 ngexesha ( okungenzeka liguqulwe nguMongameli I-Oktoba ye-Trump ka-Oktobha 2017 ). Xa isicwangciso sexesha elifutshane siphelile, kunjalo, awufanelekile ukubhalisela isicwangciso esilungelelaniso se-ACA ukuba ungaphandle kobhaliso oluvulekile.
> Imithombo:
I-Cornell Univerity Law School, i-Legal Information Institute, i-45-CFR-155.420, iiNyanga zokuBhalisa eziKhethekileyo.
ISebe lezeMpilo kunye neNkonzo zoLuntu, iPACACA; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi .