Gap yi am ci wàllu faju, Medicaid bu 90 fan ak pont COBRA¶

Soo amee jafe-jafe pajum paj mu jamp, dugg lopitaal, wala ab doxalinu paj mu gaaw ci diir bu xawa am ci diggante palaŋu assurance wérgi-yaram, wala nga gis ni ñàkk nga sa 60 fan Affordable Care Act (ACA) Special Enrollment Period (SEP) wala sa COBRA wéyal coverage jeexna ndax ñàkka fay ci lopitaal, mën na fësal sa junni dolaar faktiir yi. Malaad yu bari dañu jàpp ni suñu weesee bis biñ wara bind wala ñu dugg ci salle d'urgence te amul kàrtu assurance, amul anam wu yoon mëna am assurance ngir fay pajum paj mi jota am.

Ci dëgg, yoon federal ci Etats Unis dafa tabax ci ñatti pexe yu am doole yuy delloo ginaaw yuñ defar ngir dindi faktiiru pajum yi amul assurance ci diir bu gàtt: (1) Fàtte Medicaid buy delloo ginaaw 90 fan (42 U.S.C. § 1396a) C.R.24(3)(3). 435.915), luy forse agence Medicaid yu réew mi ñu yegg ba 3 weer yu mat ci kalandriye bi laataa weer wi ngay def say demànd ba noppi ñu fay bépp faktiiru hopitaal bu am ci weer wi sa xaalis wàññeeku; (2) Pexem pont buy delloo ginaaw bu 105 fan COBRA (29 U.S.C. § 1165 ak § 1162(2)(C)), bi lay may nga "flote" ba 60 fan ngir tànn COBRA ak beneen 45 fan ngir delloosi pursàntaasu premium bi njëkk ñàkk nga sa liggéey; ak (3) ACA Marketplace "Jamono yu amul fenn" Appel yu amul fenn ngir bind ci ginaaw (45 C.F.R. § 155.420(d)(9)), yuy jox garantie buy delloo ginaaw sudee dañu la yóbbu hopitaal, ñàkka mëna liggéey, wala njuumteg patroŋ/assurance moo waral nga dugg ci bis bi.

Defal lii leegi¶

1. Bul musa yeexal pajum paj mu jamp ndax danga nekk ci biir gap coverage: Ci wàllu federal Pajum pajum paj mu jamp ak sàrtu liggéey (EMTALA, 42 U.S.C. § 1395dd), bépp departemaa pajum paj mu jamp bu bokk ci Medicare ci Etats Unis dafa wara def test pajum paj mu jamp bu mat sëkk operaasioŋ, faj ICU, ak liggéey bu am doole) ak lu mëna nekk sa assurance, sa doomu réew, wala sa kàttan ngir fay, ak kilifa yiy bind lopitaal dañu tere ñu yeexal pajum dakkal ngir laaj assurance wala sàkku xaalis bu njëkk, muy hopitaal bi 1 kilometre (0.6 miles) wala 50 kilometre (31 kilometre) sori. Sudee yaw wala nit ku la bëgg a ngi am metit ci dënn bi, feebaru AVC, deret ju bari, jafe-jafe noyyi, wala bepp jafe-jafe bu mëna gàllankoor sa dundu, woo sa nimero jafe-jafe bi la gëna jege (911 ci Etats Unis ak Canada, 112 ci EU, 999 ci UK) wala nga xool sunu nimero paj mu jamp répertoire bi ci saasi.
2. **Laaj Medicaid balaa bis bi mujj ci weer wi ngir tëju ci 3-weer yi ñuy xoolaat ci ginaaw (42 CFR § 435.915): ** wuute na ak palaŋu ACA Marketplace (yiy tàmbali am doole ci ëlëg ci bis bi njëkk ci weer wi ci topp), (du xaalis biy dugg ci at mi) te dafay àndaale ak 90 fan yuy delloo ginaaw. Sudee danga am lopitaal bu jamp bu amul assurance ci weeru sulet te nga ñàkk sa liggéey wala nga am xaalis bu jegewul ci weeru sulet, laaj Medicaid ci wala balaa ** 31 oktoobar ** dafay forse prograamu Medicaid bu réew mi (ci etaa yi amul benn Section 1115 waiver) ngir delloo sa faktiiru pajum weeru sulet, ut, ak weeru septembre.
3. ** Jëfandikool wote COBRA bu 60 fan + Palanteer bu njëkk bu njëkk ci 45 fan ngir mëna fay paj mu jamp ci jamonoy coppite liggéey: ** Soo bàyyee sa liggéey ci 60 fan yu weesu te nga am benn gap balaa sa palaŋu wérgi-yaramu patroŋ bu bees bi di tàmbali (wala balaa sa palaŋu ACA Marketplace du am doole), ** ve pajum medsin bu seer**. Ci ERISA (29 U.S.C. § 1165), am nga 60 fan ci almanaak ginaaw bis bi sa liggéeykat jeexe wala bis bi ñu la yónnee yëgleb wote COBRA ngir nga tànn COBRA, boole ci beneen **45 fan ci almanaak bi nga fay, CORA ba 105 fan aar bu amul benn risk dellu ci bis 1 bi nga ñàkkee liggéey.
4. Bul musa bàyyi COBRA ci diggu at mi nga xalaat ni mën nga soppi ci palaŋu ACA Marketplace: Lii mooy fiir bi gëna faat bakkan ci assurance wérgi-yaram ci Etats Unis. Ci suufu 45 CFR § 155.420(e), nga teela jeexal sa COBRA (wala nga bàyyi sa COBRA ñu fomm ko ndax danga bàyyi fay faktiiru weer wu nekk) ** nekkul xew-xewu dundu buy mëna yegg ** te ** DU tax nga am 60 fan ci diiru bindu ** ci HealthCare.gov. Gunaaw boo tànnee ba noppi fay COBRA, dañu la tëj ci coppite ci palaŋu ACA Marketplace bu ñuy subsidise ba Diiru Bindu bu Ubbeeku (1 nowàmbar) at mi, fileek sa diiru 18 weer COBRA jeexna ba jeex wala subsidi COBRA liggéeykat bi jeex.
5. Xam ni ñàkka am liggéeykat COBRA Subsidy DOES trigger 60-Day ACA Enrollment Special Period: ** Bi nga bàyyi COBRA bu amul subsidi ci diggu at bi mënul am SEP, sàrti federal ( 45 CFR § 155.420) liggéeykat bi ** (d) lépp wala benn wàll ci sa prime COBRA muy bokk ci pack severance, ** jeexal liggéeykat COBRA subsidy IS Qualifying Life Event ** bi lay jox ** 60 fan calendrier ** balaa wala ginaaw bis bi mujj ci subsidi liggéeykat ngir bàyyi COBRA te dugg ci benn plan ACA Market subsidised.
6. **Defar ab "Sirkomans bu amul fenn" SEP Appeal ci 45 C.F.R. § 155.420(d)(9) sudee ñàkk nga sa palanteer ACA bu 60 fan: ** Sudee ñàkk nga sa Diiru Bindu bu Bees bu 60 fan ginaaw boo ñàkkee garantie bu lalu ci liggéey (xoolal sunu njiitu assurance wérgi-yaram) ndax dañu la tëye ci hopitaal, danga ñàkk kàttan ci wàllu paj, musiba gañcax bu FEMA laal, wala sa patroŋ wala assurance bi daf la jox këyit yu yeex wala yu jaarul yoon, woo Marketplace Call Center (1-800-318-2596) ci saasi ngir laaj Diiru Bindu bu amul fenn ak bis bi muy tàmbali liggéey.

Garab dogal: Rawale faktiiru pajum bu amul assurance wala gap coverage¶

Jëfandikool tablo triage bii ngir xam ban kaaraange yoon moo mëna efaase ab jafe-jafe pajum bu amul assurance wala ubbiwaat ab palanteer bu tëju ngir bind.

flowchart TD
    A["Emergency Médical bu amul assurance WALA palanteer biy dugg ci assurance wérgi-yaram bu amul assurance"] --> B{"Ñaata fan la Coverage bu lalu ci liggéey jeexee?"}
    B -->|"Ci diir bu weesuwul 60 fan ginaaw boo ñàkkee garantie bi (wala nga jot yëgle COBRA)"| C["Ci biir Palanteer bu 60 fan buy dox: méngale wote COBRA ak ACA SEP"]
    C -->|"Amoon naa facture bu mag ci ER/Hopitaal ci jamonoy gap bi"| D["Tannal COBRA ci saasi (dellu ci bis 1) + Jëfandikool palanteeru fay bu njëkk bu 45 fan"]
    C -->|"Amul faktiir yu mag ba leegi & soxla nañu ay pexe yu yomb"| E["Bindu ci palaŋu màrse ACA jaaraleko ci 60 fan SEP + Jëfandikool COBRA ni 60 fan yu amul fayda"]
    B -->|"fan yu weesu wala COBRA jeexna"| F{"Saytu 4 Lifeline yu Retroactif ci Jafe-jafe"}
    F -->|"Revenu Weer wu nekk ci suufu Medicaid bu réew mi (lu melni, 138% FPL / - $ 1,732 / weer wu amul jëkkër)"| G["Ñaanal Medicaid ci saasi + Ñaanal 90 fan yu ñuy delloo ginaaw (42 CFR 435.915)"]
    F -->|"Subsidi COBRA biy dakkal liggéeykat bi jeexna"| H["Woowal 60 fan COBRA subsidi jeexal SEP ci suufu 45 C.F.R. 155.420 (d) (15) ci wàllu faju"]
    F -->|"Ñàkk nañu 60 fan ci SEP ndax Hopitaal, musiba, wala njuumte ci patroŋ bi/yegle bi"| I["Dosie ci anam yu amul fenn SEP Appeal ci 45 C.F.R. 155.420(d)(9) ngir muur buy delloo ginaaw"]
    F -->|"COBRA jeexna ci 30 fan yu weesu ndax ñàkka fay"| J["Faj COBRA ci diiru 30 fan yu war (29 U.S.C. 1162(2)(C)) wala sàrt yu amul benn njariñ"]

Pexe 1: Pont Retroactif COBRA bu 105 fan (Ni ñuy amee aar ci bërëb yi te doo fay)¶

Soo bàyyee liggéey ci 31 màrs te assurance wérgi-yaramu sa patroŋ bu bees bi tàmbaliwul ba 1 mee wala 1 juin, dangay jànkoonte ak jafe-jafe yu raglu yu tollu ci diggante 30 ba 60 fan te doo assurance. Feye $900 ba $2,400 weer wu nekk ci kanam ngir COBRA (biy fay 102% ci premium groupe bi yépp) ngir mëna fay 45 fan sudee danga wér, xaalis bi nga soxla ngir luwaas. Lu moy loolu, jëfandikool Pont buy delloo ginaaw COBRA bi nekk ci suufu ERISA §§ 602 ak 605 (29 Etats Unis §§ 1162, 1165) ak 26 CFR. § 54.4980b-6:

Noo ngi doxee montor 60 fan + 45 fan¶

1. Palanteeru wote bu 60 fan (29 U.S.C. § 1165(a)(1)): Ginaaw bi sa grupu patroŋ jeexee, am nga lu mu neew 60 fan ci almanaak daale ko ci ci ganaw ci (a) bis bi sa coverage aktif jeexee, wala (b) bis bi sa **siñe **ti administratër plan ak dello këyitu wote bi.
2. Couverture Retroactive Dellu ci Bis 1: Wuute ak bépp plan wérgi-yaram bu privé ci marse bi, soo siñe ba noppi nga siñe sa Formulaire Election COBRA ci Bis 59, yoon federal dafay laaj plan bi delloosi sa assurance wérgi-yaram dellu ci Bis 1 (simili bi sa liggéey-based coverage ga.p jeex
3. Palanteer bi ñuy njëkka fay 45 fan (29 U.S.C. § 1162(2)(C)): Dañu la tere ñu sàkku ci yaw nga yónnee xaalis ak sa këyitu wote COBRA. Ci sàrtu federal bi, soo defee eleksioŋ, palaŋ bi daf lay jox 45 fan ci kalendriye ginaaw bis bi nga defee eleksioŋ COBRA ngir nga mëna fay prime yi njëkka am.
4. Ni ñuy defee "Float COBRA" ci jàmm:
5. Bindal sa këyitu wote COBRA ci bis bu njëkk bi, nga siñe ko, nga dugal ko ci enveloppe buñ tampoon, nga bindal ko administratëru COBRA ci kaw sa taabal ci waañ wi (nga bàyyi benn kopi ci sa jabar/jekker wala ki ngay jokkoo ak moom ci jafe-jafe).
6. Soo defee ko ci sa 30-ba-60-fan gap transition ci sa plan wérgi-yaram bu bees (wala sa plan ACA Marketplace bu bees) te doo damm benn yax wala dem hopitaal, dangay ** musul mail formileer COBRA **, te nga fay ** $ 0 ** ngir 60 fan aar ci musiba.
7. Soo amee appendicite wala accident auto ci bis 42 (facture ER bu tollu ci $18,000) bi ngay fay $1,400 COBRA, dangay yónnee sa Formulaire Election COBRA bi nga siñe ci Mail buñ Sertifiye balaa bis 60, nga fay ñaari weer yi assurance bi wara fay ci bis bi, ak $2. $18,000 ci lopitaal bi yépp.

Pexe 2: Medicaid buy delloo ci 90 fan ak yelleefu lopitaal¶

Sudee amoo assurance su amee paj mu jamp, bul xalaat ni dangay am xaalis bu bari ci Medicaid bu sukkandikoo ci li nga am ci ndoortelu at mi.

Lan moo waral ñiy am xaalis bu bari te ñàkk seen liggéey ñu mëna am Medicaid ci saasi¶

Ci wàllu faju bu yomb bi Soppi Revenu Brut buñ Yamale (MAGI) sàrti lim Medicaid (42 CFR § 435.603(h)), ci noonu la subsidi ACA Marketplace xoolee sa xaalis bi ngay am ci at mi yépp, Medica income (te du ci bokk xaalis biñ fayee benn yoon ci weer wi njëkk wala yenn xéewal yuñ dul fay juuti). Doonte danga am $85,000 diggante weeru saŋwiye ak weeru sulet, sudee dañu la dindi ci weeru sulet 31 te sa xaalis bi ngay am ci weeru ut bi mooy \(0 (wala ci suufu 138% ci Niveau de Pouvreté Federal ci 40+ Ad Medicaid Expansion States, lu tollu ci **\)1,732/weer/famiy, $3th for for ci ñeent**), yoon mën nga am Medicaid bu mat ci weeru ut.

Doxal sàrtu Medicaid buy delloosi 3 weer (42 Etats Unis § 1396a(a)(34))¶

Ci yoonu Medicaid federal (42 U.S.C. § 1396a(a)(34) ak 42 CFR § 435.915), agence Medicaid yu réew mi dañu wara jox ndimmbalu pajum ngir faj ak serwiis yi ñuy joxe ci wala ginaaw **ñatteelu weer balaa weer wi ñu def **d

1. Jot nga ay serwiis medikaal yuñ la fay ci weer wi weesu (lu melni seeti ER, dëkk lopitaal, operaasioŋ, yóbbug ambulance, wala ordonaas), doonte fay nga faktiir bi ba pare am déet; AK
2. Danga mëna am Medicaid ci jamono ji ñu lay jox serwiis yi sudee danga def say demànd ci jamono jooju (maanaam sa xaalis bi ngay am ci weer wi njëkk mingi woon ci biir Medicaid, wala sa faktiiru pajum musiba dafa weesu sa xaalis bu ëpp ci prograamu etaa **Medically Needy Spend / Co ** Down).

Jéego yi nga wara def ci wetu lal bu hopitaal bi (Hopitaal bi ñuy xalaat ni mën nga ko yelloo, 42 C.F.R. § 435.1110): Balaa ngay nekk ci hopitaal bi, laajal nga waxtaan ak hopitaal bi Ki yor wàllu xaalis ci wàllu Medicaid wala Avocat bi yor hopitaal bi ci wàllu xaalis a Demànd Medicaid buy delloo ginaaw (3-weer ci kaw suplement couverture). Ci suufu 42 C.F.R. § 435.1110, hopitaal yi mëna am mën nañu la jox Medicaid ci saasi ci bis bi, lépp di aju ci sa xaalis bi ngay am ci weer wu nekk, suko defee nga mëna joxe ordonaas yi soo génnee hopitaal bi, ci diir bi ñuy liggéey sa demànd bu mat 90 fan.

Tegtale pontu couverture urgent ak sàrt yuñ tëral¶

Faj ab politiku COBRA bu jeex: Diiru 30 fan yi & Sàrt bu "amul benn njariñ"¶

Sudee sa administratëru COBRA daf lay yónnee ab yëgle buy wax ni dañu fomm sa coverage COBRA ba fàww ndax payoor bu weer wu nekk daa yeex wala daa gàtt ci ay dolaar yu néew, xoolal ñetti kaaraange yooyu ci saasi:

1. Diiru 30 fan yi war ci weer wu nekk (29 U.S.C. § 1162(2)(C) ak 26 CFR § 54.4980B-8, Q&A-5): Ngir bépp weer wu COBRA di fay ginaaw 45 fan yi gëna ndaw Doonte sa faktiiru COBRA dafa wax "Dafa wara fay ci 1^st ci weer wi," fayeeku postmarked (wala ñu joxe ko ci elektronik) ci wala balaa 30 fan ginaaw bis bi ñu wara fay mën nañu ko wax ci jamono, te assuranceur bi dafa wara delloosi coverage bi ci 1^st ci weer wi.
2. **IRS "Njariñu ñàkka am solo" sàrt (26 CFR § 54.4980B-8, Q&A-5(d)): ** Ndawi COBRA dañuy faral di fomm politig yi su amee yokkute ci njëgu at mi mu soppi sa prime weer wu nekk ci $812 dem ci $845 ak sa $812pay. Ci wàllu sàrti Treasury § 54.4980B-8, Q&A-5(d), soo fayyee ci waxtu wiñ ko santaane, te daa gàtt ci **"dañu tuuti", safe harbor federal bi dafa wax ni ** lu gëna ndaw ci $50 wala 10 pursaa ci njëg yiñ laaj ** RAB dafay jeexal ** Administratër bi daf lay njëkka yónnee ab bataaxal ngir yëgal ni amna lu ñàkk, ba noppi yokkal la 30 fan ci almanaak ginaaw yëgle boobu ngir fay difference bi ñàkk.
3. Yegleb wote COBRA bu am sikk wala bu ñàkk (ERISA § 502©(1), 29 US § 1132©(1)): Ci suufu 29 USC § 1166, sa patroŋ ak kilifag palaŋ bi dañu am waxtu yu tar yuñ tëral (dafay yegg ba 44 fan boole) ngir yónnee sa yëgle bu wote COBRA ci sa adres bu mujj bi nga xam (ak yëgle dependency yu wuute su ko jaree). Sudee nangu wuñu yónnee yëgleb wote COBRA ci waxtu wiñ ko digal, sa montu wote bu 60 fan musul tàmbali dox ci anam wu yoon, te Administratëru Plan bi dafa wara jànkoonte ak daan yu yegg ba $110+ bis bu nekk boole ci ndàmpaay ci sa ndàmpaay pajum buñu mënul muur.

Kopiel-ak-pasteel modèle: Demand de couverture rétroactif & appel COBRA / SEP¶

Jëfandikool Wàll 1 ngir sàkku ACA ci anam yu amul fenn yuy delloo SEP, Wàll 2 ngir sàkku Medicaid buy Delloo 90 Fan, wala Wàll 3 ngir soppi Dakkal COBRA budul yoon.

SECTION 1: REQUEST FOR ACA MARKETPLACE "EXCEPTIONAL CIRCUMSTANCES" RETROACTIVE SEP
(PURSUANT TO 45 C.F.R. § 155.420(d)(9), § 155.420(d)(4), AND § 155.420(b)(2)(iii))

Date: [Insert Date]
TO: Health Insurance Marketplace Appeals Center / State-Based Exchange Appeals Unit
    [Mail to: Health Insurance Marketplace, Attn: Appeals, 465 Industrial Blvd, London, KY 40750-0061]
RE: Marketplace Application ID: [Insert ID] | Applicant: [Your Full Name & DOB]

Dear Marketplace Eligibility & Appeals Specialist:

I hereby request an immediate Special Enrollment Period (SEP) with a RETROACTIVE EFFECTIVE DATE of [Insert Date Coverage Should Have Started] pursuant to 45 C.F.R. § 155.420(d)(9) (Exceptional Circumstances) and/or 45 C.F.R. § 155.420(d)(4) (Misconduct or Error of Non-Exchange Entity / Employer / Issuer).

1. QUALIFYING LIFE EVENT & REASON FOR DELAY:
   My prior Minimum Minimum Coverage terminated on [Date]. I was prevented from completing my Marketplace plan selection within the standard 60-day window due to:
   [ ] Serious medical incapacitation / emergency hospitalization from [Date] to [Date] (hospital admission records attached).
   [ ] Failure of my former employer / health plan administrator to provide timely written notice of my coverage termination date or COBRA subsidy expiration until [Date] (late notice attached).
   [ ] A technical error / misrepresentation by the Marketplace, insurance carrier, or enrollment assister on [Date].

2. DEMAND FOR RETROACTIVE EFFECTIVE DATE:
   Pursuant to 45 C.F.R. § 155.420(b)(2)(iii), I request that my Marketplace coverage be made retroactively effective to [Insert Date] upon my payment of the corresponding binder premiums so that emergency medical claims incurred during the involuntary gap are covered.

--------------------------------------------------------------------------------
SECTION 2: NOTICE TO COBRA ADMINISTRATOR OF UNLAWFUL TERMINATION / INSIGNIFICANT SHORTFALL

TO: [Name of COBRA Third-Party Administrator & Employer Plan Administrator]
RE: Participant: [Your Full Name] | COBRA Account No.: [Insert Number]

PLEASE TAKE NOTICE that your purported termination of my COBRA continuation coverage effective [Date] violates ERISA §§ 602 and 605 (29 U.S.C. §§ 1162, 1165) and Treasury Regulation 26 C.F.R. § 54.4980B-8:
[ ] My premium payment was postmarked / transmitted on [Date], within the mandatory 45-day initial payment window or 30-day monthly grace period under 29 U.S.C. § 1162(2)(C) and 26 C.F.R. § 54.4980B-8, Q&A-5.
[ ] Any alleged underpayment of $[Amount] was less than the lesser of $50 or 10% of the required premium, triggering the mandatory 30-day written cure notice requirement under 26 C.F.R. § 54.4980B-8, Q&A-5(d). Enclosed is immediate payment of $[Amount].

Demand is hereby made for immediate reinstatement of my COBRA coverage with zero gap.

Sincerely,

____________________________________
[Your Signature, Printed Name, Address, Phone, and Email]

Couverture internationale ci wàllu wérgi-yaram ci jamonoy jafe-jafe ak njëgu rëset¶

Soo ñàkkee sa palaŋu drog/wérgi-yaram ci barabu liggéey bi wala nga jànkoonte ak faktiiru pajum bu metti ci jamonoy coppite ci bitim Etats Unis, tàmbalil yii prograam yu ñépp bokk ci saasi:

• Canada (Pharmacare publik bu dëkk bi ak Trillium / Njàngat bu jaar yoon): Bi nga xamee ni hopitaal yi ak sarwiisu doktër yi dañuy nekk ci assurance wérgi-yaram bu dëkk bi (OHIP, MSP, AHCIP, RAMQ), soo ñàkkee sa liggéey dina dindi sa patroŋ Planu Wérgi-yaram bu Yaatu Dr. Sudee ci saasi nga daje ak garab yu seer lool (lu melni insulin, biologik, wala garabi xol), gaawal nga ñaan ci prograamu garabi musiba yu mag yi nga am ci sa province, lu ci melni Ontario Trillium Drug Program (biy wàññi sa njëgu ordonaas ci sa poos ci lu tollu ci 4000 kër). PharmaCare, wala Njariñu Alberta bu bokkul ak kuréel. Jëf ju am solo: Laajteel prograam bi Njàngat ci sa xaalis ci at mi / Xoolaat lu wuute suko defee ñu xayma sa deductible ci sa sa xaalis bi nga am ginaaw bi nga ñàkkee liggéey, te baña xayma ci deklaraasioŋu juuti bu daaw. Ngeen bàyyi xel itam ni am ngeen 60 fan ginaaw bi ngeen ñàkkee seen palaŋu grupu patroŋ ngir soppi leen ci palaŋu wérgi-yaram bu "ToppMa / Assured Access" te amul benn garanti pajum.
• Royaume-Uni (NHS Low Income Scheme, Form HC1 & 3-Weer Retroactive HC5 Refund): Bi nga xamee ni NHS hopitaal bi dafay faj paj mu jamp ci barab bi ñuy jëfandikoo ngir ñi dëkk UK, soo ñàkkee sa xaalis mën nala bàyyi nga mënatul fay NHS ordonaas (ci Angleterre), pajum bëñ, wala pajum bëñ. Sudee jotagul leble bu mat sëkk, yonneel Demànd bu NHS Low Income Scheme (Formulaire HC1) ci net bi wala ci post ngir am Sàrtifikaa HC2 (100% rëset ak pajum bëñ bu amul fayda) wala Sàrtifikaa HC3 (ndimbal lu néew). Regle buy delloo xaalis: Sudee danga wara fay ab ordonaas wala pajum bëñ bu jamp ci NHS tay ci di xaar ñu nangu sa HC1 wala Universal Credit, laajal farmasist bi Formulaire de reçu NHS FP57 ofisel ci waxtu bi ngay fay (mën nga jot ** HC5** ci diiru 3 weer ngir ñu dello xaalis bi yépp.
• Australie (Medicare Safety Net, kàrtu pajum wérgi-yaram bu am xaalis bu néew & Suspension 60 fan ci wàllu pajum wérgi-yaram): Képp kuy dëkk foofu mën nga am hopitaal bu ñepp bokk ak PBS jëfandikoo garabi garab jaaraleko ci Medicare, doonte ñàkka am liggéey. Sudee sa xaalis wàññeeku bu baax ginaaw bi nga ñàkkee sa liggéey, laajal Services Australia (Centrelink) ngir am Kartu Faju bu am xaalis bu néew (ñu koy xayma ci diiru 8 ayu-bis ci palanteeru xaalis buy dem, du xaalis bi ngay am ci juuti at mi), loolu mooy wàññi sa **Njariñu Farmasi) ($7.70 AUD) nga wàññi sa Reelu Kaaraange Medicare bu Yaatu (EMSN). Sudee mënatu nga fay sa Assurance Santé Privé prime lopitaal (wala nga bëgga moytu Medicare Levy Surcharge ak Lifetime Health Cover daan), laajal sa assurance santé privé mu am Suspension bu mat sëkk ci wàllu xaalis / Politigu ñàkkum liggéey (li gëna bari ci xaalis dafay may **suspension at yu bari sa diiru xaar wala sa dundu Couverture Santé).

Laaj yi ñuy faral di laaj¶

Saytu nañu ay balluwaay¶

• **NU. Departemaa bi yor Wérgi-yaram ak Serwiisu Nit ñi (HHS) ak Centre yiy Yorandi Medicaid & Medicaid (CMS, Etats Unis): ** Sàrtu yelleefu Medicaid bu 90 fan (42 U.S.C. § 1396a(a)(34)) ak sàrt yi (42 C.F.R.5§1) Regle yiñ tëral ngir am xaalis (42 CFR § 435.603), Yàgg ci Hopitaal (42 CFR § 435.1110), ak Sàrtu Pajum Jafe-jafe ak Liggéey (EMTALA, 42 U.S.C.)dd59.
• Centres for Medicare & Medicaid Services (CMS / HealthCare.gov, Etats Unis): ACA Exchange Jamonoy Bindu bu Yeesal (45 CFR § 155.420), Jeexal Liggéeykat COBRA Sep (45 CFR §1(x)55 155.420(d)(9) ak § 155.420(b)(2)(iii)), ak *Assurance bu gàtt, diir bu gàtt) Regle bu mujj (45 C.1F.
• **NU. Departemaa bi yor liggéey (EBSA) ak Serwiisu Revenu Interne (Etats Unis): ** Sàrtu Déggoo Budget Omnibus (COBRA, ERISA §§ 601 ba 608, 29 U.S.C. § 54.4980B-6 ci diiru wote yi ak § 54.4980B-8 ci 45 fan/30 fan ngir fay ay palanteer ak ay njuumte yu tuuti).
• Ministëru Wérgi-yaram bu Ontario ak Ministère bu Wérgi-yaram bu BC (Canada): Prograamu Drog Trillium ci Njàngalem Njàngat ci At mi ak Sàrti Njàngat ci Mbootaayu PharmaCare bu BC.
• Baŋxaasu NHS bi yor wàllu liggéey (NHSBSA, Royaume-Uni): NHS ngir am xaalis bu néew (HC1/HC2/HC3) ak sàrti delloosi xaalis biñ bindal/bëñ (Formulaire FP57 ak HC5).
• Serwiisu Australie ak Ombudsman bu Assurance Wérgi-yaram (Australie): Kàrtu Wérgi-yaram bu am xaalis bu néew Test bu 8 ayu-bis, Net Kaaraange Medicare bu Yaatu, ak Njàngale ngir Dakkal Jafe-jafe Xaalis bu Assurance Wérgi-yaram.

Gid yu jëm ci loolu¶

• Ñàkka assurance wérgi-yaram, COBRA, ak Bindu bu Bees
• Dajale faktiiru pajum, ndimmbalu xaalis lopitaal, ak pajum saraxe
• Assurance invalidite bu gàtt wala bu yàgg (ERISA appel)
• Ñàkk liggéey ci saasi ak dundu xaalis ci saasi
• Woo feebar ak jël congé médical buñu aar (FMLA)
• Nimero paj mu jamp ci réew mi