Ubungakanani buhlanganiswe kuwo onke amatsha amacandelo kunye namacandelo amancinci
Ngaphambi koMthetho wokuNakekelwa ongenakunqwenelekayo (ACA, owaziwa ngokuba yi-Obamacare) usebenze, ubuninzi bokubonelela ngeenkonzo ze-inshorensi zempilo zahluka ngokubanzi ukusuka kwelinye ilizwe ukuya kwelinye. Ukukhuselwa kwabathengi kuye kwaba yimpembelelo yemigaqo-siseko esekelwe nguRhulumente eyayinamandla kwezinye iindawo kwaye iyancinci kwabanye.
Iimfuno zikaRhulumente ezigqithiseleyo kunokuba i-ACA isasebenza, kodwa kuwo wonke umbuso, i-ACA ifake imigangatho ephantsi.
Izinzuzo zezeMpilo ezibalulekileyo (i-EHBs) zineentlobo zontoni zonyango olufuneka lufunyenwe- ngaphandle kwemida yedola kwimisebenzi yonyaka okanye yexesha elizeleyo- kuzo zonke izicwangciso zeqela kunye namancinci kunye nemihla ephumelelayo kaJanuwari 2014 okanye kamva. I-EHB ihlanganiswa ngaphandle nokuba ingaba isicwangciso sithengiswa ngokutshintshiselana okanye ukutshintshiselana .
Izicwangciso ezizikhulu kunye nezizukulwana ezininzi zikhona, kodwa zineentsuku eziyimpumelelo ngaphambi ko-2014. Ngoko iimfuno ze-EHB azisebenzi kwizicwangciso ezincinci kunye nezikhulu, ngaphandle kokunyamekela okukhuselekileyo, ezifunekayo ukuba zifakwe kwi-grandmothered- cwangciso. Iimfuno ze-EHB nazo azisebenzi kwizicwangciso zeqela elikhulu .
Nantsi i-EHB, kunye nendlela abasebenza ngayo:
IiNkonzo ezixhasayo
Oku kubandakanya ukutyelela iiofisi zoogqirha kunye neekliniki, kunye nokunakekelwa kwezibhedlele ezilungiselelwe kwisigulana.
Ukulawulwa kwezifo ezingapheliyo, ukunakekelwa kwezempilo, kunye neenkonzo zokukhusela
Ukunyamekela okukhuselweyo kuhlanganiswe kungekho sabelo -mali kwisigulane (oko kukuthi, inkampani yomshuwalense ihlawula iindleko ezipheleleyo), kodwa kuphela ukuba inkonzo yokukhusela ekhutshelweyo iluhlu lwale nkathalo yokukhusela.
Kukho ii-arhente ezintathu ezithatyathwayo iziphakamiso zokudala uluhlu lokukhathalela okukhuselweyo. Uluhlu luphuhliswe ngokukodwa kwiinkonzo ezifumana "A" okanye "B" ukusuka kwi-US Prestation Services Task Force (USPSTF). Ukuhlola umhlaza wesifuba kubantwana abasetyhini abaneminyaka engama-40 ukuya ku-49 kuphela kunomlinganiselo we "C" ovela kwi-USPSTF, kodwa kubekho okungafaniyo okufakwe ukulufaka kwiluhlu lweenkonzo zokukhusela phantsi kwe-ACA.
Ukongeza kwiikhokelo ze-USPSTF, iKomiti yeNgcebiso ye-CDC yeeNkqubo zokuNgcwaba (ACIP) inikeza iingcebiso zokugonya, kunye neZibonelelo zezeMpilo kunye noLawulo lweeNkonzo (HRSA) inikeza iingcebiso ezongezelelweyo zokunakekelwa kokukhusela kwabasetyhini, iintsana kunye nabantwana.
Ulwaphulo-mboleko luhlanganiswe phantsi kokunyamekela, oku kuthetha ukuba lufumaneka ngaphandle kweendleko kwi-insured. Kodwa izicwangciso ze-inshorensi zempilo zifunwa kuphela ukukhupha okungenani enye inguqu yee-FDA ezivunyiweyo zokukhulelwa kwabantwana.
IiNkonzo eziPhezulu
Nangona abathwali be-inshorensi yempilo banokuthi banciphise ubuninzi bokunikezelwa kwee-network-providers, oko akunjalo kwiinkonzo zongxamiseko.
I-insurer yakho yempilo ayikwazi ukubeka ukwabelana ngeendleko eziphezulu kwiinkathalo zecandelo lezonyango eziphuthumayo, kwaye kufuneka ikuvumele ukuba uye kwigumbi eliphuthumayo, nangona kungenakucwangciso lwenethiwekhi yakho.
Imfuno yokuba abatshutshisi bempilo baxakeke unyango olujongene noxinzelelo lwangxamnye nalo luya kwi-ambulensi zothutho, kuquka ne-ambulensi yomoya.
Kubalulekile ukuba uqaphele, nangona kunjalo, ukuba imali yokuhlawula ibhalansi isenokubakho ingxaki kwiimeko ezixakekayo xa kuthengiswa iinkonzo eziphuthumayo zangaphandle kunye / okanye iinkonzo ze-ambulensi. Nangona i-ACA idinga iithwali zokukhupha unyango olungxamisekileyo kumaziko angaphakathi-inethiwekhi nangona ukuba isibhedlele okanye umniki-ambulensi ungekho ngaphandle kwenethiwekhi, oko akunyanzelisi esibhedlele, oogqirha, okanye i-ambulensi nkampani ekuhlawuleni isigulane ibhilida yabo, ngaphezu kwayo nayiphi na into ehlawulwa yinkampani ye-inshurensi yesigulane.
Amanye amazwe avumele ukuhlawula ukuhlawula imali kwiimeko ezixakekileyo, kwaye umthetho ofanayo uthathelwe ingqalelo-kodwa ungagqithwanga-kumgangatho wesigqeba.
Bhedlele
Oku kubandakanya uluhlu olupheleleyo lweenkonzo zokunyamekela, okubandakanya unyango ngabagqirha kunye nabongikazi, iibrabhu zesifo sengqondo kunye neenkonzo zoshishini, kunye nokunyamekela.
IiNkonzo zeLebhu
Umsebenzi weLab owela phantsi kobuncwane bokukhusela okuchazwe ngasentla ukhankanywe ngokungabikho ukwabelana ngeendleko kwisigulane.
Olunye umsebenzi ofunekayo welebhu uhlanganiswe phantsi kwesiqhelo sesicwangciso-sabelo sokwabelana ngeendleko.
Ukunakekelwa koMama noNtsana
Oku kubandakanya konke ukunyameka, ukuhanjiswa kunye nokunyamekela umntwana, nangona ukuhlolwa kokubeletha kubanzi kuhlanganiswe phantsi kokunyamekela okukhuselweyo (kuchazwe ngasentla) kwaye kungabhekiswa ngaphandle kokwabelana ngeendleko kumama olindelekileyo.
Ngokutsho kwe-HRSA, ukunakekelwa kwangaphambi kokubeleka kuwela phantsi kwecandelo lokunyamekela kwabesifazane. Kwaye nangona kunjalo kwiimeko ezininzi ezihlanganiswe kanye ngonyaka, i-agency ichaza ukuba ngamanye amaxesha "kukho ukutyelela kangako ukufumana zonke iinkonzo zokukhusela eziyimfuneko."
Ukongezelela ekuhloliseni ngokwabo, kukho iimvavanyo ezithile (isifo sikashukela sesifo sikashukela, i-Hepatitis B kunye ne-Rh Incompatibility) ezifunyenwe ngabasetyhini abakhulelweyo phantsi kwecandelo lokunyamekela ukukhusela, ngaphandle kokwabelana ngeendleko.
Impilo yengqondo kunye nokusetyenziswa kakubi kweziyobisi
Oku kubandakanya unyango kunye nesifo sengqondo sokuphulukiswa kwezempilo yengqondo kunye nokusetyenziswa kakubi kweziyobisi.
Iimfuno zengqondo yempilo yengqondo zandulela i-ACA, nangona i-ACA yandise umthetho wobuhlanga ukufaka izicelo kwizicwangciso zorhwebo ngamanye kunye nenkxaso-mboleko exhaswe ngumqeshi. Ngaphantsi kweemfuno zesigaba, isicwangciso sezempilo asikwazi ukuba nemida yokukhutshwa kwempilo yengqondo kunokuba ithole unyango / unyango oluphambili.
Iinkonzo zonyango, kubandakanya ukunakekelwa kwamazinyo kunye nombono wabantwana
Ngokungafani namanye ama-EHB, amazinyo omntwana akufanele afakwe kwizicwangciso ze-inshorensi yempilo kwiindawo ezininzi. Endaweni yoko, ukutshintshisana kunokunikela nje ngee-self-pediatric cents plans for sale.
Ukuba ukuthengiselana kuthengisa izicwangciso zamazinyo ezizinzileyo ezizimeleyo kunye neentsapho zithengisa isicwangciso sezempilo kunye nesicwangciso sezinyo zonyango esahlukileyo, kuphela iindleko zesicwangciso sezempilo zibalwe xa kubalwa inkxaso-mali yabo ye- premium . Oku kungatshintsha, nangona kunjalo, phantsi komgaqo ophakanyisiweyo okhutshwe yi-IRS ngoJulayi 2016 . Ngaphantsi komgaqo ohlongozwayo, iindleko zenkxaso yezinyo zomntwana ziza kubandakanywa kwizibalo zenkxaso-mali ye-premium, nangona ukuba ukuthengiswa kwamazinyo kuthengiswa ngokutshintshana njengomgaqo ohlukeneyo, kunokuba kubekho inxalenye yesicwangciso sezempilo.
Akukho mfuneko yokuba izicwangciso zezempilo zibandakanya amazinyo okanye umbono kubantu abadala.
Iziyobisi
Izicwangciso zeqela kunye namancinci kufuneka zifake izidakamizwa ezisemthethweni, kwaye iifomthi zazo mazibandakanye ubuncinane esinye isilwanyana kwi-United States ye-Pharmacopeia (i-USP) kunye neklasi (okanye ngaphezulu, ukuba isicwangciso somlinganiselo welizwe siquka ngaphezulu).
Iifomularies nazo ziphuhliswe ngegalelo ezivela kwiikomiti ze-pharmacy kunye neengcali (P & T), kodwa ziyakwazi ukuhluka ngokuthe ngqo kwi-insurer enye yezempilo.
Ngaphantsi kwezikhokelo zokunakekelwa kwezikhuselo ezichazwe ngasentla, izicwangciso zezempilo mazizifihla-ngaphandle kweendleko kwi-insured-okungenani enye inguqu yelo hlobo olulodwa lwe-FDA oluvunyiweyo lokukhulelwa kwabafazi.
Kweminye imichiza, imigaqo yokwabelana ngeendleko zisebenza, kwaye izicwangciso zingafuna unyango lwangonyathelo (umyalelo oqalayo wokuqinisekisa ukuba i-insured iyasebenza kunye neziyobisi ezinobungozi kakhulu ukuba zibone ukuba ziyasebenza yini, ngaphambi kokuzama ukubiza amayeza athile aphezulu) .
Uninzi lwamaziko okhuseleko lwempilo lufakela iziyobisi kuma-third party, ukusuka kwi-one ukuya kwezine. Inqanaba elinye lonyango liphantsi kweendleko eziphantsi kwe-pocket, kunye nezobisi ezine (okanye izidakamizwa ezikhethekileyo) zineendleko eziphezulu eziphezulu.
Iinkonzo zokuvuselela kunye nezibonelelo
Oku kufaka zombini unyango kunye nezixhobo ezifunekayo zokulungiswa nokulungiswa.
Iinkonzo zokuvuselela zijolise ekuphinda ziphinde zikwazi ukulahleka, ezifana nokunyanga emsebenzini okanye kwinyango emva kwengozi okanye ngesifo.
Iinkonzo ezinobuncedo zibonelela ngoncedo ngokufumana izakhono kwindawo yokuqala, njengentetho okanye unyango lomsebenzi onomntwana ongathethiyo okanye ohamba ngokwemiqathango.
Imilinganiselo kwinani lokutyelela ngonyaka lisebenza (nangona izicwangciso zingenako ukubeka imida yeDola kwii-EHB, ukuhanjiswa kwemida kuvunyelwe). Kwamanye amazwe, umda usebenza ekudibaniseni unyango lomzimba, unyango lomsebenzi, kunye nonyango lwentetho, kanti abanye banemiqathango eyahlukileyo yohlobo ngalunye lweyeza.
> Imithombo:
> Isiko soLwazi lwaBathengi kunye noLawulo lweNtshuwalense, uMgangatho wezeMpilo yengqondo kunye noMthetho wokuLungiswa koMlingo.
> Amacandelo okuLawula nokuKhuselwa kwezifo, iKomidi elicebisi ngeZenzo zokuNgcwaba (ACIP).
> Isebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu, uLwazi lwezeMpilo kunye noLawulo lweeNkonzo.
> Isebe lezeMpilo lase-US kunye neeNkonzo zoLuntu, uLwazi lwezeMpilo kunye noLawulo lweeNkonzo, iikhokelo zeeNkxaso zeeNkxaso zabasetyhini.
> I-US Preventive Services Task Force, i-USPSTF ye-A kunye ne-B.