Amalungelo abathengi kunye nokukhuselwa

UmThetho woKhathalelo ongenakufikeleleka (i-ACA) waqala ukusebenza nge-23 ka-Septemba ka-2010. Wawuquka amalungelo athile kunye nokukhuselwa kwabathengi.

La malungelo kufuneka abonelelwe ngezicwangciso ze-inshurensi kwindawo yentengiso yeinshurensi yezempilo kunye nezinye iintlobo zeinshurensi yezempilo.

Amalungelo athile anokungagutyungelwani nezicwangciso ezithile zezempilo, ezinje ngezicwangciso zezempilo zokhulu. Isicwangciso sobukhulu ngumgaqo-nkqubo we-inshurensi yezempilo ethengiweyo ngomhla okanye phambi kuka-Matshi 23, 2010.

Ngalo lonke ixesha jonga izicwangciso zakho zezempilo ukuze uqiniseke ukuba loluphi uhlobo lokugubungela onalo.

AMALUNGELO NOKHUSELEKO

Nazi iindlela zokuba umthetho okhathalela ezempilo ukhusela abathengi.

Kuya kufuneka ukhuselwe, nokuba unemeko esele ikho.

• Akukho sicwangciso seinshurensi sinokukulahla, ukuhlawulisa ngaphezulu, okanye ukwala ukuhlawulela izibonelelo ezifanelekileyo zempilo kuyo nayiphi na imeko obukade unayo ngaphambi kokuba ukhuseleko lwakho luqale.
• Nje ukuba ubhalise, esi sicwangciso asinakukukhanyela ukugubungela okanye ukunyusa amaxabiso akho ngokusekwe kuphela kwimpilo yakho.
• I-Medicaid kunye neNkqubo ye-Inshurensi yezeMpilo yaBantwana (CHIP) nayo ayinako ukwala ukukugubungela okanye ukuhlawulisa ngaphezulu ngenxa yemeko yakho esele ikho.

Unelungelo lokufumana ukhathalelo lwasimahla lokukhusela.

• Izicwangciso zezempilo kufuneka zigubungele iintlobo ezithile zononophelo kubantu abadala nakubantwana ngaphandle kokukuhlawulisa nge-copayment okanye nge-coinsurance.
• Ukhathalelo lothintelo lubandakanya ukuhlolwa koxinzelelo lwegazi, ukujonga imibala, ugonyo, kunye nezinye iintlobo zononophelo lothintelo.
• Olu khathalelo kufuneka lubonelelwe ngugqirha othatha inxaxheba kwisicwangciso sakho sempilo.

Unelungelo lokuhlala kwisicwangciso sempilo somzali wakho ukuba ungaphantsi kweminyaka engama-26 ubudala.

Ngokubanzi, ungazibandakanya nesicwangciso somzali kwaye uhlale kude ube uneminyaka engama-26, nokuba:

• Tshata
• Unomntwana ongamzalanga abe ngowakho
• Qalisa okanye ushiye isikolo
• Hlala ngaphakathi okanye ngaphandle kwikhaya lomzali wakho
• Ayifunwanga njengomntu oxhomekeke kwirhafu
• Yala isibonelelo senkxaso esekwe kwimisebenzi

Iinkampani zeinshurensi azinakunciphisa unyaka okanye ixesha lokugubungela izibonelelo eziyimfuneko.

Ngaphantsi kweli lungelo, iinkampani zeinshurensi azinakho ukuseta umda kwimali echithwe kwizibonelelo ezibalulekileyo ngalo lonke ixesha ubhalise kwisicwangciso.

Izibonelelo zezempilo eziyimfuneko ziintlobo ezili-10 zeenkonzo ekufuneka zigqityiwe zizicwangciso zeinshurensi yezempilo. Ezinye izicwangciso zigubungela iinkonzo ezininzi, ezinye zinokwahluka kancinci ngokwamazwe. Jonga izibonelelo zakho zesicwangciso sempilo ukuze ubone ukuba isicwangciso sakho siquka ntoni.

Izibonelelo zezempilo ezibalulekileyo zibandakanya:

• Unonophelo lwangaphandle
• Iinkonzo ezingxamisekileyo
• Isibhedlele
• Ukukhulelwa, ukukhulelwa kunye nokunyamekela
• Impilo yengqondo kunye neenkonzo zokuphazamiseka ekusebenziseni iziyobisi
• Amachiza amiselweyo
• Iinkonzo zokubuyisela kwimeko yesiqhelo kunye nezixhobo
• Ulawulo lwezifo ezinganyangekiyo
• Iinkonzo zaselebhu
• Unonophelo lothintelo
• Ulawulo lwezifo
• Ukunyamekelwa kwamazinyo kunye nombono wabantwana (umbono wabantu abadala kunye nokunakekelwa kwamazinyo akufakiwe)

Unelungelo lokufumana ingcaciso ekulula ukuyiqonda malunga nezibonelelo zakho zempilo.

Iinkampani zeinshurensi kufuneka zibonelele:

• Isishwankathelo esifutshane seZibonelelo kunye nokuGcina (i-SBC) ebhalwe ngolwimi ekulula ukuluqonda
• Iglosari yamagama asetyenziswa kunyango nakwezempilo

Unokusebenzisa olu lwazi ukuthelekisa ngokulula izicwangciso.

Ukhuselekile ekunyukeni kweqondo le-inshurensi ngokungekho ngqiqweni.

La malungelo akhuselwe ngoHlolo lokuHlola kunye nomgaqo wama-80/20.

Ukuhlaziywa kweRhafu kuthetha ukuba inkampani yeinshurensi kufuneka ichaze esidlangalaleni nakuphi na ukunyuka kwenqanaba le-10% okanye nangaphezulu ngaphambi kokunyusa ipremiyamu

Umgaqo we-80/20 ufuna ukuba iinkampani ze-inshurensi zichithe ubuncinci i-80% yemali abayithathileyo kwiipremiyamu kwiindleko zokhathalelo lwempilo kunye nokuphuculwa komgangatho. Ukuba inkampani iyasilela ukwenza njalo, unokufumana isaphulelo kwinkampani. Oku kusebenza kuzo zonke izicwangciso zeinshurensi yezempilo, nkqu nezo zinkulu

Awunako ukwaliwa ukugubungela ngenxa yokuba wenze impazamo kwisicelo sakho.

Oku kusebenza kwiimpazamo ezilula zobufundisi okanye ukushiya ulwazi olungafunekiyo ukulungiselela ukugubungela Umyinge unokucinywa kwimeko yobuqhetseba okanye iipremiyamu ezingahlawulwanga okanye ezifike kade.

Unelungelo lokukhetha umboneleli okhathalelayo oyintloko (PCP) kwinethiwekhi yesicwangciso sezempilo.

Awudingi ukuthunyelwa kwi-PCP yakho ukufumana ukhathalelo kwingcali yokubelekisa / ugqirha wababhinqileyo. Kananjalo akufuneki uhlawule ngaphezulu ukuze ufumane ukhathalelo olungxamisekileyo ngaphandle kwenethiwekhi yesicwangciso sakho.

Ukhuselekile kwimpindezelo yomqeshi.

Umqeshi wakho akanakukugxotha okanye aziphindezele kuwe:

• Ukuba ufumana ikhredithi yerhafu yeprimiyamu ngokuthenga isicwangciso sempilo kwindawo yentengiso
• Ukuba unika ingxelo ngolwaphulo mthetho

Unelungelo lokubhena kwisigqibo senkampani yeinshurensi yezempilo.

Ukuba isicwangciso sakho sezempilo siyasikhaba okanye siyasigqiba isigubungelo, unelungelo lokwazi ukuba kutheni kwaye ubhenele kweso sigqibo. Izicwangciso zezempilo kufuneka zikuxelele ukuba ungabhena njani izigqibo zabo. Ukuba imeko ingxamisekile, isicwangciso sakho kufuneka sijongane naso ngexesha elifanelekileyo.

AMALUNGELO AMANYE

Izicwangciso zezempilo kwindawo yeNtengiso ye-Inshurensi yezeMpilo kwaye uninzi lwezicwangciso zezempilo zabaqeshi kufuneka zibonelele:

• Izixhobo zokuncancisa kunye neengcebiso kubafazi abakhulelweyo nabanyisayo
• Iindlela zokuthintela ukukhulelwa kunye neengcebiso (ngaphandle kwenzelwe abaqeshi bezenkolo kunye nemibutho yezenkolo engenzi nzuzo)

Amalungelo abathengi ezempilo; Amalungelo abathengi ezempilo

• Iindidi zababoneleli ngezempilo

Umbutho waseMelika woMhlaza. Ibhili yamalungelo esigulana. www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/patients-bill-of-rights.html. Ukuhlaziywa ngoMeyi 13, 2019. Kufumaneka ngo-Matshi 19, 2020.

CMS.gov iwebhusayithi. Uhlengahlengiso kwimarike yeinshurensi yezempilo. www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/index.html. Ukuhlaziywa ngoJuni 21, 2019. Kufumaneka ngo-Matshi 19, 2020.

Indawo yezempilo.gov iwebhusayithi. Amalungelo einshurensi yezempilo kunye nokukhuselwa. Lwezempilo.gov/zempilo-ukhuseleko-law-protections/rights-and-protions/. Kufumaneka ngo-Matshi 19, 2020.

Indawo yezempilo.gov iwebhusayithi. Zithini iiplani zeinshurensi yezempilo kwindawo yentengiso. Lwezempilo.gov/coverage/what-marketplace-plans-cover/. Kufumaneka ngo-Matshi 19, 2020.