Hakkokin masu amfani da kariya

Dokar Kulawa mai arha (ACA) ta fara aiki ne a ranar 23 ga Satumbar, 2010. Ya haɗa da wasu haƙƙoƙi da kariya ga masu amfani.Wadannan haƙƙoƙin da kariyar na taimaka wajan sa ido game da kiwon lafiya ya zama mai adalci da sauƙin fahimta.

Dole ne a samar da waɗannan haƙƙoƙin ta hanyar tsare-tsaren inshora a cikin Kasuwar Inshorar Kiwan lafiya da yawancin sauran nau'ikan inshorar lafiya.

Wasu rightsancin haƙƙoƙin baza su iya ɗaukar wasu tsare-tsaren kiwon lafiya ba, kamar su tsare-tsaren kiwon lafiya. Tsarin kakanni shine tsarin inshorar lafiya na mutum wanda aka saya a ko kafin Maris 23, 2010.

Koyaushe bincika fa'idodin shirin lafiyar ku don tabbatar da wane nau'in ɗaukar hoto kuke dashi.

HAKKOKI DA KARIYA

Anan akwai hanyoyin da dokar kula da lafiya ke kare masu amfani.

Dole ne a rufe ku, koda kuwa kuna da yanayin da kuke ciki.

• Babu wani shirin inshora da zai iya kin ka, ya kara maka caji, ko kuma ya ki biyan muhimman fa'idodin kiwon lafiya ga duk wani yanayin da kake da shi kafin fara aikin ka.
• Da zarar an sanya ku, shirin ba zai iya hana ku ɗaukar hoto ba ko haɓaka ƙimar ku dangane da lafiyar ku kawai.
• Medicaid da Shirin Inshorar Kiwan Lafiyar Yara (CHIP) suma ba za su iya ƙi rufe ka ba ko cajin ka da yawa ba saboda yanayin da kake ciki.

Kana da damar karɓar kulawa ta rigakafin kyauta.

• Shirye-shiryen lafiya dole ne su rufe wasu nau'ikan kulawa ga manya da yara ba tare da cajin ku ko biyan kuɗi ba.
• Rigakafin rigakafin ya haɗa da bincikar cutar hawan jini, binciken launi, rigakafi, da sauran nau'ikan kulawa na rigakafi.
• Dole ne likitan da ke shiga cikin shirin lafiyar ku ya samar da wannan kulawa.

Kana da damar tsayawa kan tsarin lafiyar mahaifinka idan ka kasance kasa da shekaru 26.

Gabaɗaya, zaku iya shiga shirin iyaye kuma ku tsaya har sai kun cika shekaru 26, koda kuna:

• Yi aure
• Da ko ɗauke da yaro
• Fara ko barin makaranta
• Kasance cikin gidan mahaifinka
• Ba'a da'awar cewa ya dogara da haraji
• Yi watsi da tayi na tushen aikin

Kamfanonin inshora ba za su iya iyakance duk shekara ko tsawon rayuwa game da mahimman fa'idodi ba.

A ƙarƙashin wannan haƙƙin, kamfanonin inshora ba za su iya sanya iyaka a kan kuɗin da aka kashe a kan mahimman fa'idodi a duk tsawon lokacin da kuka shiga cikin shirin ba.

Abubuwan fa'idodin kiwon lafiya sune nau'ikan ayyuka 10 waɗanda tsare-tsaren inshorar lafiya zasu rufe su. Wasu tsare-tsaren suna ɗaukar ƙarin sabis, wasu na iya ɗan bambanta da jiha. Duba fa'idodin shirin lafiyar ku don ganin abin da shirin ku ya ƙunsa.

Abubuwan fa'idodin kiwon lafiya sun haɗa da:

• Kulawar marasa lafiya
• Ayyukan gaggawa
• Asibiti
• Ciki, haihuwa da kula da haihuwa
• Kiwan lafiyar hankali da ayyukan rashin amfani da abu
• Magungunan magani
• Ayyukan gyarawa da na'urori
• Gudanar da cutar na kullum
• Ayyukan dakunan gwaje-gwaje
• Rigakafin kariya
• Kula da cututtuka
• Dental da hangen nesa ga yara (hangen nesa da kulawar hakora ba a haɗa su)

Kana da damar karɓar bayanai cikin sauƙin fahimta game da fa'idodin lafiyar ka.

Dole ne kamfanonin inshora su samar da:

• Takaitaccen Takaita Fa'idodi da ɗaukar hoto (SBC) wanda aka rubuta cikin yare mai sauƙin fahimta
• Gloamus ɗin kalmomin da aka yi amfani dasu a kula da lafiya da ɗaukar hoto

Kuna iya amfani da wannan bayanin don kwatanta sauƙin tsare-tsare.

An kiyaye ka daga karuwar inshorar mara hankali.

Waɗannan haƙƙoƙin an kiyaye su ta hanyar Rimar Bincike da ƙa'idar 80/20.

Binciken Rima yana nufin cewa kamfanin inshora dole ne a bayyane ya bayyana duk wani ƙaruwa na 10% ko fiye kafin haɓaka ƙimar ku.

Dokar 80/20 ta buƙaci kamfanonin inshora su kashe aƙalla 80% na kuɗin da suke karɓa daga farashi kan farashin kula da lafiya da haɓaka inganci. Idan kamfanin ya gaza yin hakan, kuna iya samun ragi daga kamfanin. Wannan ya shafi duk tsare-tsaren inshorar lafiya, har ma wadanda suka kasance kaka

Ba za a hana ku ɗaukar hoto ba saboda kun yi kuskure a kan aikace-aikacenku.

Wannan ya shafi ƙananan kuskuren malami ko barin bayanan da ba a buƙata don ɗaukar hoto. Za'a iya soke ɗaukar hoto game da batun zamba ko ba za a biya ko ƙarshen riba ba.

Kuna da damar zaɓar mai ba da kulawa na farko (PCP) daga cibiyar sadarwar shirin kiwon lafiya.

Ba kwa buƙatar turawa daga PCP ɗinku don karɓar kulawa daga likitan mata / mata. Hakanan bai kamata ku biya ƙarin don karɓar kulawa ta gaggawa ba a cikin hanyar sadarwar shirinku.

An kiyaye ka daga daukar fansa daga mai aiki.

Mai ba ka aiki ba zai iya korar ka ko ramuwar gayya a kanka ba:

• Idan kun karɓi darajar haraji ta musamman daga siyan tsarin kiwon lafiya na kasuwa
• Idan kayi rahoton karya doka game da garambawul kan Dokar Kulawa Mai Araha

Kana da damar daukaka kara game da shawarar kamfanin inshorar lafiya.

Idan shirin lafiyar ku ya ƙaryata ko ƙare ɗaukar hoto, kuna da damar sanin dalilin da ya sa kuka ɗaukaka shawarar. Shirye-shiryen lafiya dole ne su gaya muku yadda zaku daukaka kara game da shawarar da suka yanke. Idan halin da ake ciki na gaggawa ne, shirinku dole ne ya yi aiki da shi a kan kari.

RARIN HAKKOKI

Shirye-shiryen lafiya a cikin Kasuwar Inshorar Kiwan lafiya kuma mafi yawan tsare-tsaren kiwon lafiya masu aiki dole ne su samar da:

• Kayan aikin shayarwa da nasiha ga mata masu ciki da masu shayarwa
• Hanyoyin hana daukar ciki da ba da shawara (ban da masu ba da addini da kungiyoyin addinai masu zaman kansu)

'Yancin kula da lafiyar mabukata; Hakkin mabukaci na kiwon lafiya

• Ire-iren masu bada kiwon lafiya

Tashar yanar gizon Cibiyar Cancer ta Amurka. Hakkin mai haƙuri. www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/patients-bill-of-rights.html. An sabunta Mayu 13, 2019. An shiga Maris 19, 2020.

Yanar gizo CMS.gov. Inganta kasuwar inshorar lafiya. www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/index.html. An sabunta Yuni 21, 2019. An shiga Maris 19, 2020.

Yanar gizo Healthcare.gov. Hakkokin inshorar lafiya da kariya. www.healthcare.gov/health-care-law-protections/rights-and-protections/. An shiga Maris 19, 2020.

Yanar gizo Healthcare.gov. Abin da tsare-tsaren inshorar lafiya na Kasuwa ke rufewa. www.healthcare.gov/coverage/what-marketplace-plans-cover/. An shiga Maris 19, 2020.