Malinga ndi Inshuwalansi Yathandizi Labwino Yopindulitsa

Malamulo Othandizira Zaumoyo Amatsutsana

Zopindulitsa zowonjezereka (zomwe zimatchedwanso kuti "zothandizira inshuwalansi zaumoyo" ndi "maudindo") ndizopindulitsa zomwe zimayenera kuthandizira chithandizo chamankhwala, magulu ena a othandizira zaumoyo, ndi ena omwe amadalira, monga ana omwe apatsidwa kuti abwezeretsedwe. Zopindulitsa zambiri zaumoyo zimaperekedwa ndi lamulo la boma, malamulo a federal - kapena nthawi zina - zonsezi.

Pakati pa federal boma ndi mayiko, pali mabungwe ambiri a inshuwaransi.

Ngakhale kuti mandates akupitiriza kuwonjezeredwa ngati inshuwalansi ya umoyo, iwo amakangana. Odwala amavomereza kuti mandates amathandizira kuonetsetsa kuti inshuwalansi yathandizi ikhale yeniyeni pomwe ena (makamaka makampani a inshuwalansi) akudandaula kuti maudindo akuwonjezera ndalama za inshuwalansi ndi inshuwalansi.

Amapindula Malamulo a Inshuwalansi Ovomerezeka

Malamulo a inshuwalansi ovomerezeka omwe amaperekedwa ku federal kapena ku boma nthawi zambiri amagwera m'gulu limodzi mwa magawo atatu:

• Chofunika kuti mapulani azaumoyo azigwira ntchito zosiyanasiyana zothandizira zachipatala, monga mankhwala osokoneza bongo, kulera pathupi, in vitro fertilization, maubereki, mankhwala osokoneza bongo, ndi kusuta fodya.
• Cholinga chakuti mapulani azaumoyo akuphatikizapo kulandira chithandizo kwa opereka ena osati madokotala, monga acupuncturists, chiropractors, anamwino azamwino, ogwira ntchito zachipatala, ndi ogwira nawo ntchito.

• Cholinga chakuti mapulani azaumoyo azikhala odzisunga ndi anthu ena okhudzidwa, monga ana ovomerezeka, ophunzira ogonjera, zidzukulu, ndi abwenzi apakhomo.

Malamulo omwe amapindula nawo amathandiza nthawi zambiri inshuwalansi ya umoyo woperekedwa ndi olemba ntchito ndi inshuwalansi yaumwini yomwe idagulidwa ndi anthu, kaya kudzera mu inshuwalansi ya umoyo kapena kusinthanitsa .

Koma palinso maudindo omwe amagwiritsidwa ntchito kwa Medicare ndi Medicaid / CHIP .

Phindu la Inshuwalansi Lovomerezeka ndi Mtengo wa Inshuwalansi ya Umoyo

Anthu ambiri - kaya ndi chifukwa chotsutsana ndi maudindo - amavomereza kuti ubwino wathanzi umapititsa patsogolo inshuwalansi ya inshuwalansi. Malingana ndi phindu lovomerezedwa ndi momwe phindu limatanthawuzira, mtengo wowonjezeka wa mwezi uliwonse ukhoza kuwonjezeka kuchoka pa 1% kufika pa 5%.

Kuyesera kuona momwe phindu lovomerezeka lidzakhudzidwa ndi inshuwalansi yowonjezera ndi yovuta kwambiri. Malamulo ovomerezeka amasiyana ndi boma kupita ku boma komanso ngakhale udindo womwewo, malamulo ndi malamulo angasinthe.

Mwachitsanzo, maofesi ambiri amalembera mauthenga a chiropractors, koma chiwerengero cha maulendo ololedwa chimasiyana kuchokera ku boma kupita kudziko. Mayiko amodzi angachepetse chiwerengero cha odwala matenda opita kuchipatala kukayendera anayi pachaka pamene boma lina lingalole kuti odwala 12 azitchedwe chaka chilichonse. Popeza mankhwala opangira mankhwala amatha kukhala odula, zotsatira za inshuwalansi zaumoyo zingakhale zazikulu mu boma ndi zopindulitsa kwambiri.

Chitsanzo china ndi kufotokozera kwa ana, zomwe sizowonjezedwa pansi pa lamulo la federal, koma limafunidwa ndi mayiko angapo. Pakati pa maikowa, pali kusiyana kwakukulu pa zomwe ziyenera kuchitika ponena za chithandizo cha infertility, zomwe zikutanthauza kuti zomwe zimaperekedwa pa malipiro amasiyana kwambiri kuchokera ku boma kupita kudziko.

Kuonjezera apo, kusowa kwa maudindo kungapangitsenso mtengo wa chithandizo chaumoyo komanso inshuwalansi ya inshuwalansi. Ngati munthu amene ali ndi matenda amachilendo safunikira thandizo lachipatala chifukwa salikuphimbidwa ndi inshuwalansi, akhoza kukhala odwala ndipo amafunikira thandizo lamtengo wapatali m'tsogolomu. Chitsanzo cha izi ndizakuti kusamalira mazinyo sikuti ndi chimodzi mwa zinthu zofunika kwambiri zaumoyo zomwe zimaperekedwa pansi pa ACA, komanso kusamalidwa kwa mazinyo akuluakulu kumafunika kuti agwirizane ndi Medicaid (zina zimaphatikizapo kulumikiza mano m'misewu yawo ya Medicaid, pamene ena akupereka 't). Chifukwa chosoŵa kupeza chithandizo chokwera mano amatha kukhala ndi mavuto aakulu a nthawi yaitali.

Federal Mandated Health Benefits

Lamulo la boma limaphatikizapo maudindo angapo a inshuwalansi:

ACA mapindu othandizira azaumoyo (EHBs).
The Careable Affordable Act anali kusintha kwakukulu pazinthu zothandizira thanzi labwino, kupanga ponseponse pansi pa zofunika zaumoyo zomwe ziyenera kuphatikizidwa pa ndondomeko iliyonse yatsopano ya thanzi labwino m'madera onse. Cholinga chophatikizapo EHBs chikugwiritsidwa ntchito pazinthu zonse za gulu limodzi ndi zing'onozing'ono ndi masiku okwanira a January 1, 2014 kapena mtsogolo. Mndandanda wa EHB umaphatikizapo:

• Ntchito zowonongeka (zosamalidwa bwino)
• Mapulogalamu oopsa
• Kuchekera kuchipatala
• Kusamalira ana ndi kubereka kumene
• Matenda a m'maganizo ndi ntchito zamagwiritsidwe ntchito kosokoneza bongo
• Mankhwala osungirako mankhwala
• Ntchito zothandizira komanso zowathandiza
• Ntchito zamapulogalamu
• Kusamalira ndi kuteteza matenda aakulu ( zina mwachindunji zowonongeka ndi zaufulu pazinthu zonse zatsopano, mosasamala kanthu kuti wopanga ndondomekoyo watenga deductible).
• Maphunziro a zachipatala, kuphatikizapo kulankhula ndi mawonedwe ( akuluakulu a mano ndi masomphenya sakuyenera kuti aphimbidwe , ndipo pali kusintha kwina pambali ya maudindo a mano a ana).

Kuwonjezera pa chithandizo chodziletsa komanso kuchipatala, ma EHB sayenera kukonzedwa ndi magulu akuluakulu ("gulu lalikulu" nthawi zambiri limatanthauza mapulani operekedwa ndi olemba ntchito ogwira ntchito oposa 50, ngakhale pali mayiko anayi pamene "kagulu kakang'ono" kamaphatikizapo olemba ntchito ndi antchito okwana 100 ).

Zolinga zamagulu akuluakulu zimakhala zochepa ndithu. Ndipo maudindo ena (mwachitsanzo, chofunikira-chofotokozedwa m'munsimu - kuti mapulani onse operekedwa ndi abwana omwe ali ndi antchito 15 kapena angapo akugwira ntchito yosamalira amayi) amagwiritsidwa ntchito ku msika wa gulu lalikulu.

COBRA kupitiriza kufalitsa
COBRA imapatsa anthu ena omwe kale anali ogwira ntchito komanso ogwira ntchito awo ufulu woyenera kufalitsa miyezi 18 mpaka 36.

Kugwirizana kwa ana omvera
Ndondomeko zina zaumoyo zimapereka chithandizo kwa ana omwe apatsidwa ndi mabanja kuti azithandizidwa pazikhalidwe zomwe zimagwiritsidwa ntchito kwa ana achilengedwe, kaya kukhazikitsidwa kukhala kotsiriza kapena ayi.

Malingaliro am'maganizo
Ngati ndondomeko ya thanzi imapereka chithandizo chamankhwala, ndalama za pachaka kapena zapakati pa dola zonse ziyenera kukhala zofanana kapena zopitirira malire a zothandiza nthawi zonse zachipatala.

Malo osachepera a chipatala kwa ana obadwa ndi amayi
Potsatira malamulo a chitetezo cha atsikana aang'ono ndi amayi ndi a amayi a chaka cha 1996, ndondomeko zaumoyo sangathe kuchepetsa ubwino wa chipatala chilichonse chokhudzana ndi kubereka kwa mayi kapena mwana wakhanda.

Kuchita opaleshoni yowonongeka pambuyo pa kugonana
Ndondomeko yaumoyo iyenera kupereka munthu amene akulandira ubwino wokhudzana ndi vutoli komanso kulumikizidwa kwa chifuwa chomwe chachitidwa mastectomy.

Amayi Achimereka Olemala (ADA)
Anthu olemala ndi osalimba ayenera kupatsidwa phindu lofanana ndi malipiro, malipiro, malire pa chithandizo, komanso nthawi yomwe akuyembekezera.

Kuchokera Pakhomo la Banja ndi Zamankhwala (FMLA)
Amafuna abwana kuti azikhala ndi thanzi labwino pa nthawi ya kupita kwa FMLA.

Maofesi Osagwirizanitsa Ntchito Yowona Ufulu ndi Ntchito (USERRA)
Amapatsa antchito ufulu wopitiriza kulandira chithandizo chaumoyo pansi pa zolinga za abwana awo pamene sakuchoka kuntchito chifukwa chogwira ntchito yunifolomu.

Mchitidwe Wosalera Mimba
Zolinga zaumoyo zomwe zimagwiritsidwa ntchito ndi abwana omwe ali ndi antchito 15 kapena kuposa omwe ayenera kugwira ntchito ayenera kupereka mlingo womwewo wa kufalitsa mimba monga zofunikira zina.

Malamulo Amtundu Wathanzi Wovomerezedwa ndi boma

Izi zimasiyana kwambiri ndi chiwerengero ndi mtundu wa zopindulitsa, koma kudutsa makumi asanu ndi awiri (50) akuti, paliponse 2,000 amapindula maudindo omwe aperekedwa zaka 30 zapitazi.

Mungapeze zambiri zokhudza maudindo a boma kuchokera kumagulu osiyanasiyana:

• Dipatimenti ya inshuwalansi ya boma lanu, yomwe mungathe kupeza kuchokera ku webusaiti ya National Association of Insurance Commissioners
• Msonkhano Wachigawo wa Malamulo a boma (NCSL)
• Kaiser Family Foundation yokhala ndi State Health Facts

Pansi pa ACA, zonse zatsopano (kuyambira 2014) zogwirizana ndi magulu ang'onoang'ono ndi ang'onoang'ono m'mayiko onse ziyenera kuphatikizapo kulumikizidwa kwa EHBs, ziyenera kukhala ndi malo ogwiritsira ntchito okwanira, ndipo ziyenera kuwonetsa zochitika zomwe zakhalapo kale ndikuperekedwa mosasamala za mbiri yachipatala.

Ndicho chiwerengero chochepa chomwe zolinga ziyenera kumamatira, koma izi zikhoza kupitirira zofunikira za ACA. Zitsanzo zina za maudindo ena apadera a boma ndi kulandira chithandizo, kutseguka kwa autism, ndi kuchepetsa ndalama zopezeka pamatumba.

Koma palinso malamulo omwe amafuna mabungwe-m'malo molemba mabungwe a inshuwalansi-kutenga mtengo wa zopindula zomwe zimapititsa patsogolo zofunikira za ACA, zomwe zikutanthauza kuti mayiko ena adasankha kugwiritsa ntchito maudindo atsopano pokhapokha pazinthu zazikulu, zomwe sizikugwirizana ndi Zofunika za ACA zothandiza zaumoyo (onetsetsani kuti, malingaliro anu omwe ali ndi inshuwalansi amalamulidwa pansi pa malamulo a federal m'malo moyang'anitsitsa, kotero iwo sakugonjera zofunikira zatsopano zomwe zimapereka; ambiri mwa magulu akuluakulu amapanga okhaokha).

> Zotsatira:

> Kaiser Family Foundation. Mfundo za Zaumoyo za State

> Msonkhano Wadziko Lonse wa Malamulo a Boma. Autism ndi Inshuwalansi, Malamulo a boma. June 7, 2017.

> Msonkhano Wadziko Lonse wa Malamulo a Boma. 2011-2014 Kusintha kwa inshuwalansi ya zaumoyo yomwe inakhazikitsidwa Malamulo a boma okhudzana ndi mtengo wothandizira ntchito. June 17, 2014.

> Msonkhano Wadziko Lonse wa Malamulo a Boma. Boma la Inshuwalansi Mandata ndi ACA Zofunikira Zopindulitsa. March 8, 2017.