Uhlelo lwezempilo lwe-Association (AHPs) luye lwaba khona amashumi eminyaka, luvela ku-Employee Retirement Income Security Act (ERISA) ka-1974, futhi ngokuyinhloko kuncike kumthethonqubo wombuso ngaphansi kwemithetho emisha eyasungulwa ekuqaleni kwawo-1980. Umthetho Wokunakekelwa Okunenzuzo (ACA) unqume imithethonqubo emisha eklanyelwe ukuhlinzeka ngokuvikeleka okwengeziwe kumalungu e-AHP.
Kodwa i-Administration Trump ifuna ukuphumula imithetho ye-AHPs, yingakho beyenze izinhloko ezintsha kamuva.
Ngo-Okthoba 2017, ukuhleleka kweMongameli uTrump Trump ka-"Healthcare Choice and Competition" kusho ukuthi phakathi kwezinye izinto, imithethonqubo emisha ehloswe ngokuthi "ukwandisa ukufinyelela" kuma-AHPs emabhizinisini amancane nakwabantu abaziqashile njengamanje ngaphansi kweqembu elincane le- ACA nemithetho yamakethe ngayinye .
Ekuqaleni kukaJanuwari 2018, uMnyango Wezabasebenzi washicilela imithethonqubo ehlongozwayo evela ekutheni umongameli we-Okthoba u-Okthoba, evula isikhathi sokubeka isikhathi somphakathi sosuku lwama-60 (ungahambisa amazwana lapha).
Ngokucaphuno: Indlela i-AHPs engayishintsha ngayo umshuwalense wakho wezempilo
Uma unomsebenzi ovela kumqashi omkhulu, i-Medicaid, noma i-Medicare, imithetho emisha ehlongozwayo ngeke ithinte ukufakwa kwakho. Uma unesitatimende kumakethe noma ngamakethe amancane, noma kunjalo, imithethonqubo ehlongozwayo ingathinta ukufakwa kwakho, kuye ngokuthi uhlalaphi.
Imithetho ayingakapheli, futhi akucaci ukuthi izifunda ezikude zizobe zidinge kanjani ukukhawulela imithetho emisha uma iphothuliwe futhi nini.
Kodwa ukwandisa ukufinyelela ku-AHPs kungabangela amaphrimiyamu omshwalense wezempilo aphansi kumaqembu amancane nabantu abaziqashile abajoyina izinhlangano ezinikeza i-AHPs. Kodwa-ke, nalawo maphrimiyamu aphansi angase afike ekunciphiseni izinzuzo zomshuwalense wezempilo. I-adage "uthola lokho okukhokhayo" kunzima ukugwema.
Ngakolunye uhlangothi, abantu ngabanye namabhizinisi amancane abangajoyina izinhlangano futhi bathole ukukhokhelwa ngaphansi kwe-AHPs bangabona amaphrimiyamu aphakeme esikhathini esizayo, kanye / noma imakethe yomshuwalense ongenamathele, nabaningi besikhwama sokungenisa umshwalense abanikeza ukuhlinzekwa. Lokhu kuzovela ekutheni i-AHPs ingase iklanyelwe ukunxusa amabhizinisi anempilo, abasebenzi abasha, ashiya imakethe endala, egulayo kumacebo ahambisana ne-ACA.
Labo abangajoyina i-AHPs bazobandakanya amabhizinisi amancane nabantu abazisebenzayo abakhetha ukugcina ukwaziswa kwabo okunamandla okunamandla kwe-ACA, kanye nabantu abangabasebenzi-ngakho-ke abafanelekile ukujoyina i-AHP-kubandakanye nabaqashile .
Uma okwamanje usebenzela umqashi omncane ongahlinzeki ngezempilo futhi uthola ukukhokhelwa kwakho ekushintsheni, ukufaneleka kwakho kwezibonelelo ze- premium (credits tax premium) kusekelwe enyangeni yakho. Kodwa uma umqashi wakho ejoyina inhlangano futhi enikeze ukuhlinzekwa kwe-AHP ehlangabezana nencazelo ye-ACA engabizi, ngeke usakwazi ukukhokhela izinsizakalo ze-premium.
Imithethonqubo yamanje: Imithetho eVary ngokuya ngobukhulu beqembu
Isihloko sezimiso ezihlongozwayo, "Incazelo 'yomqashi' ngaphansi kwesigaba 3 (5) se-ERISA-Association Health Plans," ihlanganisa i-crux yalolu daba: Ngokuyinhloko, ubani ovunyelwe ukujoyina ndawonye ukudala iqembu elikhulu, umqashi -uhlelo oluqondisiwe?
Kubalulekile ngoba i-ACA ilawula amaqembu amakhulu nezincane ngokuhlukile. "Iqembu elincane" lisho abasebenzi abangaba ngu-50 emazweni amaningi, kodwa abasebenzi abangaba ngu-100 eCalifornia, e-Colorado, eNew York naseVermont. Futhi iqembu elincane lilawula ngaphansi kwe-ACA (izinhlelo eziphumelelayo ngoJanuwari 2014 noma kamuva) ngokuvamile kufana nemithetho yokuthengiswa kwemakethe ngayinye: Amacebo kufanele aqinisekiswe-ama-premiums ahlukahluka kuphela ngokususelwa endaweni, iminyaka yobudala (abasebenzi) ngaphakathi kwesilinganiso esiphezulu se-3: 1 kwabasebenzi abadala noma abasebancane), kungakhathaliseki ukuthi abasebenzi bancike kuloluhlelo, nokusetshenziswa kogwayi.
Izinto ezifana nobulili, uhlobo lwemboni, futhi impilo yonke yeqembu ayikwazi ukusetshenziselwa ukunquma amaphrimiyamu.
Futhi amahlelo amancane amaqembu aqaliswa kusukela ngonyaka ka-2014 kumele ahlanganise izinzuzo zezempilo ze-ACA, futhi afinyelele kwelinye lezinga lezinsimbi ze-ACA (ithusi, isiliva, igolide, noma i-platinum), okuyisilinganiso sokubaluleka kwamanje .
Ezinye izimiso ze-ACA zisebenza kumacebo amakhulu eqembu kanye nezinhlelo zokuzimela (ezithandwa ikakhulukazi nabaqashi abakhulu kakhulu), kepha imithetho ayiyona eqinile. Amaphromoshini weqembu elikhulu nezinhlelo zokuzikhokhela azikho ngaphansi kwenqubo efanayo yokubuyekezwa esebenza kumapulani eqembu ngalinye namancane, angashintsha ngokusekelwe emlandweni wezinsolo zezokwelapha, futhi akudingeki ahambisane ne-age 3: 1 yobudala isilinganiso esisebenza emakethe yeqembu elincani (okungukuthi, izinkokhelo zabasebenzi asebekhulile zingaba ngaphezu kwezikhathi ezintathu ama-premium akhokhiswa abasebenzi abasha). Futhi iqembu elikhulu nezinhlelo zokuzikhokhela akudingeki zimboze izinzuzo ezibalulekile zezempilo ze-ACA.
Ngaphezu kwalokho, nakuba izidingo eziningi ze-ACA zingasebenzi eqenjini elikhulu nezinhlelo ezizimele, izinhlelo zokuzikhokhela nazo azikho ngaphansi kwemithethonqubo kahulumeni. Kunalokho, zilawulwa uhulumeni wesifundazwe, ngaphansi komhlahlandlela we-ERISA. Ngakho-ke ungacabanga ukuthi uhlaka olulawulayo lube lukhuni kakhulu kumacebo omuntu ngamunye noma amancane, okuncane kakhulu kunezinhlelo ezizimele, futhi phakathi naphakathi amaqembu amakhulu athengisa inkampani evela kunkampani yomshuwalense esikhundleni sokuzimela, ngoba izinkampani zomshuwalense ezithengisa lezo zinhlelo zihambisana nesimiso sombuso, naphezu kwemithetho ekhululekile ngaphansi kwe-ACA uma kuqhathaniswa nezinhlelo zomuntu ngamunye kanye nezincane (ngokuvamile, inhlangano enkulu, kungenzeka ukuthi i-self-insure).
Izinkombandlela ze-AHP ezihlongozwayo zizobe zikhulula Imithetho
Ngaphansi kwemithetho yamanje, i-AHPs ivunyelwe ukunikeza iqembu elikhulu noma izinhlelo zokuzikhokhela kumalungu azo, kodwa imithetho iqinile kakhulu: Abaqashi kumele bahlanganyele ngenhloso ngaphandle kokudala i-AHP (lokhu kubizwa ngokuthi "okuvamile" of interest ", ngokuvamile okusho ukuthi kufanele babe embonini efanayo), kumele babe nokulawulwa kwe-AHP, futhi abaqashi abalungu kumele babe nabasebenzi abangaphezu kwesisodwa (okungukuthi, abakwazi ukuba ngabanikazi bodwa abangenawo abasebenzi).
Imithethonqubo ehlongozwayo izophumula leyo mithetho. Uma kuqedile njengoba kuhlongozwa, imithetho emisha ingavumela abaqashi ukuba bajoyine ndawonye ukudala i-AHP ngokusekelwe embonini okwabelwana ngayo noma indawo eyabelwe indawo, okungaba yisifunda noma isifunda esingaziwa kakhulu, njengesizinda noma idolobha elikhulu (ukugcina engqondweni ukuthi ezinye izindawo zedolobhana zidlulisa ngaphezu kombuso owodwa). Ngakho izitolo ezimbalwa ezincane zokulungisa izinto ezihlukahlukene zingabuthana ndawonye ukuze zenze i-AHP, noma amabhizinisi amaningana angabambisene nawo wonke ahlala edolobheni elifanayo noma ezwe angajoyina ndawonye ukudala i-AHP.
Ngenkathi iqembu lama mechanics lizokwazi ukulinganisa incazelo yanamuhla ye-association engase ihlangane nesivamile senzuzo, imithetho emisha ingavumela abaqashi ukuba benze inhlangano ngisho noma indawo yendawo evamile yesithakazelo.
Kodwa-ke, imithethonqubo ehlongozwayo izoqhubeka idinga izinhlangano ukuba zibe "izinhlangano zangempela nesakhiwo senhlangano okudingekayo ukuba senze 'ngenzuzo' yabaqashi abathintekayo." Inhlangano yayizodingeka ibe nemithetho kamasipala kanye nokubusa futhi iqondiswe ngamabhizinisi afaka ubulungu bayo. Ngakho-ke ngenkathi iqembu labaqashi lingakwazi ukujoyina ngenhloso evamile yokuthola iqembu elikhulu noma umshuwalense wezempilo ozimele (futhi ngaleyo ndlela ugweme imithethonqubo yeqembu le-ACA ngabanye kanye nezincane), kuzodingeka ukuthi benze umhlangano we-bonafide ukuze wenze kanjalo.
Ngaphansi kwemithetho yamanje, abantu abazisebenzayo abangenazo izisebenzi abakwazi ukujoyina i-AHPs ukuze bathole ukuhlinzeka ngezempilo kwe-ERISA (okungafani nokuhlinzekwa kwemakethe okuhambisana ne-ACA). Kodwa imithethonqubo ehlongozwayo iyophumula leyo mithetho, ivumele "abanikazi bezisebenzi" ukuba bajoyine i-AHPs uma nje bengakufanelekeli umshuwalense wezempilo osizayo kusuka kwelinye uhlelo oluxhaswe ngumqashi, sebenze okungenani amahora angu-120 ngenyanga, futhi uzuze ngokwanele ekuziphatheni kwabo -ukusebenza ukumboza izindleko zokuhlinzeka nge-AHP.
Uhlobo Luni Lokungaba Khona U-AHPs Luzohlinzeka?
Uma ngabe umthetho ohlongozwayo usuqedile, ama-AHP amasha angase avele avele ngokushesha, futhi kungenzeka ukuthi kube nokuhluka okubanzi ngokuhambisana nekhwalithi yokuhlinzeka kwabo. Kodwa ngokubanzi, iphuzu lonke lokukhulisa i-AHPs ukunciphisa izindleko zemisebenzi yezempilo. Futhi njengoba imigomo ehlongozwayo ingenzi lutho lokunciphisa izindleko zokunakekelwa kwezempilo (okuyinto eyenza izindleko zemshuwalense wezempilo), indlela ewukuphela kwabo ukuba babe nama-premium aphansi ukuhlukanisa izingqinamba ngokwezinzuzo ezinikezwayo, noma ukunciphisa ubulungu obunempilo kunokulinganisa.
Imithetho ehlongozwayo ingavimbela i-AHPs ekubandleni ngokucacile ngokusekelwe esimeni sezempilo, ngakho ngeke bakwazi ukulahla ibhizinisi noma isisebenzi esivela kubulungu ebambiswaneni (futhi ngaleyo ndlela i-AHP coverage) ngokusekelwe emlandweni wezokwelapha. Kodwa-ke, i-AHPs izoba nebala eliphawulekayo lokuklama ukusakazwa kwabo ngendlela engathandeki kubantu abanezimo ezinzima ezikhona ngaphambili. Ababambiseneli base bevele bekwenza lokhu ngezinga elithile ngaphambi kokuba i-ACA-isibonelo, inikeze izinhlelo zezempilo ezihlanganisa kuphela izidakamizwa ezivamile, noma lokho akuzange kuhlinzekwe ngezempilo yengqondo nhlobo.
I-ACA imisa leyo mikhuba, futhi zonke izinqubomgomo zomshuwalense wezempilo zomuntu ngamunye nezincane ezisebenza kusukela ngoJanuwari 2014 ziye zadingeka zihlangabezane nezindinganiso zokugcina ezisezingeni eliphezulu. Kodwa imithetho eminingi ye-ACA ayisebenzisi eqenjini elikhulu nezinhlelo ezizimele, ngakho-ke umqondo wokwandisa ukufinyelela kuma-AHPs uyathinta amabhizinisi amancane anabasebenzi abaphilile.
I- American Academy of Actuaries kanye neNational Association of Insurance Commissioners yabonisa ukukhathazeka ngo-2017 (lapho ukukhuliswa kwe-AHP kucatshangwa ngabakhi bomthetho) mayelana nomphumela we-AHPs eyandisiwe emakethe yeqembu ngalinye namancane. Zombili izinhlangano zithi ama-AHPs amasha futhi anwetshwa angabangela ukhetho olubi emakethe yeqembu ngabanye nalabo abancane, (i-non-AHP), njengoba i-AHPs ingahlela izinhlelo zabo ukukhalela amabhizinisi amancane (nabantu abazisebenzayo) abanempilo , abasebenzi abasha, beshiya abantu asebekhulile, abagulayo ezimakethe ezilawulwa nguhulumeni, ze-ACA-ezivumelanisiwe namanye amancane.
I-AAA ne-NAIC nayo yonke inothi ukuthi i-AHPs yamashumi eminyaka adlule ayebhekene nokungabonakali, inkinga engase iphakame futhi. Futhi njengoba lezi zinhlelo zingalawulwa yizinkomishana zomshuwalense wombuso, amalungu angeke abe nokunciphisa indlela uma i-AHP yabo iphelile bengakwazi ukukhokha izimangalo zabo.
> Imithombo:
> I-American Academy of Actuaries. Incwadi kubomthetho ngokuphathelene nokwandiswa kwezinhlelo zezempilo zenhlangano . Mashi 8, 2017.
> Amasevisi e-Medicare naseMedicaid Services, Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshwalense. Isilinganiso seMakethe Shintsha; Ukuhluka kwesilinganiso sikaHulumeni.
> UMnyango Wezabasebenzi, Ukuphathwa Kwezokuphepha EzokuHlaliswa kwabasebenzi. Incazelo "Umqashi" Ngaphansi kwesigaba 3 (5) se-ERISA-Association Health Plans. Ishicilelwe ku-Federal Register January 4, 2018.
> Keith, Katie. Izindaba zezeMpilo. I-Health Association Plan Ephakanyisiwe Umthetho: Okushoyo Nalokho Okuyokwenza. NgoJanuwari 5, 2018.
> Association National of the Insurance Commissioners. Incwadi kubomthetho ngokuphathelene nokwandiswa kwezinhlelo zezempilo zenhlangano . Ngo-February 28, 2017.