Yintoni i-inshurensi yezempilo yeCOBRA?

Inkampani yezeMpilo ichaziwe

I-COBRA inokukhupha imifanekiso yenyoka eyingozi, kodwa eneneni ngumthetho wokunceda abantu abaphulukene nemisebenzi okanye ababone iiyure zabo zincitshisiwe ukugcina i-inshurensi yabo yezempilo. Ibizwa ngokuba yi-COBRA kuba ibizwa ngokuba yi-Consolidated Omnibus Budget Reconciliation Act ka-1985.

Ukusukela ngo-2018 , Ama-49% abantu baseMelika bafumana i-inshurensi njengenxalenye yesicwangciso sempilo seqela ngomqeshi wabo. Ukuba abo bantu baphulukana nemisebenzi yabo okanye babone ukuba iiyure zabo zokusebenza ziyancitshiswa zisisigxina ziye kumaxeshana kungekho zibonelelo zempilo-njengoko kwenzekile kwisikali kulo lonke ubhubhane we-COVID-inokuba yimeko ekhohlisayo. Kulapho i-COBRA ingena khona. Ivumela abantu ukuba bahlale kwisicwangciso seqela okwethutyana ngelixa befumana enye indlela yokugubungela i-inshurensi yezempilo.

Ngelixa oko kuvakala njengenketho elungileyo, i-inshurensi ye-COBRA ihlala ibiza kakhulu kunesicwangciso sabasebenzi abakhutheleyo kwaye ayisoloko iyindlela ebiza kakhulu. Nangona kunjalo, ikho ukukhusela abasebenzi abangenalo olunye ukhetho kwixesha elifutshane.

Ezinxulumene: Yintoni i-inshurensi yezempilo yexesha elifutshane?

Yintoni i-inshurensi ye-COBRA?

I-COBRA ngumthetho olawulwa ngurhulumente womanyano kunye neSebe lezabaSebenzi lase-US, kodwa uninzi lwamazwe lunemithetho yawo efanayo. Okubalulekileyo, ukuba ne-inshurensi ye-COBRA-ekwabizwa ngokuba yi-COBRA yokuqhubeka nokugubungela-kuthetha ukuba wena kunye nosapho lwakho nivunyelwe ukuba nihlale kwisicwangciso sempilo seqela lomqeshi wakho ixesha elincinci emva kokuba umsebenzi uphelile okanye utshintshile.

Kodwa ayinguye wonke umntu ophulukana nomsebenzi wakhe ofanelekileyo kwi-COBRA. Umthetho womdibaniso usebenza kuphela kumashishini anabasebenzi abangama-20 okanye nangaphezulu. Abanye bathi 'imithetho efana ne-COBRA igubungela amashishini amancinci. Le mithetho ihlala ibizwa ngokuba zii-mini-COBRAs.

Ukuze ufaneleke kwi-COBRA, kufuneka ube namava okulungela, okubandakanya ukupheliswa njengomqeshwa kuyo nayiphi na into ngaphandle kokuziphatha gwenxa okanye ukunciphisa iiyure. NgokweSebe lezabaSebenzi , iqabane okanye abantwana abaxhomekeke kubasebenzi abakhuselweyo banelungelo lokufumana i-COBRA kwezi ziganeko zilandelayo:

• uqhawulo-mtshato okanye ukwahlukana ngokusemthethweni kumqeshwa o-inshoriweyo
• ukubhubha komsebenzi o-inshoriweyo
• Umntwana oxhomekekileyo ujika i-26 kwaye akasafaneleki kwisicwangciso sempilo seqela lomqeshwa phantsi kwe-Affordable Care Act (ACA)

Ukuze umntu afaneleke, umqeshwa okhuselweyo (okanye iqabane lakhe kunye nabantwana abaxhomekeke kuye) kufuneka ukuba babhalisile kwisicwangciso se-inshurensi yeqela lenkampani kusuku olungaphambi kokuba kwenzeke isiganeko esifanelekileyo, kwaye isicwangciso kufuneka siqhubeke sisebenza kubasebenzi abasebenzayo emva umcimbi ofanelekileyo.

Ndisifaka njani isicelo se COBRA?

Emva komsitho ofanelekileyo, umqeshi kufuneka azise abaxhamli abaqeqeshiweyo malunga nokufaneleka kwabo kwe-COBRA, kwaye nokuba umqeshi okanye umqeshwa ogqunyiweyo makazise inkampani yeinshurensi elawula isicwangciso seqela malunga nomsitho.

Luxanduva lomqeshi ukwazisa isicwangciso ngaphakathi kweentsuku ezingama-30 koku kulandelayo imicimbi efanelekileyo :

• ukugubungela ukupheliswa komqeshwa
• ukuncitshiswa kweeyure zokuqeshwa komqeshwa
• yagubungela ukusweleka komqeshwa
• Umsebenzi okhuselweyo uyafaneleka kwi-Medicare
• Inkampani yecandelo labucala iyabhanga

Umsebenzi o-inshoriweyo okanye omnye umntu oza kufumana izibonelelo ezifanelekileyo unoxanduva lokwazisa isicwangciso ukuba isiganeko esifanelekileyo kukuqhawula umtshato okanye ukwahlukana ngokwasemthethweni, okanye ukuba umntwana uphulukana nenqanaba lakhe lokuxhomekeka phantsi kwesicwangciso seqela.

Emva kokuba icebo lazisiwe, inkampani yeinshurensi kufuneka inike abaxhamli abafanelekileyo isaziso esichaza amalungelo abo phantsi kwe-COBRA kunye nendlela yokwenza ngokubhalisela ukuqhubeka nokugubungela. Esi saziso sonyulo kufuneka sinikezelwe kubaxhamli abafanelekileyo kwithuba leentsuku ezili-14. Emva kokufumana isaziso sonyulo, uya kuba neentsuku ezingama-60 zokuthatha isigqibo sokuba uza kuyikhetha na i-COBRA.

Umxhamli ngamnye ofanelekileyo ohlawulwa sisicwangciso seqela unokwenza isigqibo malunga ne-inshurensi ye-COBRA, kwaye ukuba ngaba nawuphi na umntu oza kufumana isibonelelo kwi-COBRA, bavunyelwe ukuba bayirhoxise loo nto kwaye bakhethe ukugubungela i-COBRA kamva, ukuba benza njalo kwi-60 efanayo ixesha lonyulo.

Ihlala ixesha elingakanani i-COBRA?

Ubude bexesha lokugubungela i-COBRA kuxhomekeke kumnyhadala ofanelekileyo kunye nesicwangciso seqela lenkampani. Umthetho oHlanganisiweyo woHlahlo lwabiwo-mali lwe-Omnibus ufuna ukuba ukuqhubeka kokugubungela kufumaneke kangangeenyanga ezili-18 okanye ezingama-36, kodwa ezinye izicwangciso zempilo zeqela zinokubonelela ngogqatso ixesha elide kunelo.

Ukuba ulahlekelwa ngumsebenzi okanye ubona ukunciphisa iiyure zomsebenzi, unelungelo lokufumana i-COBRA kwiinyanga ezili-18. Eminye iminyhadala efanelekileyo (ngaphandle kokufaneleka kweMedicare) ikhokelela ekubeni ube nelungelo lokufumana iinyanga ezingama-36.

Nangona kunjalo, ukuba i-inshurensi yakho ikhutshiwe kwiinyanga ezili-18, unokulungela ukongezwa kwingxelo ngezihlandlo ezibini: Okokuqala, ukuba ukhubazekile kwaye uhlangabezana neemfuno ezithile, apho imeko yabo bonke abaxhamli abafanelekileyo inokwandiswa iinyanga ezili-11. . Okwesibini, ukuba umsitho wakho ofanelekileyo ukuvumela ukuba ungakufanelekeli ukugubungela kwakhona. Ezo ziganeko zibandakanya ukusweleka komqeshwa o-inshoriweyo, uqhawulo-mtshato lomqeshwa o-inshoriweyo, umqeshwa okhuselweyo ofanelekile kwi-Medicare, okanye umntwana ophulukana nenqanaba lokuxhomekeka phantsi kwesicwangciso seqela. Kwezi meko, ukogquma i-COBRA kungandiswa ezinye iinyanga ezili-18 ukuya kwiinyanga ezingama-36 zizonke.

Unyango kunye neCOBRA

Xa umqeshwa ogqunyiweyo elungele ukufumana i-Medicare ngaphantsi kweenyanga ezili-18 ngaphambi komsitho ofanelekileyo, ukuqhubeka nokugubungela iqabane lomqeshwa kunye nabantwana abaxhomekeke kuye kungagcina ukuya kwiinyanga ezingama-36, kususwe inani leenyanga umqeshwa lowo afaneleke ngazo kwi-Medicare. Umzekelo, ukuba umqeshwa ogqunyiweyo wayenelungelo lokufumana i-Medicare kangangeenyanga ezili-10 ngaphambi komsitho ofanelekileyo, abanye abaxhamli abafanelekileyo kwisicwangciso sezempilo seqela banelungelo lokufumana i-COBRA iinyanga ezingama-26.

Kuyenzeka, kwaye ngamanye amaxesha kuyacetyiswa, ukuba zombini i-COBRA kunye ne-Medicare yokugubungela ngaxeshanye. Ngolwazi oluthe kratya malunga nokuba ukufaneleka kwe-Medicare kukuchaphazela njani ukugubungela i-COBRA, iSebe lezabaSebenzi lezoLawulo lweZibonelelo linokufikelelwa askebsa.dol.gov okanye ngefowuni ngo-1-866-444-3272.

Ixabisa malini i-COBRA?

Phantse kuwo onke amatyala, ukogquma i-COBRA kubiza kakhulu kunokuba ingxelo efanayo iya kuba yeyabasebenzi abakhutheleyo.

Ngaphantsi koMthetho woKhathalelo ongenakufikeleleka, izicwangciso zempilo esekwe emisebenzini ziyafuneka ukubonelela ngobuncinci bokugubungela okanye okungcono. Ubuncinane bokugubungela ichazwe njengesicwangciso esihlawulayo I-60% ubuncinci beendleko zizonke zeenkonzo zonyango kubemi abasemgangathweni, kwaye zibandakanya ukuhanjiswa okuphezulu kweenkonzo zonyango kunye nezibhedlele. Oko kushiya abasebenzi behlawula enye iipesenti ezingama-40%.

Ngokwesiqhelo, phantsi kwe-COBRA, awusayi kuphinda umqeshi wakho ahlawule isabelo sayo esingama-60%, okuthetha ukuba ungabanjelwa yonke indleko zepolisi yeinshurensi. Ngapha koko, phantsi komthetho we-COBRA inkampani yeinshurensi ivumelekile ukubiza ukuya kuthi ga kwiipesenti ezingama-102 zeendleko zesicwangciso esifanayo somsebenzi osebenzayo (i-2% eyongezelelweyo iya kwiindleko zolawulo). Kwaye ukuba uthatha ukongezwa kweenyanga ezili-11 zokukhubazeka, inkampani yeinshurensi iyavunyelwa ukuba ihlawulise ukuya kuthi ga kwiipesenti eziyi-150 zeendleko zesiqhelo zezo zinyanga zilishumi elinanye.

Konke ukuxelelwe, kuthetha ukuba iipremiyamu zomshuwalense wezempilo -Isixa esihlawulwa rhoqo kwinkampani yeinshurensi- sinokubiza kakhulu phantsi kweCOBRA. Kwaye nkqu ne-COBRA, abaxhamli kusafuneka bahlawule iikopi zesicwangciso esiqhelekileyo sokundwendwela ugqirha kunye nokutsalwa konyaka (isixa iqela eline-inshurensi ekufuneka lihlawule ngaphambi kokuba i-inshurensi ikhabe). Iindleko ozihlawulayo zinokunyuka nokuba iindleko zesicwangciso seqela ziyenyuka.

Umthetho we-COBRA ucacisa ukuba inkampani yeinshurensi kufuneka ikuvumele ukuba wenze iintlawulo zepremiyamu rhoqo ngenyanga ukuba ukhetha. Ezinye izicwangciso zinokuvumela ukuba wenze iintlawulo ngeveki okanye ngekota. Abaxhamli abafanelekileyo bahlala kufuneka benze intlawulo yabo yokuqala kwiintsuku ezingama-45 zokuqala kwi-inshurensi ye-COBRA. Ukuba uphose intlawulo, inkampani yeinshurensi kufuneka ikunike ixesha leentsuku ezingama-30 zokuba wenze naziphi na iintlawulo ezingekahlawulwa, kodwa emva koko, ukuba intlawulo ayikenziwa, ungaphulukana nazo zonke izibonelelo zakho ze-COBRA.

Ezinye iindlela ze-COBRA

Ngenxa yobunzima be-inshurensi ye-COBRA, iSebe lezabaSebenzi licebisa ukuba abantu abasandula ukufumana amava afanelekileyo bajonge i-inshurensi efikelelekayo ngeendlela ezahlukeneyo. Nazi iindlela ezimbalwa zokugubungela:

Isicwangciso sezempilo somlingane: Ukuba usapho lwakho luphulukana nokuhlawulwa kwezempilo okusekwe ngumqeshi, jonga ukuba umqeshi weqabane lakho unikezela nge-inshurensi yezempilo. Oku kuya kuba nexabiso eliphantsi kunokuqhubeka nokugubungela i-COBRA.

Elinye iqela lesicwangciso: Ukuba uphulukana neinshurensi yezempilo esekwe emsebenzini, wena, iqabane lakho, okanye abantu abaxhomekeke kuwe banokuvunyelwa ukuba babhalise kwelinye icebo lezempilo leqela ngexesha elithile lobhaliso. Oko kuthetha ukuba akukho mfuneko yokuba ulinde de kufike ixesha elizayo elivulekileyo lokubhalisa.

Indawo yentengiso ye-Inshurensi yezeMpilo: Umnyhadala ofanelekileyo ukuvumela ukuba usebenzise ixesha elithile lobhaliso ukubhalisa kwiNdawo yeNtengiso ye-Inshurensi yezeMpilo okanye ukutshintshiselana nge-inshurensi ngurhulumente. Kulapho unokuthelekisa khona imigaqo-nkqubo kwaye ubone iipremiyamu eziqikelelweyo, ezitsalwayo, kunye neendleko zokuphuma epokothweni. Akunyanzelekanga ukuba ulinde de kube lilandelayo ixesha lokubhalisa elivulekileyo , kwaye ukuba ufumana i-inshurensi yezempilo kwindawo yentengiso, unokulungela ukufumana ityala lerhafu elinokuhlisa iipremiyamu zakho. Ukufaka isicelo sesicwangciso seMarike, ndwendwela ukhathalelo lwempilo.gov okanye utsalele umnxeba ku-1-800-318-2596.

I-Medicaid okanye iNkqubo ye-Inshurensi yezeMpilo yaBantwana (CHIP): Kwiintsapho ezinengeniso ephantsi kunye nabantu abafanelekileyo, iMedicaid kunye ne-CHIP zibonelela ngononophelo lwempilo oluphantsi okanye olungenaxabiso. Ukubona ukuba ufanelekile na kwiMedicaid, ndwendwela ilizwe lakho kwiwebhusayithi yeMedicaid okanye iSebe lezeMpilo laseMelika kunye neenkonzo zoLuntu e Yinyama.gov . Ukufaka isicelo se-CHIP, tsalela umnxeba ku-1-800-318-2596 okanye ugcwalise isicelo nge Indawo yeNtengiso ye-Inshurensi yezeMpilo .

Uyigcina njani imigqaliselo kunye okanye ngaphandle kwe-COBRA

Nokuba ukhetha i-COBRA eqhubeka nokugubungela okanye hayi, ungasoloko ugcina amayeza amiselweyo kunye namatikiti avela kwi-SingleCare. Kusimahla ukusebenzisa kwaye uya kufumana amaxabiso anokubiza ixabiso eliphantsi kune-inshurensi yakho. Qalisa ukukhangela singlecare.com amayeza akho kwaye ubone ukuba ungagcina ntoni.