Ngubani ohlawula okuyinhloko, owesibili, noma ophakeme kumabango ezempilo

Ukuqonda Ukulungiswa Kwezinzuzo

Ukuhlanganiswa kwezinzuzo (COB) igama elisetshenziswe lapho isiguli sinamapulani amabili omshwalense wezempilo noma ngaphezulu. Imithetho ethile isebenza ukunquma ukuthi iyiphi inqubo yomshuwalense wezempilo ekhokhela okuyinhloko (yokuqala), eyesibili (yesibili) noma ephakeme (yesithathu). Kunemihlahlandlela eminingana yokunquma ukuthi yikuphi ukulandelwa kwehhovisi lezokwelapha okufanele likhokhise uhlelo lomshuwalense wezempilo:

Umthetho othembekile / ongenamalungelo

Umthetho othembekile / ongenamthetho usebenza kumbhalisi wemphuwalense yezempilo kanye nomlingani wombhalisi. Umkhokheli oyinhloko yiluhlelo lomshuwalense wezempilo oluhlanganisa isiguli njengesisebenzi, ubhalisile noma ilunga. Umkhokheli wesibili wuhlelo lomshuwalense wezempilo oluhlanganisa isiguli njengomuntu othembekile.

Umthetho wokuzalwa

Umthetho wokuzalwa osebenza kubantwana abaxhomekile uma abazali beshadile, bengavunyelwanga, noma babe ne-oda lokubambisana elingahlanganisi umthwalo wemfanelo wezempilo. Umthetho wokuzalwa wokuzalwa uthi umkhokhi oyinhloko unqunywa umzali wakhe wokuzalwa owela kuqala ngonyaka wekhalenda. Uma kwenzeka ukuthi bobabili abazali banalo lokuzalwa okufanayo, uhlelo lwe-inshuwalense yezempilo oluye lwahlinzeka ngokufaka isikhathi eside kunomkhokheli oyinhloko.

Ukulawula Umthetho

I-Custody Rule isebenza kubantwana abasondelene nabazali abahlukanisile noma abahlukanisiwe ngaphandle komyalelo wesahlukaniso. Umyalelo wabakhokhisi bomshuwalense ulandela lo myalelo:

1. Umzali wokulondeka
2. Umlingani womzali wokulondeka
3. Umzali ongabambeleli
4. Umlingani womzali ongabambeleli

Uma kwenzeka kukhona umyalelo wesehlukaniso, uhlelo lomshuwalense wezempilo lomzali olunikezwa izinkantolo ukuthi luthwale umshwalense wempilo yengane ngumkhokheli oyinhloko.

Umthetho Wokubhaliselwa

Umthetho wokuBhalisa unquma:

1. Lapho umbhalisi enesishuwalense sempilo yomshuwalense osebenzayo kanye nesuhlelo lwe-COBRA ( Consolidated Omnibus Budget Reconciliation Act ), uhlelo lomshwalense lwempilo olusebenzayo ngumkhokheli oyinhloko.
2. Lapho obhalisile noma oshade naye ephethe uhlelo lomshwalense wezempilo olusebenzayo kanye nohlelo lwe-COBRA, uhlelo lomshuwalense wezempilo lombhalisi ngumkhokheli oyinhloko.
3. Lapho umbhalisile enesishuwalense sempilo yomshwalense esebenzayo kanye nesicwangciso somshuwalense wezempilo engasebenzi, uhlelo lwe-inshuwalense yezempilo olusebenzayo ngumkhokheli oyinhloko.
4. Uma lowo obhalisile enamapulani amabili omshwalense wezempilo asebenzayo, uhlelo lomshuwalense wezempilo oluye lusebenza isikhathi eside kunabo bonke abahola kakhulu.

I-Medicare Secondary Payer

I-Medicare Secondary Payer noma i-MSP ikhuluma ngezinzuzo zeMedare uma uMedare engeyona umshuwalense oyinhloko. I-Medicare idinga bonke abanikezeli bezempilo ukuthi bazi ukuthi kanjani uma uM Medicare engumshwalense oyinhloko noma wesibili weziguli zabo zeMedare. I-Medicare iyinhloko uma isiguli singe:

1. 65 noma ngaphezulu futhi unehlelo lempilo yeqembu elincane ngokusebenzisa umqashi wabo wamanje noma ngomqashi wamanje womlingani wakhe
2. 65 noma ngaphezulu ngomshuwalense ngokusebenzisa uhlelo lokuthatha umhlalaphansi
3. Bakhubazekile futhi banehlelo lempilo yeqembu elincane ngokusebenzisa umqashi wabo wamanje noma ngomqashi wamanje womlingani wakhe

Ezimweni lapho umshuwalense oyinhloko ephika isimangalo, uM Medicare angakhokha kuphela ezimweni ezithile.

Umshuwalense Wezinkokhelo Zesithathu

Mayelana nezinsizakalo ezihlobene nengozi, umshuwalense wemfanelo elandelayo wesithathu kumele uhlale unikezwa njengenhloko:

1. Imoto noma Umshwalense Wokuzivocavoca okubandakanya akukhophutha, inqubomgomo noma i-Med Pay
2. Umshuwalense Wokuvuselelwa Komsebenzi
3. Umshuwalense womninikhaya
4. Umshwalensi Wokungasebenzi
5. Umshuwalense Wokukhokhelwa Kwebhizinisi

I-Medicaid - Umkhokha Wendawo Yokugcina

I-Medicaid ihlale ikhokha isenzo sokugcina. Lokhu kusho ukuthi iMedicaid ihlale ikhokha ekugcineni lapho kukhona khona izinhlelo zomshuwalense wezempilo. Abamukeli kuyadingeka ukuthi bahlale benolwazi mayelana nolwazi lomshuwalense wezempilo. Abahlinzeki nabo banomthwalo wokwazisa i-Medicaid yomshuwalense wesithathu abathola ngakho kanye nokwazisa i-Medicaid nganoma yiziphi izinkokhelo zomphakathi ezitholayo egameni lomamukeli.