Uyini umshuwalense wezempilo we-COBRA?

Ukuchazwa Kwezempilo Kenkampani

I-COBRA ingahle ivuse izithombe zenyoka eyingozi, kepha empeleni kungumthetho wokusiza abantu abalahlekelwe yimisebenzi yabo noma ababone ukuthi amahora abo ancishisiwe ukugcina imishwalense yabo yezempilo. Ibizwa nge-COBRA ngoba ibizwa nge-Consolidated Omnibus Budget Reconciliation Act ka-1985.

Kusukela ngo-2018 , Abantu baseMelika abangama-49% bathole imishwalense yabo njengengxenye yohlelo lwezempilo lweqembu ngomqashi wabo. Uma labo bantu belahlekelwa yimisebenzi noma bebona ukuthi amahora abo okusebenza ancishisiwe kusuka esikhathini esigcwele kuya etoho kungekho zinzuzo zezempilo-njengoba kwenzekile esikalini esikhulu kulo lonke ubhadane lwe-COVID — kungaba isimo esikhohlisayo. Yilapho i-COBRA ingena khona. Ivumela abantu ukuthi bahlale ohlelweni lweqembu okwesikhashana ngenkathi bethola enye indlela yokutholakala komshuwalense wezempilo.

Yize lokho kuzwakala njengenketho enhle, umshuwalense we-COBRA uvame ukubiza kakhulu kunohlelo lwabasebenzi abasebenzayo futhi akuyona inketho engabizi kakhulu ngaso sonke isikhathi. Kodwa-ke, ikhona ukuvikela abasebenzi abangenakho okunye ukukhetha esikhathini esifushane.

OKUSHIWO: Uyini umshuwalense wezempilo wesikhashana?

Uyini umshuwalense we-COBRA?

I-COBRA ngumthetho olawulwa nguhulumeni wesifundazwe kanye noMnyango Wezabasebenzi wase-U.S., Kepha amazwe amaningi anemithetho yawo efanayo. Ngokuyinhloko, ukuba nomshuwalense we-COBRA-obizwa nangokuthi i-COBRA ukuqhubeka ukumbozwa-kusho ukuthi wena nomndeni wakho nivunyelwe ukuhlala ohlelweni lwezempilo lweqembu lomqashi wakho isikhathi esilinganiselwe ngemuva kokuphela komsebenzi wakho noma ushintsho.

Kepha hhayi wonke umuntu olahlekelwa ngumsebenzi ufanelekile ukumbozwa kwe-COBRA. Umthetho wesifundazwe usebenza kuphela kumabhizinisi anabasebenzi abangama-20 noma ngaphezulu. Eminye ithi 'imithetho efana ne-COBRA ihlanganisa amabhizinisi amancane. Le mithetho kuvame ukubizwa ngokuthi ama-mini-COBRAs.

Ukuze ufanelekele i-COBRA, kufanele futhi ukuthi uhlangabezane nomcimbi ofanelekile, ofaka ukunqanyulwa njengomsebenzi nganoma yini enye ngaphandle kokuziphatha kabi ngokweqile noma ukunciphisa amahora. Ngokusho koMnyango Wezabasebenzi , oshade naye noma izingane ezincikene nabasebenzi abamboziwe zifanelekile ukuthola i-COBRA kumicimbi elandelayo efanelekile:

• isehlukaniso noma ukwehlukaniswa ngokomthetho nesisebenzi esimboziwe
• ukufa kwesisebenzi esimboziwe
• ingane encike eminyakeni engama-26 futhi ayisafanele ukuthola uhlelo lwezempilo lweqembu lomsebenzi olumboziwe ngaphansi kwe-Affordable Care Act (ACA)

Ukuze ufaneleke, umsebenzi ohlanganisiwe (noma owakwakhe kanye nezingane zakhe) kumele ngabe babhalisiwe ohlelweni lomshuwalense wezempilo wenkampani ngosuku olwandulela umcimbi ofanelekile, futhi uhlelo kumele luqhubeke nokusebenza kubasebenzi abasebenzayo ngemuva umcimbi ofanelekile.

Ngisifaka kanjani isicelo se-COBRA?

Ngemuva komcimbi ofanelekile, umqashi kufanele azise abahlomuli abafanelekile ukuthi bazi ngokufaneleka kwabo kwe-COBRA, futhi umqashi noma umsebenzi ohlanganisiwe kumele avumele inkampani yomshuwalense elawula uhlelo lweqembu yazi ngomcimbi.

Kungumsebenzi womqashi ukwazisa uhlelo zingakapheli izinsuku ezingama-30 kokulandelayo imicimbi efanelekayo :

• kwahlanganisa ukunqanyulwa kwesisebenzi
• ukuncishiswa kwamahora okuqashwa komsebenzi
• kwahlanganisa ukufa komsebenzi
• Umsebenzi ohlanganisiwe ufanelekile ukuthola iMedicare
• inkampani yangasese izimele

Isisebenzi esimboziwe noma omunye umzuzi ofanelekayo unesibopho sokwazisa uhlelo uma umcimbi ofanelekayo kungukuhlukanisa noma ukwahlukana okusemthethweni, noma uma ingane ilahlekelwa yisimo sayo sokuncika ngaphansi kohlelo lweqembu.

Ngemuva kokuthi uhlelo selwazisiwe, inkampani yomshuwalense iyadingeka ukuthi inikeze abahlomuli abafanelekile isaziso esichaza ngamalungelo abo ngaphansi kwe-COBRA nokuthi bangasayina kanjani ukuze baqhubeke nokutholakala. Lesi saziso sokhetho kufanele sinikezwe abazuzi abaqeqeshiwe kungakapheli izinsuku eziyi-14. Ngemuva kokuthola isaziso sokhetho, uzoba nezinsuku ezingama-60 zokuthatha isinqumo sokuthi ukhethe i-COBRA noma cha.

Umzuzi ngamunye ofanelekile ohlanganiswe uhlelo lweqembu angazenzela esakhe isinqumo maqondana nomshuwalense we-COBRA, futhi uma noma yimuphi umzuzi eyekela ukumbozwa kwe-COBRA, bavunyelwe ukuhoxisa lokho kukhishwa bese bekhetha ukumbozwa kwe-COBRA ngokuhamba kwesikhathi, inqobo nje uma bekwenza lokho ngaphakathi kwe-60 efanayo Isikhathi sezinsuku zokhetho.

Ihlala isikhathi esingakanani i-COBRA?

Ubude besikhathi sokufakwa kwe-COBRA buxhomeke kumcimbi ofanelekile nakuhlelo lweqembu lenkampani. Umthetho Wokuhlanganiswa Kwebhajethi Ye-Omnibus Budget udinga ukuthi ukutholakala okuqhubekayo kutholakale izinyanga ezingama-18 noma ezingama-36, kepha ezinye izinhlelo zezempilo zeqembu zinganikeza ukumbozwa isikhathi eside kunalokho.

Uma ulahlekelwa ngumsebenzi noma ubona ukuncishiswa kwamahora okuqashwa, unelungelo lokutholakala kwe-COBRA izinyanga eziyi-18. Eminye imicimbi efanelekayo (ngaphandle kokufaneleka kweMedicare) iholela ekubeni ube nelungelo lokutholakala izinyanga ezingama-36.

Kodwa-ke, uma ukumbozwa kwakho kufakwe ezinyangeni eziyi-18, ungahle ufaneleke ukunwetshwa ekusetshenzisweni kwezimo ezimweni ezimbili: Okokuqala, uma ukhubazekile futhi uhlangabezana nezidingo ezithile, lapho-ke ukumbozwa kwabo bonke abahlomuli abafanelekayo kunganwetshwa izinyanga eziyi-11 . Okwesibili, uma umcimbi wakho ofanelekayo ukwenza ukuthi ungafaneleki ukumbozwa futhi. Imicimbi enjalo ifaka ukushona kwesisebenzi esimboziwe, isehlukaniso somsebenzi ohlanganisiwe, isisebenzi esimboziwe sifanelwe iMedicare, noma ingane elahlekelwa yisimo sokuncika ngaphansi kohlelo lweqembu. Kulezi zimo, ukumbozwa kwe-COBRA kunganwetshwa ezinye izinyanga eziyi-18 kuya ezinyangeni ezingama-36.

I-Medicare ne-COBRA

Lapho umsebenzi ohlanganisiwe efaneleka ukuthola i-Medicare ezinyangeni ezingaphansi kwezingu-18 ngaphambi komcimbi ofanelekile, ukuqhubeka nokutholakala komlingani womntwana ohlanganisiwe kanye nezingane ezincike kuye kungadlulela ezinyangeni ezingama-36, kukhishwe inani lezinyanga isisebenzi esimboziwe ebelifanele iMedicare. Isibonelo, uma isisebenzi esimboziwe besifanelekile ukuthola iMedicare izinyanga eziyishumi ngaphambi komcimbi ofanelekile, abanye abazuzi abafanelekile ohlelweni lwezempilo lweqembu bazoba nelungelo lokutholakala kwe-COBRA izinyanga ezingama-26.

Kungenzeka, futhi kwesinye isikhathi kunconywe, ukuba nakho kokubili i-COBRA kanye ne-Medicare ngasikhathi sinye. Ukuthola eminye imininingwane yokuthi ukufaneleka kwe-Medicare kukuthinta kanjani ukumbozwa kwe-COBRA, uMnyango Wezabasebenzi we-Benefits Security Administration ungafinyelelwa kuwo askebsa.dol.gov noma ngocingo ku-1-866-444-3272.

Kubiza malini i-COBRA?

Cishe kuzo zonke izimo, ukumbozwa kwe-COBRA kubiza kakhulu kunokutholakala okufanayo kungaba kubasebenzi abasebenzayo.

Ngaphansi koMthetho Wokunakekelwa Okungabizi kakhulu, izinhlelo zezempilo ezisuselwa emisebenzini ziyadingeka ukuhlinzekwa ngezinga eliphansi noma okungcono. Ukusabalala okuncane kungukuthi kuchazwa njengohlelo olukhokhelayo okungenani ama-60% wezindleko eziphelele zezinsizakalo zezokwelapha kubantu abajwayelekile, futhi kufaka phakathi ukutholakala okukhulu kwezinsizakalo zodokotela nezibhedlela ezingalaliswayo. Lokho kushiya abasebenzi bekhokha amanye amaphesenti angama-40%.

Imvamisa, ngaphansi kwe-COBRA, ngeke usaba nomqashi wakho okhokha isabelo saso esingu-60%, okusho ukuthi ungaba sengcupheni yazo zonke izindleko zomshwalense. Eqinisweni, ngaphansi komthetho we-COBRA inkampani yomshuwalense ivunyelwe ukukhokhisa kuze kufike ku-102% wezindleko zohlelo olufanayo lomsebenzi osebenzayo (i-2% eyengeziwe iya ezindlekweni zokuphatha). Futhi uma uthatha isandiso sezinyanga eziyi-11 sokukhubazeka, inkampani yomshuwalense ivunyelwe ukukhokhisa kuze kufike ku-150% wezindleko ezijwayelekile zohlelo kulezo zinyanga eziyi-11.

Konke okushiwo, kusho lokho amaphrimiyamu omshwalense wezempilo - inani elikhokhelwa inkampani yomshuwalense njalo-lingabiza kakhulu ngaphansi kwe-COBRA. Futhi noma ngabe kukhona i-COBRA, abahlomuli kusamele bakhokhe ama-copay ajwayelekile ohlelo lokuvakasha kodokotela kanye nokwehliswa ngonyaka (inani iqembu elinomshwalense okufanele likhokhe ngaphambi kokuba umshwalense ungene). Izindleko ozikhokhayo zingaze zikhuphuke uma izindleko zohlelo lweqembu zikhuphuka.

Umthetho we-COBRA ubeka ukuthi inkampani yomshuwalense kufanele ikuvumele ukuthi ukhokhe imali ekhokhwa njalo ngenyanga uma ukhetha. Ezinye izinhlelo zingakuvumela futhi ukuthi ukhokhe masonto onke noma ngekota. Abahlomuli abafanelekile imvamisa kufanele benze inkokhelo yabo yokuqala ye-premium zingakapheli izinsuku ezingama-45 beqale kumshuwalense we-COBRA. Uma uphuthelwa inkokhelo, inkampani yomshuwalense kufanele ikunikeze isikhathi somusa sezinsuku ezingama-30 lapho uzokwenza khona noma yiziphi izinkokhelo ezingakakhokhwa, kepha ngemuva kwalokho, uma ukukhokha kungakenziwa, ungalahlekelwa yizo zonke izinzuzo zakho ze-COBRA.

Ezinye izindlela ze-COBRA

Ngokunikezwa kwemvelo yomshuwalense we-COBRA obizayo, uMnyango Wezabasebenzi uncoma ukuthi abantu abasanda kuthola umcimbi ofanele bafune umshwalense ongabiza kakhulu ngezindlela ezahlukahlukene. Nazi izinketho ezimbalwa zokuhlanganisa:

Uhlelo lwezempilo lomlingani: Uma umndeni wakho ulahlekelwa ukufakwa kwezempilo okususelwa kumqashi wakho, hlola ukuthi umqashi womlingani wakho unikeza umshuwalense wezempilo. Lokhu kungenzeka kubize kancane kunokuqhubeka nokufakwa kwakho okukhona nge-COBRA.

Olunye uhlelo lweqembu: Uma ulahlekelwa ngumshuwalense wakho wezempilo osuselwa emsebenzini, wena, oshade naye, noma abantu obethembele kuwe ungavunyelwa ukubhalisa kwelinye uhlelo lwezempilo leqembu ngesikhathi Esikhethekile Sokubhalisa. Lokho kusho ukuthi akudingeki ulinde kuze kufike isizini elandelayo evulekile yokubhalisa.

Indawo Yemakethe Yomshuwalense Wezempilo: Umcimbi ofanelekayo futhi ukuvumela ukuthi usebenzise isikhathi esikhethekile sokubhalisa ukubhalisela i-Health Insurance Marketplace noma ukushintshaniswa komshuwalense wombuso wakho. Yilapho ungaqhathanisa khona izinqubomgomo bese ubona amaprimiyamu alinganiselwe, ama-deductibles, nezindleko ezingaphandle kwesikhwama. Ngeke kudingeke ukuthi ulinde kuze kufike okulandelayo isikhathi sokubhalisa esivulekile , futhi uma uthola umshuwalense wezempilo eMakethe, ungahle ufaneleke ukuthola isikweletu sentela esinganciphisa amaphrimiyamu akho. Ukufaka isicelo sohlelo lweMakethe, vakashela ezempilo.gov noma ushayele ku-1-800-318-2596.

I-Medicaid noma i-Children's Health Insurance Program (CHIP): Emindenini ehola kancane kanye nabantu abafanelekayo, iMedicaid ne-CHIP zinikeza ukunakekelwa kwezempilo okungabizi kakhulu noma okungabizi. Ukubona ukuthi uyayifanelekela yini iMedicaid, vakashela iwebhusayithi yakho yezwe iMedicaid noma uMnyango Wezempilo kanye Nezinsizakalo Zabantu e-U.S hhs.gov . Ukufaka isicelo se-CHIP, shayela ku-1-800-318-2596 noma ugcwalise isicelo nge Indawo Yemakethe Yomshwalense Wezempilo .

Ungonga kanjani ngemiyalelo nge-COBRA noma ngaphandle kwayo

Kungakhathalekile ukuthi ukhetha ukumbozwa okuqhubekayo kwe-COBRA noma cha, ungagcina njalo kumuthi kadokotela onamakhuphoni avela ku-SingleCare. Kumahhala ukuyisebenzisa futhi uzothola amanani angabiza ngisho ukwedlula i-copay yakho yomshuwalense. Qala ukusesha singlecare.com ngemithi yakho bese ubona ukuthi yini ongayonga.