Amalungelo abathengi nokuvikelwa

Umthetho Wokunakekelwa Ongabizi (ACA) waqala ukusebenza ngoSepthemba 23, 2010. Wawufaka amalungelo athile nokuvikelwa kwabathengi.

Lawa malungelo kumele ahlinzekwe ngezinhlelo zomshuwalense ku-Health Insurance Marketplace kanye nezinye izinhlobo eziningi zomshuwalense wezempilo.

Amalungelo athile angahle angatholakali ezinhlelweni ezithile zezempilo, ezinjengezinhlelo zezempilo zabazukulu. Uhlelo olwenziwe mkhulu yinqubomgomo yomshuwalense wezempilo ngamunye othengwe ngaphambi noma ngaphambi kuka-Mashi 23, 2010.

Njalo hlola izinzuzo zohlelo lwakho lwezempilo ukuze uqiniseke ukuthi hlobo luni lokumboza onalo.

AMALUNGELO NOKUVIKELWA

Nazi izindlela lapho umthetho wokunakekelwa kwezempilo uvikela abathengi.

Kufanele umbozwe, noma ngabe unesimo esivele sikhona.

• Alukho uhlelo lomshuwalense olungakulahla, lukukhokhise ngaphezulu, noma lunqabe ukukhokhela izinzuzo zezempilo ezibalulekile nganoma yisiphi isimo owawunaso ngaphambi kokuthi ukumbozwa kwakho kuqale.
• Uma usubhalisile, uhlelo alukwazi ukukuncisha ukumbozwa noma ukukhuphula amanani akho ngokususelwa kuphela empilweni yakho.
• IMedicaid neChildren's Health Insurance Program (CHIP) nayo ayikwazi ukwenqaba ukukukhokhela noma ukukukhokhisa kakhulu ngenxa yesimo sakho esivele sikhona.

Unelungelo lokuthola ukunakekelwa mahhala.

• Izinhlelo zezempilo kumele zihlanganise izinhlobo ezithile zokunakekelwa kubantu abadala nezingane ngaphandle kokukukhokhisa imali ekhokhwayo noma i-coinsurance.
• Ukunakekelwa kokuzivikela kufaka ukuhlolwa kwegazi, ukuhlolwa kwamabala, ukugoma, nezinye izinhlobo zokunakekelwa kokuvimbela.
• Lokhu kunakekelwa kumele kunikezwe ngudokotela obamba iqhaza ohlelweni lwakho lwezempilo.

Unelungelo lokuhlala ohlelweni lwezempilo lomzali wakho uma ungaphansi kweminyaka engama-26 ubudala.

Ngokuvamile, ungajoyina uhlelo lomzali futhi uhlale kuze kube yilapho usuba neminyaka engama-26, noma ngabe:

• Shada
• Yiba nengane noma ube ngowakho
• Qala noma ushiye isikole
• Hlala ngaphakathi noma ngaphandle kwekhaya lomzali wakho
• Akufunwanga njengomuntu othembele enteleni
• Yehlisa ukunikezwa kokufakwa emsebenzini

Izinkampani zomshuwalense azikwazi ukukhawulela ukufakwa minyaka yonke noma impilo yonke kwezinzuzo ezibalulekile.

Ngaphansi kwaleli lungelo, izinkampani zomshuwalense azikwazi ukubeka umkhawulo emalini esetshenziswe ezinzuzweni ezibalulekile sonke isikhathi obhalise ngaso kuhlelo.

Izinzuzo ezibalulekile zezempilo yizinhlobo eziyi-10 zezinsizakalo okumele izinhlelo zomshuwalense wezempilo kumele zihlanganise. Amanye amapulani ahlanganisa izinsizakalo eziningi, ezinye zingahluka kancane ngezwe. Bheka izinzuzo zohlelo lwakho lwezempilo ukuze ubone ukuthi uhlelo lwakho limbozani.

Izinzuzo ezibalulekile zezempilo zifaka:

• Ukunakekelwa kweziguli ezingalaliswayo
• Izinsizakalo zezimo eziphuthumayo
• Ukulaliswa esibhedlela
• Ukukhulelwa, ukukhulelwa nokubeletha
• Izinsizakalo zokuphazamiseka kwengqondo nezengqondo
• Izidakamizwa ezibekiwe
• Izinsizakalo zokuvuselela kanye namadivayisi
• Ukuphathwa kwezifo ezingamahlalakhona
• Izinsizakalo zelebhu
• Ukunakekelwa kokuvimbela
• Ukuphathwa kwezifo
• Ukunakekelwa kwamazinyo nokubona kwezingane (umbono wabantu abadala nokunakekelwa kwamazinyo akufakiwe)

Unelungelo lokuthola ulwazi okulula ukuluqonda mayelana nezinzuzo zakho zezempilo.

Izinkampani zomshuwalense kumele zinikeze:

• Isifinyezo esifushane semihlomulo nokutholakala (SBC) esibhalwe ngolimi olulula ukuqondakala
• I-glossary yamagama asetshenziswa ekunakekelweni kwezempilo nasekuhlanganisweni kwezempilo

Ungasebenzisa lolu lwazi ukuqhathanisa kalula amapulani.

Uvikelwe ekunyukeni kwamazinga omshwalense ongenangqondo.

Lawa malungelo avikelekile nge-Rate Review kanye nomthetho ka-80/20.

Ukubuyekezwa Kwezinga kusho ukuthi inkampani yomshuwalense kumele ichaze esidlangalaleni noma yikuphi ukukhuphuka kwezinga lika-10% noma ngaphezulu ngaphambi kokukhuphula imali yakho ekhokhwayo.

Umthetho ka-80/20 udinga ukuthi izinkampani zomshuwalense zisebenzise okungenani u-80% wemali eziyitholayo kusuka kumaphrimiyamu ezindlekweni zokunakekelwa kwezempilo nokwenza ngcono ikhwalithi. Uma inkampani yehluleka ukwenza kanjalo, ungathola isaphulelo kunkampani. Lokhu kusebenza kuzo zonke izinhlelo zomshuwalense wezempilo, ngisho nalezo ezizelwe

Awunakunqatshelwa ukumbozwa ngoba wenze iphutha kuhlelo lwakho lokusebenza.

Lokhu kusebenza kumaphutha alula wokubhala noma ukushiya imininingwane engadingeki ukumbozwa. Ukutholakala kungakhanselwa uma kwenzeka inkohliso noma amaprimiyamu angakhokhiwe noma sekwephuzile.

Unelungelo lokukhetha umhlinzeki wokunakekelwa okuyisisekelo (i-PCP) kunethiwekhi yohlelo lwezempilo.

Awudingi ukuthunyelwa kusuka ku-PCP yakho ukuthola ukunakekelwa kudokotela wokubelethisa / wezifo zabesifazane. Akudingeki nokuthi ukhokhe okuningi ukuthola ukunakekelwa okuphuthumayo ngaphandle kwenethiwekhi yohlelo lwakho.

Uvikelwe ekuziphindiseleni komqashi.

Umqashi wakho akakwazi ukukuxosha noma ukuphindisela kuwe:

• Uma uthola isikweletu sentela se-premium ngokuthenga uhlelo lwezempilo emakethe
• Uma ubika ukwephulwa kwezinguquko ze-Affordable Care Act

Unelungelo lokufaka isikhalazo ngesinqumo senkampani yomshuwalense wezempilo.

Uma uhlelo lwakho lwezempilo luphika noma luphela ukumbozwa, unelungelo lokwazi ukuthi kungani futhi usidlulise leso sinqumo. Izinhlelo zezempilo kumele zikutshele ukuthi ungazidlulisa kanjani izinqumo zabo. Uma isimo siphuthuma, uhlelo lwakho kufanele lubhekane naso ngesikhathi esifanele.

AMALUNGELO OKWENGEZA

Izinhlelo zezempilo endaweni yezimakethe zomshuwalense wezempilo kanye nezinhlelo eziningi zezempilo zabaqashi kumele futhi zinikeze:

• Imishini yokuncelisa ibele nokwelulekwa kwabesifazane abakhulelwe nabancelisayo
• Izindlela zokuvikela ukukhulelwa nokwelulekwa (okwehlukile kwenzelwa abaqashi bezenkolo nezinhlangano zezenkolo ezingenzi nzuzo)

Amalungelo abathengi ezempilo; Amalungelo omthengi wezokunakekelwa kwempilo

• Izinhlobo zabahlinzeki bokunakekelwa kwempilo

Iwebhusayithi yeAmerican Cancer Society. Umthetho wamalungelo eziguli. www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/patients-bill-of-rights.html. Kubuyekezwe ngoMeyi 13, 2019. Kufinyelelwe ngoMashi 19, 2020.

CMS.gov iwebhusayithi. Ukuguqulwa kwemakethe yomshuwalense wezempilo. www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/index.html. Kubuyekezwe ngoJuni 21, 2019. Kufinyelelwe ngoMashi 19, 2020.

I-Healthcare.gov iwebhusayithi. Amalungelo omshuwalense wezempilo nokuvikelwa. www.healthcare.gov/health-care-law-protections/rights-and-protections/. Kufinyelelwe ngoMashi 19, 2020.

Healthcare.gov iwebhusayithi. Imiphi imishwalense yezempilo ye-Marketplace ehlanganisa. www.healthcare.gov/coverage/what-marketplace-plans-cover/. Kufinyelelwe ngoMashi 19, 2020.