Imicimbi efanelekayo iqala izikhathi zokubhalisa ezikhethekile
Vula ukubhaliswa emakethe yomshuwalense wezempilo ngamunye ophelile ngoJanuwari 31. Ezimweni eziningi, hlela izinguquko kanye nokubhaliswa okusha kuka-2016 manje kungagcwaliswa kuphela uma unomcimbi ofanelekayo, nakuba amaMelika aseMelika angabhalisa unyaka wonke ohlelweni ngokushintshaniswa (Ukubhaliswa kwe-Medicaid ne-CHIP nakho nakho unyaka wonke).
Ifasitela lokubhalisa elivulekile lisebenza kokubili futhi livala ukushintshaniswa , futhi izenzakalo ezifanelekayo ziyadingeka uma ubhalisa ngaphandle kokubhaliswa okuvulekile, kungakhathaliseki ukuthi uthenga uhlelo lwakho ngokushintshanisa noma ngokuqondile kumthwali womshuwalense wezempilo (inothi ukuthi i-premium izinsizakalo zitholakala kuphela uma ubhalisa nge-exchange; uma ungabaza, uhlelo lokushintshanisa lungcono kakhulu lokubheja, njengoba linikeza ithuba lokuzibiza ngokuzenzekelayo izinsizakalo ze-premium uma imali yakho engenayo isiphezulu kunalokho ucabanga ukuthi kuzoba khona) .
Kungani ukubhaliswa kunqunyelwe?
Imakethe ngayinye kufanele ibe nefasitela lokubhalisa elinganiselwe ngoba ukusabalala manje sekuqinisekisiwe kwabo bonke abafakizicelo, kungakhathaliseki ukuthi banezimo ezandulele. Iwindwangu yokubhalisa yonyaka evulekile ivimbela abantu ukuba balinde baze bagule ukuthenga. Kodwa ngezinye izikhathi, abantu banomcimbi wokuphila - ngaphandle kokugula! - okudinga ikhono lokubhalisa ohlelweni olusha lwezempilo ngaphandle kokubhalisa okuvulekile.
Yilapho kufike khona izikhathi ezikhethekile zokubhalisa. Sekuyisikhathi eside zisetshenziswe emakethe yomshuwalense wezempilo oxhaswe ngumqashi, futhi manje ziyingxenye yemakethe ngayinye futhi. Futhi ngenkathi kunokuningi okwenziwe ngokwezinto ezibangela isikhathi sokubhalisa esikhethekile, kunezenzakalo ezithile ezifanelekayo ezihlukile emakethe ngayinye ngaphansi koMthetho Wokunakekelwa Onganakekelwayo.
Yini ebaluleke njengomcimbi ofanelekayo?
Kukhona uhlu olubanzi lwezehlakalo ezifanelekayo ezizokuvumela ukuba ubhalise ohlelweni noma ushintshele ohlelweni oluhlukile ngaphandle kokubhalisa okuvulekile.
Ngokuvamile, banomqondo ovamile, futhi ngeke babhekisele kubantu abaye bashintsha ingqondo yabo ngokudinga umshuwalense wezempilo ingxenye yonyaka. Futhi kubalulekile ukuqaphela ukuthi i-HHS iye yafaka inqubo yokuqinisekisa izenzakalo ezifanelekayo kulo nyaka - uma ubhalisa usebenzisa isenzakalo esifanelekayo, lungele ukunikeza ubufakazi bokufaneleka.
Kodwa uma uhlangabezana nanoma iyiphi yalezi zenzakalo ezifanelekayo, uzoba nenkathi ekhethekile yokubhalisa, ngokuvamile ehlala izinsuku ezingu-60 (ezimweni eziningi, ukufakwa kwezimali kuyosebenza ngempumelelo ngenyanga yokuqala kule nkathi uma ubhalisa ngo-15 inyanga, nakuba kukhona okunye okuhlukile kanye nezimbalwa ezimbalwa ezibekiwe kamuva):
- Ukulahlekelwa kokunye ukufakwa . Uhlelo olulahlekelwayo lufanele lubhekwe njengento encane yokubambisana okubalulekile (okungukuthi, angeke kube yinto efana necebo lesikhathi esifushane noma ukwesekwa kwengozi). Futhi ukulahlekelwa kokusabalalisa akunakuphumela kokungakhokhi kweprimiyamu, ukukhishwa, noma ukukhansela ngokwakho. Ngakho-ke lokhu kusebenza ezimweni ezifana nehlelo lakho lempilo eliphuma emakethe, noma ukulahlekelwa kokufinyelela ohlelweni oluxhaswe ngumqashi ngenxa yesehlukaniso, ushiya umsebenzi, njll (ngisho noma unikezwa i-COBRA , usafanelekile ukubhaliswa okukhethekile isikhathi lapho ungathenga khona uhlelo olulodwa esikhundleni). Unemihla engama-60 ngaphambi nangemva kwezinsuku ezingu-60 ukulahlekelwa kokusabalalisa lapho ungabhalisa khona kuhlelo olusha. Lesi sikhathi sokubhalisa esikhethekile sisebenza kubantu abaningi abalahlekelwa ukukhokhelwa ngezizathu ezihlukahlukene ekupheleni kuka-2015 .
- Ukuba umuntu othembekile noma othembekile ngenxa yokuzalwa, ukwamukelwa, noma ukubekwa ekunakekelwa kwabantwana. Uma unomntwana, isikhathi sakho sokubhalisa esikhethekile siqala usuku umntwana azalwa ngalo, futhi ukufakaza kungahle kube yisikhathi ngosuku lokuzalwa / lokutholwa kwengane. I-HHS yenza isikhathi esifanayo sokubhalisa esikhethekile esisebenza kubantu abashintsha umndeni wabo ngenxa yezizathu ezithile, kufaka phakathi isahlukaniso noma ukufa komuntu othembekile (inothi ukuthi ngesikhathi ukuzalwa kwengane kuyisenzakalo esifanelekayo, ukukhulelwa akusiyo - ngaphandle kwaseNew York).
- Umshado . Uma ushada, isikhathi sakho sokubhalisa esikhethekile sezinsuku ezingu-60 siqala usuku lomshado wakho, futhi ukufakwa kuzoba usizo ngenyanga yokuqala emva kokubhalisa kwakho, kungakhathaliseki ukuthi ubhalisile usuku.
- Ukuba yisakhamuzi sase-US . Izakhamizi ezintsha zase-US zifanele ukuthola isikhathi sokubhalisa esikhethekile, nakuba kusebenza kuphela ngaphakathi kokuthengiselana - izinhlelo zokushintshaniswa ngaphandle kokudingwa ukubhalisa abantu ngenxa yalesi senzakalo esifanelekayo, nakuba bangakhetha ukukwenza.
- Ukunyakaza okuhlala njalo endaweni lapho izinhlelo ezahlukene zezempilo zitholakala khona . Ukuthutha akukwazi ukuba okwesikhashana, futhi okungenani ezinye zezinhlelo zezempilo ezitholakalayo endaweni entsha kumele zihluke kulabo ababekhona endaweni yakho yangaphambili. I-HHS yacacisa maduzane ukuthi ukuthuthela esibhedlela ukwelashwa endaweni entsha akufaneleki ukuthutha unomphela. Futhi kusukela ngo-July 2016, ukuthutha okuhlala njalo kuzothatha isikhathi sokubhalisa esikhethekile uma usuvele unesibalo esincane sokubalulekile okungenani kwezinsuku ezingu-60 ngaphambi kokuhamba. Ngamanye amazwi, awukwazi ukuhamba uninsured bese uthola ukuthutha ngokuya endaweni entsha lapho unesidingo ukunakekelwa kwezempilo (kukhona okuhlukile kubantu abasanda kukhululwa ekuboshweni, ukuphuma emkhakheni wokuvikelwa eMedicaid , noma ukubuyela emuva e-US ngemuva kokuhlala kwelinye izwe).
- Uhlelo lwezempilo lomuntu ngamunye luvuselelwa ngaphandle kokubhaliswa okuvulekile . Ngaphansi kwe-ACA, izinhlelo ezintsha zigijima ngonyaka wekhalenda, futhi zonke zivuselelwa ngoJanuwari. Kodwa izinhlelo ezincane nezinhlelo eziningi zingaba nezinsuku zokuvuselela nganoma yisiphi isikhathi sonyaka. Uma uhlelo lwakho luzovuselelwa ngaphandle kokubhaliswa okuvulekile, uvumelekile ukushintshela kuhlelo lwe-ACA oluvumelanisiwe kunokuvuselela uhlelo lwakho olukhona.
- Iphutha noma inkinga ngenqubo yokubhalisa eyengewona iphutha lokubhalisa (okungukuthi, libangelwa ukushintshaniswa, noma ngokubhalisa umsizi noma umshuwalense wezempilo). Ukushintshaniswa kanye / noma othintekayo angabhalisa kabusha umfakisicelo ngaphandle kokubhalisa okuvulekile ukuze alungise inkinga.
- Uhlelo oluxhaswe ngumqashi luba olungenakulungiswa noma alusekeli inani eliphansi . Ngo-2016, izinhlelo ezixhaswe ngumqashi zibhekwa njengezithengekayo uma nje isabelo somsebenzi se-premium (ngoba nje ukukhokhelwa kwabasebenzi - ukungabali izindleko zokumboza abaxhomekile ) akuyona engaphezulu kuka- 9.66% yengeniso yomndeni. Uma uhlelo lomqashi luba neminyaka emaphakathi (kungakhathaliseki ukuthi i-premium yomsebenzi ikhuphuka, noma ngenxa yokuthi imali engenayo yomsebenzi iyancipha), isisebenzi sifike isikhathi sokubhalisa esikhethekile. Isikhathi sokubhalisa esikhethekile sisebenza futhi uma uhlelo oluxhaswe ngumqashi luyanciphisa izinzuzo ezinjalo kangangokuthi alisekho okungenani ama-60% wezindleko zokubhalisa isilinganiso (okungenani, inani elincane).
- Ukhona igebe lokufihla esimweni esingakaze sandisa i-Medicaid futhi imali yakho engenayo iyanda kuze kube ngu-100% wezinga lobuphofu . Izinsizakalo ze-premium ku-exchange ayitholakali kunoma ubani onenzuzo engaphansi kwezinga lobuphofu. Ezizweni ezingazange zandise i-Medicaid, abantu abanenzuzo engaphansi kwezinga lobuphofu abangakufanelekeli i-Medicaid ngaphansi kwemikhombandlela ekhona abakuthole ukufinyelela okungokoqobo kumshuwalense wezempilo. Uma imali yabo engenayo iyanda phakathi nonyaka ukubenza bakwazi ukuthola izinsizakalo ze-premium, bangakwazi ukubhalisa ngaleso sikhathi.
- Usuvele unayo uhlelo lokushintshanisa futhi imali yakho engenayo ingashintsha njengokuthi usanda kufaneleka noma usanda kungafaneleki ukuthola usizo. Lesi senzakalo esifanelekayo sisebenza kuphela kubantu ababhalisile ohlelweni lokushintshanisa.
- Usuvele unayo uhlelo lokushintshanisa futhi uhlelo "luphula ngokweqile" isivumelwano sakho nawe . Kunenqubo esemthethweni yokubhalisa ukuphulwa kombiko nokucela isikhathi sokubhalisa esikhethekile ukushintshela kuhlelo oluhlukile.
Isikhathi sokubhalisa esivulekile sohlelo lwe-2017 sizoba ngoNovemba 1, 2016 kuya kuJanuwari 31, 2017. Uma ungenalo umcimbi ofanelekayo, ithuba elilandelayo lokubhalisa liyoba phakathi naleso sikhathi, futhi usuku lokuqala olusebenzayo olusebenzayo luzoba NgoJanuwari 1, 2017. Kodwa uma uhlangabezana nesenzakalo esifanelekayo ngesikhathi esithile sonyaka, uzoba nethuba lokubhalisa ngaleso sikhathi.
Imithombo:
I-Cornell Univerity Law School, i-Legal Information Institute, i-45-CFR-155.420, Izikhathi Ezibalulekile Zokubhalisa. Kufinyelelwe ku-4/20/16.
UMnyango WezeMpilo kanye Nezinsizakalo Zabantu, PPACA; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe futhi oluhlelekile . Ifinyelele ngo-5/25/6.
Insizakalo yangaphakathi yeRevenue, Inqubo Yokuthola Imali 2014-62 . Ifinyelele ngo-5/25/6.