Izinhlelo Zomkhulu Ezihlelelwe Ukuqeda Ekupheleni kuka-2018
Lapho i-ACA ingene ngemvume emthethweni ngo-2010, ibiza izinguquko ezinkulu ezimakethe zomshuwalense wezempilo nomuntu ngamunye. Ukuhlinzekwa kwakhiwe emthethweni ukuvumela izinhlelo ezazikhona kakade ngo-Mashi 23, 2010 ukuba ziqhubeke nokusebenza kuze kube nini nanini, uma nje kungekho ushintsho olubalulekile olwenziwe kulolu hlelo, futhi nje uma othwala abanikezela ukunikela uhlelo.
Lezi zinhlelo zithandwa kakhulu futhi azikhululeki ezimfuno eziningi ze-ACA.
Kodwa i-ACA ayizange ibeke izibonelelo ezithile zezinhlelo zomuntu ngamunye nezincane eziphumelela emva kukaMashi 23, 2010, kodwa ngaphambi kokuba iningi lemithetho yomshwalense ye-ACA iqale ukusebenza ngo-2014. Kulindeleke ukuthi baqede ekupheleni kuka-2013 futhi kufakwe esikhundleni se-ACA-coverage ehambisanayo ngaleso sikhathi.
Ukuxhaswa Kwesiguquko Kwenziwe "Amacebo Omkhulu"
Kwasekuseni ekupheleni kuka-2013, njengoba ukushintshaniswa kwe-inshuwalense yezempilo kwakuqhubeka-ne-glitches ebalulekile yezobuchwepheshe-futhi njengoba izaziso zokukhansela zezinhlelo ezingavumelekile zaqala ukubonakala kubhokisi labama-mail, abathengi bezinhlelo zokukhansela bafinyelele emgodini we-fever .
Ngempendulo, i-HHS yakhipha ukukhululeka okwesikhashana okwakuvumela izifunda ukuthi zivumele lezi zinhlelo ezingenakulinywa ukuthi zivuselelwe kuze kube sekupheleni kuka-Okthoba 1, 2014, ngokuvunywa okuvunyelwe ukuqhubeka kusebenza kuze kube ngo-September 30, 2015.
Ngaphansi kwezinyanga ezine kamuva, ngo-Mashi 2014, i-HHS ikhishwe ukwandiswa kokukhululeka kwesikhashana, inika indlela yokuvumela lezi zinhlelo (ezibizwa ngokuthi "ezishintshayo" noma "izinhlelo ezinkulu") ukuvuselela ngasekupheleni kuka-Okthoba 1, 2016, ngokufakwa lokho kungavunyelwa ukuqhubeka nokusebenza ngasekupheleni kuka-Septhemba 30, 2017.
Ngomhlaka 29 kuFebruwari, 2016, i-CMS yakhipha isandiso esengeziwe esavumela izinhlelo ezinkulu ukuthi zihlale zisebenza ngasekupheleni kukaDisemba 31, 2017. Kodwa esinye isandiso sakhishwa ekuqaleni kuka-2017, okuvumela izinhlelo ezinkulu ukuba ziqhubeke ziphoqele kuze kube sekupheleni kuka-2018.
Ngenxa yalokho, iningi lamazwe, kukhona namanje amaqembu amancane nezinhlelo ezincane ezingekho, futhi azihambisani ngokugcwele ne-ACA. Lezi zinhlelo eziguquguqukayo, noma ezinkulu, zihlala zingasebenzi kuze kube nguDisemba 31, 2018. Nakhu okudingeka ukwazi ngakho:
Amalungiselelo omkhulu akuyona into efana nezinhlelo ezinkulu . Zinezidingo ezahlukene ngokuhambisana nezici ezihlukahlukene ze-ACA, futhi azivunyelwe ukuba ziqhubeke zisebenza njalo. Amapulani amakhulu aphelelwe yisikhathi, ngokungafani namacebo amakhulu, okungahle-ku-inory-ahlale esebenza kuze kube phakade uma abathwali bakhetha ukuhamba ngaleyo ndlela ( okungenakwenzeka ).
2. Ezinye izizwe zakhetha ukungavumeli izinhlelo ezinhle kakhulu, ezinye zazinqamula ngaphambi kuka-2018 . Ngisho nasezifundeni ezivumela izinhlelo ezinkulu ukuthi ziqhubeke zivuselela, abanye abathwali baqeda izinhlelo, futhi bafaka esikhundleni sabo nge-ACA-yokubambisana okuhambisanayo.
Ukuhlinzekwa kwezidingo zesikhashana kukhishwe ngasekupheleni konyaka ngo-2013, lapho abathile abathile kanye nabathwali bebehamba kakhulu endleleni ye-ACA-ukuqaliswa ukuthi bazimisele ukuthi angeke kube nesithakazelo esihle se-insureds ukuguqula inkambo ngaleso sikhathi. Emazweni angu-15 naseDkt, kwakungekho izinhlelo ezinhle kakhulu ezikhona ngo-2016. Futhi nakuba zonke ezinye izifundazwe ziye zavumela izinhlelo ezinkulu ukuba ziqhubeke, kunenani okungenani ezine kulawo mazwe lapho kungekho khona izinhlelo eziningi ezikhona.
Amalungiselelo omkhulu ahlanganisa ukunakekelwa kokuvikela ngaphandle kokwabelana ngezindleko, kodwa akudingeki ukuba agubungele zonke izinzuzo ezibalulekile zezempilo ze-ACA .
I-ACA yaqala ukufuna ukuthi zonke izinhlelo zezempilo zihlanganise ukunakekelwa kokuvikela ngaphandle kokwabelana ngezindleko (okungukuthi, mahhala ngenkathi insizakalo inikezwa) kuwo wonke amapulani iminyaka kusukela ngo-September 23, 2010. Lokhu kusetshenziswe ezinhlelweni ezintsha nokuvuselela, nakuba akuzange kusetshenziswe ezinhlelweni eziningi . Ngakho izinhlelo ezinhle kakhulu eziphumelela emva kukaMashi 23, 2010 kodwa ngaphambi kukaSeptemba 23, 2010, kwadingeka ziqale ukumboza ukunakekelwa kokuvimbela ngaphandle kokwabelana ngezindleko njengosuku lokuqala lokuvuselela. Futhi wonke amacebo amakhulu asebenza kahle noma ngemuva kukaSeptemba 23, 2010 ahlanganisa ukunakekelwa kokuvikela ngaphandle kokwabelana ngezindleko kusukela kokuhamba.
4. Amalungiselelo amakhulu awakwazi ukuthengiswa . Amacebo omkhulu yilowo aqala ukusebenza ngemuva kukaMashi 23, 2010, kodwa kungakapheli u-Okthoba 1, 2013, noma kwezinye izimo, ngoDisemba 31, 2013. Emva kwalokho, kwakungasenakwenzeka ukuthenga uhlelo futhi kube khona kucatshangwa ukuthi unkulu. Ngomhla kaJanuwari 2014 egijima nxazonke, ayikho iqembu elincane noma izinhlelo eziningi zokwelapha ezinkulu ezingathengiswa nhlobo (kufaka phakathi ukushintshaniswa) uma bezingavumelani ngokugcwele ne-ACA. Qaphela ukuthi abathembeki bangakwazi ukungezwa ohlelweni olukhulu (uma usuhlelweni oluhle kakhulu futhi unomntwana, unganezela umntwana ohlelweni), futhi abasebenzi abasha abafanelekayo bangathola ukukhokhelwa ngaphansi kwepulani lomqashi omkhulu okhona . Kodwa amapulani amasha amancane awazange atholakale ekuthengeni kusukela ekupheleni kuka-2013.
5. Amalungiselelo omkhulu awafaneleki ukuthola izinsizakalo noma izikweletu zemali yomshuwalense wezamabhizinisi ezincane . Ayithengiswa ekushintsheni, okusho ukuthi abafaneleki ukuthola izinsizakalo ze-premium. Uma unecebo elilodwa lomuntu ngamunye, ukhokhela i-premium egcwele ngokwakho.
6. Uma uhlelo lwakho olukhulu lukhipha imibandela yakho ekhona ngaphambili, lelo lungiselelo lisasebenza . Kuwo wonke amahlanu kodwa athi, umshuwalense wezempilo ngamunye wayedokotela-ubhalwe phansi ngaphambi kuka-2014. Futhi emazweni amaningi, ukufakwa kweqembu elincane kungakhishwa ama-premium aphezulu ngokusekelwe emlandweni wezokwelapha weqembu. Nakuba lokho akusasekho amalungiselelo amasha, imigomo yelungiselelo lakho elikhulu aliguquli-uma lingabandakanyi isimo sakho esandulele noma sikukhokhise i-premium ephakeme ngenxa yomlando wakho wezokwelapha, osasebenza nanamuhla.
7. Uma uhlelo lwakho olukhulu luphela (noma luvuselela), uzothola isikhathi sokubhalisa esikhethekile . Ngisho noma uhlelo lwakho lwezempilo luphela ngaphandle kokubhaliswa okuvulekile, usazokwazi ukubhalisa kuhlelo olusha ngaleso sikhathi , kungekho gap ekufundeni. Ngaphansi kokuqondiswa okukhishwe yi-CMS ekuqaleni kuka-2017, izinhlelo eziningi ezivunyelwe ukuvuselelwa zivunyelwe ukuvuselela ngasekupheleni kuka-Okthoba 1, 2018, kodwa ukuhlanganiswa kumele kuphele ngaphambi kukaDisemba 31, 2018. Uma uhlelo lwakho lwezempilo lulandela lolu hlelo futhi luvumela uhlelo lwakho ukuba luqhubeke ukuthi uzoba khona kuze kufike kuDisemba 31, 2018, uzokwazi ukubhalisa ngesikhathi sokubhalisa okuvulekile ukuhlinzeka ngo-2019, futhi ube nokufakwa okungaxhunyiwe kuhlelo ngaphansi kwe-ACA-plan ehambisanayo eqala ukusebenza ngoJanuwari 1, 2019.
Kodwa uma uhlelo lwakho lunezinhlelo zonyaka ongekho-ikhalenda (isb., Luqala kusukela ngoJuni kuya kuMeyi, isibonelo, futhi luvuselela ngoJuni 1 unyaka ngamunye), umshwalense wakho angase akhethe ukuqeda lolu hlelo ngosuku lokuvuselela, esikhundleni ukuyivuselela unyaka owodwa futhi uyivumele ukuba iqhubeke isebenza ngawo wonke u-2018. Kuleso simo, uzokwazi ukuthola isikhathi sokubhalisa esikhethekile lapho ungakhetha khona uhlelo olusha, okubangelwa ukulahleka kokubika, okuyinto isenzakalo esifanelekayo .
Ngaphezu kwalokho, unesikhathi sokubhalisa esikhethekile lapho ungakhetha khona uhlelo olusha, i-ACA-ehambisanayo, uma uhlelo lwakho lwe-non-ikhalenda lonyaka omkhulu (noma lukhulu) luvuselela phakathi nonyaka, noma ngabe uhlelo aluqedi lelo phuzu.
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services, uMnyango WezeMpilo kanye Nezinsizakalo Zabantu. I-Letter to Commissioners Insurance-Transitional Plan Relief . NgoNovemba 16, 2013.
> Amasevisi e-Medicare naseMedicaid Services, uMnyango WezeMpilo kanye Nezinsizakalo Zabantu. Ama-Insurance Standards Bulletin Series-Ukwaziswa-Ukwandiswa Kwezimiso Zesigodi Ngonyaka Wekhalenda 2018 . Ngo-February 23, 2017.
> Cornell Law School, Legal Information Institute. 45 CFR 155.420 (d) (1) (ii).