Iziganeko zokufaneleka zizisa ixesha lokubhalisa olulodwa
Ukuvulwa kokubhalisa kwimarike yempilo yomshuwalense ophele ngomhla kaJanuwari 31. Kwiimeko ezininzi, uguqulwa utshintsho kunye nokubhaliswa kwabasebenzi abango-2016 ngoku kungagqitywa kuphela ukuba unesiganeko esifanelekileyo, nangona amaNative aseMelika angabhalisa unyaka kwicebo ngokusebenzisa utshintsho (Ubhaliso lwama-Medicaid kunye ne-CHIP nako jikelele).
Ifowuni yokubhalisa evulekileyo isebenza kokubili kwaye icime ukutshintshisana , kwaye iziganeko ezifanelekileyo ziyimfuneko ukuba ubhalisa ngaphandle kobhaliso oluvulekile, kungakhathaliseki ukuba uthengisa isicwangciso sakho ngokutshintshiselana okanye ngqo kwi-inshurensi yezempilo (qaphela ukuba i-premium Izibonelelo zifumaneka kuphela xa ubhalisa ngokutshintshiselana; ukuba ngokungathandabuzekiyo, isicwangciso sokutshintshiselwa kukubheja phambili, njengoko kukunika ithuba lokubambelela ngokukhawuleza inkxaso-mali yeprayimenti ukuba ingeniso yakho iphela isezantsi kunokuba ucinga ukuba kuya kuba) .
Kutheni kubhalisiwe ukubhaliselwa?
Imarike nganye kufuneka ibe nefestile yokubhalisa encinci ngenxa yokuba ukugqithiswa ngoku kuqinisekisiweyo kubo bonke abafake izicelo, kungakhathaliseki ukuba baneemeko zangaphambili. Iwindow yokubhalisa evulekileyo yonyaka ivimbela abantu ukuba balinde baze bagule ukuthenga ingxelo. Kodwa ngamanye amaxesha, abantu banomcimbi wokuphila - ngaphandle kokugula! - efuna ukuba ubhalise kwisicwangciso esitsha sezempilo ngaphandle kobhaliso oluvulekile.
Yilapho kufike khona ixesha lokubhalisa olukhethekileyo. Sekude kusetyenziswe kwimarike yempilo yomshuwalense-mali, kwaye ngoku iyingxenye yentengiso nganye. Yaye ngelixa kuninzi kakhulu ekubanjeni ngokwemiqathango eyenza ukuba kubhaliswe ixesha elilodwa lokubhalisa, kukho iziganeko ezifanelekileyo ezizodwa kwiimarike phantsi koMthetho woNonophelo ongenakunciphisa.
Yintoni ebalulekileyo njengesiganeko esifanelekileyo?
Kukho uluhlu olukhulu lweziganeko ezifanelekileyo eziza kukuvumela ukuba ubhalise kwisicwangciso okanye utshintshe kwisicwangciso esithile ngaphandle kobhaliso oluvulekile.
Ngokubanzi, banemithetho engqiqo yemigaqo, kwaye abayi kusebenza kubantu abaye batshintsha ingqondo yabo ngokufuna i-inshorensi yezempilo kwinxalenye yonyaka. Kwaye kubalulekile ukuba uqaphele ukuba iHHS ifake inkqubo yokuqinisekisa yeziganeko ezifanelekayo kulo nyaka - ukuba ubhalisa usebenzisa isiganeko esifanelekayo, lungele ukubonelela ubungqina bokufaneleka.
Kodwa ukuba ufumana nayiphi na yezi ziganeko ezifanelekileyo, uza kuba nexesha elithile lokubhalisa, elihlala lihlala kwiintsuku ezingama-60 (kwiimeko ezininzi, i-coverage iya kusebenza ngolokuqala lwenyanga elandelayo nje kuphela xa ubhalisa ngomhla we-15 inyanga, nangona kukho ezinye iimeko kwaye ezinye zimbalwa zixesha elilandelayo):
- Ukulahlekelwa kwamanye amajelo . Isicwangciso olahlekelwayo kufuneka sithathwe njengento encinci yenkcazo ebalulekileyo (okt, ayikwazi ukuba yinto efana nesicwangciso sexesha elifutshane okanye isongezelelo seengozi). Kwaye ukulahlekelwa kwenkcazo ayiyi kuba ngumphumo wokungahlawulwanga kweprayimenti, ukuchithwa, okanye ukukhanselwa. Ngoko oku kusebenza kwiimeko ezifana nesicwangciso sakho sempilo esivela kwimarike, okanye ukulahleka kokufikelela kwisicwangciso esixhaswe ngumqeshi ngenxa yokuqhawula umtshato, ukushiya umsebenzi, njl. (Nangona unikwe i-COBRA , usenelungelo lokubhalisa okhethekileyo ixesha apho ungathenga khona isicwangciso ngasinye kunoko). Unemihla engama-60 phambi kweentsuku ezingama-60 emva kokulahlekelwa kwenkcazo ngexesha ungabhalisa kwisicwangciso esitsha. Eli xesha lokubhalisa elikhethekileyo lisebenza kubantu abaninzi abalahlekelwe ukufumana ingxelo ngezizathu ezahlukahlukeneyo ekupheleni kuka-2015 .
- Ukuba ngumxhomekeke okanye ukufumana uxhomekeke kuye ngenxa yokuzalwa, ukumkelwa, okanye ukufakwa kwinkathalo yabantwana. Ukuba unomntwana, ixesha lakho lokubhalisa elikhethekileyo liqala usuku umntwana azalwayo ngalo, kwaye ukukhawulelwa kungagqithiselwa kwintsuku yokuzalwa / yokumkelwa komntwana. I-HHS yenza ixesha elifanayo lobhaliso olusebenzayo kubantu abatshintshileyo kwintsapho kwezinye izizathu, kubandakanywa ukwahlukanisa okanye ukufa komntu oxhomekeke kuyo (inqaku lokuba ngelixa ukuzalwa komntwana kuyisiganeko esifanelekileyo, ukukhulelwa akusiyo - ngaphandle kweNew York).
- Umtshato . Ukuba uthe watshata, ixesha lakho lokubhalisa elikhethekileyo leentsuku ezingama-60 liqala ngosuku lomtshato wakho, kwaye ukugqithiswa kuya kusebenza ngolokuqala lwenyanga emva kokubhaliswa kwakho, kungakhathaliseki ukuba ungabhalisa umhla.
- Ukuba ngummi wase-US . Abemi baseMzantsi Afrika banelungelo lokufumana ixesha lokubhalisa okhethekileyo, nangona lusebenza kuphela kwiintlobo-zintengiso-izicwangciso zokutshintshiselana ngaphandle kufuneka zibhalise abantu ngenxa yesi siganeko esifanelekayo, nangona banokukhetha ukwenza njalo.
- Ukuhamba ngokusisigxina kwindawo apho izicwangciso zezempilo ezahlukeneyo zifumaneka khona . Ukunyuka akukwazi ukuba okwethutyana, kwaye ubuncinci kwezinye izicwangciso zempilo ezikhoyo kwindawo entsha kufuneka zihluke kwiiindawo ezikhoyo kwindawo yakho yangaphambili. I-HHS icacise ngokutsha ukuba ukuhambisa esibhedlele unyango kwindawo entsha ayifanelekanga ukuhamba ngokusisigxina. Kwaye ngoJulayi 2016, ukunyuswa okusisigxina kuya kubangela ukuba kubekho ukubhaliswa okuthe ngqo xa sele sele unobuncinci obufunekayo ubuncinane ubuncinane kwiintsuku ezingama-60 ngaphambi kokuhamba. Ngamanye amagama, awukwazi ukuhamba uninsuredured kwaye ufumane ukufihlakeleyo ngokufudukela kwindawo entsha xa unesidingo sokhathalelo lwempilo (kukho ukungabikho kwabantu abasandul 'ukuvalelwa ekugqibeleni, ekuphumeni kwisebe lokukhusela iMedicaid , okanye ukubuyela kwi-US emva kokuhlala kwamanye amazwe).
- Isicwangciso sempilo somntu ngamnye sokuhlaziywa ngaphandle kobhaliso oluvulekile . Ngaphantsi kwe-ACA, izicwangciso ezintsha ziqhutywa kwikota yekhalenda, kwaye zonke ziyavuselelwa ngoJanuwari. Kodwa izicwangciso ezinkulu kunye nezicwangciso ezinokuzala zingaba neentsuku zokuhlaziya nanini na unyaka. Ukuba isicwangciso sakho siphakanyiswa ngaphandle kokubhaliswa okuvulekile, uvumelekile ukutshintshela kwisicwangciso se-ACA esilungeleleneyo endaweni yokuvuselela isicwangciso sakho esele sikho.
- Impazamo okanye ingxaki kwinkqubo yokubhalisa engeyonto yecala lokubhalisa (oko kukuthi, kubangelwa ukutshintshiselana, okanye ngabafundi ababhalisa okanye umthumeli womshuwalense wezempilo). Ukutshintshiselana kunye / okanye umphathiswa angabhalisa umfaki sicelo ngaphandle kobhaliso oluvulekile ukuze alungise le ngxaki.
- Isicwangciso esixhaswe ngumqeshi siba nexabiso okanye asibe sinikela ixabiso elincinci . Ngo-2016, izicwangciso ezixhaswe ngumqeshi zibhekwa njengezithengekayo nje kuphela xa isahlulo somqeshwa se-premium (ngenxa nje yomsebenzi - kungabalwa iindleko zokubambisa abaxhomekeke kuye ) ayikho ngaphezulu kwe- 9.66% yengeniso yomzi. Ukuba isicwangciso somqeshi siba neminyaka emininzi (mhlawumbi ngenxa yokuba i-premium yomqeshwa iyanda, okanye ngenxa yokuba ingeniso yomqeshwa iyancipha), umqeshwa unako ukufikelela kwixesha elizodwa lokubhalisa. Ithuba lokubhalisa elikhethekileyo lisebenza kwakhona xa icebo elixhaswe ngumqeshi linciphisa iinjongo ezinokuthi zingabandakanyekanga ubuncinane ama-60% eendleko zokubhalisa (ubuncinane, xabiso).
- Unesiphakamiso sokungena kwi-state engazange ikhulise iMedicaid kwaye ingeniso yakho iya kwanda ukuya kwi-100% yezinga lehlwempu . Inkxaso-mali ye-Premium kwintsebenziswano ayifumanekanga kumntu onomvuzo ongezantsi kwinqanaba lehlwempu. Kwimihlaba engazange ikhulise iMedicaid, abantu abanomvuzo ongaphantsi kwezinga lehlwempu abangenakufaneleka kwiMedicaid phantsi kwezikhokelo ezikhoyo abakwazi ukufikelela ngokuqinisekileyo kwinshuwalense yezempilo. Ukuba ingeniso yabo iyanda ngexesha lonyaka ukwenzela ukuba banelungelo lokufumana inkxaso-mali ye-premium, banako ukubhalisa kweso sikhundla.
- Usuke unesicwangciso sokutshintshisana kunye neengeniso zakho zenguqu njengokuba usanda kulungela okanye usandula ukungafumaneki. Esi siganeko esifanelekileyo sisebenza kuphela kubantu abaye babhalisa kwisicwangciso sokutshintshiselana.
- Usuke unesicwangciso sokutshintshisana kwaye isicwangciso "siphulaphula kakhulu" isivumelwano sakho kunye nawe . Kukho inkqubo esemthethweni yokubhala ukuphulwa kwezinto kunye nokucela ixesha lokubhalisa elikhethekileyo ukutshintshela kwisicwangciso esithile.
Ixesha lokubhalisa elivulekileyo le-2017 liza kuba ngoNovemba 1, 2016 ukuya kuJanuwari 31, 2017. Ukuba awukwazi ukufumana isiganeko esifanelekileyo, ithuba elilandelayo lokubhalisa liya kuba ngelo xesha, kwaye umhla wokuqala osebenzayo uza kuqala NgoJanuwari 1, 2017. Kodwa ukuba unamava afanelekileyo ngexesha elithile kunyaka, uza kuba nethuba lokubhalisa kweso sizathu.
Imithombo:
I-Cornell Univerity Law School, i-Legal Information Institute, i-45-CFR-155.420, iiNyanga zokuBhalisa eziKhethekileyo. Fi kelele 4/20/16.
ISebe lezeMpilo kunye neNkonzo zoLuntu, iPACACA; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi . Fi kelele 5/25/16.
INkonzo yeNgeniso yangaphakathi, iNkqubo yeNgeniso 2014-62 . Fi kelele 5/25/16.