Ukutshintshela kwi-inshorensi yezempilo yomlingane okanye isicwangciso sezempilo seqabane lingakusindisa imali.
Ukuba wena kunye neqabane lakho okanye umlingani nabo bobabini banelungelo lokufumana iinkonzo zempilo, khangela iinketho ze-inshorensi yezempilo nganye ngexesha lokubhalisa okuvulekileyo ukuba ubone oko kukuhlawula imali. Abaqeshi bahluke kakhulu ngokwemivuzo abayenzayo kwiiprayimari ezipheleleyo, kwaye unokukwazi ukugcina imali ngokutshintshela kwintsapho yomlingane wakho.
Ngexesha lakho lokubhalisa elivulekileyo lenkampani, jonga kwiindlela ezahlukeneyo zokukhetha umqeshi wakho. Unokwazi ukugcina imali ngokukhetha isicwangciso esihlukileyo, njenge-HMO efuna ukuba ukhethe ugqirha wokunyamekela okuphambili ukulungiselela ukunakekelwa kwakho. Kwezinye iindawo zelizwe, oogqirha basekhaya bangabakho kuzo zonke okanye amaninzi kwinqanaba lezonxibelelwano zezempilo kwaye akufanele ube nexhala malunga nokutshintsha oogqirha .
Thatha inzuzo yoBhaliso oluvulekileyo
Iinkampani ezininzi ezininzi zinika izicwangciso zezempilo ezahlukeneyo. Ngexesha lokubhalisa kwenkampani yakho evulekile, unokutshintsha isithuba sakho esivela kwisicwangciso esinye sezempilo kwisicwangciso esithile (imbali yakho yezobugqirha ayinayo indima ekufanelekile ukutshintsha amacebo). Ngokuxhomekeka kwisicwangciso esiqeshwe ngumqeshi wakho, unokwazi ukwenza ezinye iinqunto, ezifana nokunyuka okanye ukunciphisa inani lemali yakho yonyaka. Kananjalo ungasayina ukuze ufumane inkcazo yempilo ukuba awuzange ubhaliswe ngaphambili okanye uphononise i-coverage yakho.
Uninzi lweenkampani zibambe ixesha lokubhalisa elivulekile (ngokuqhelekileyo lihlala lenyanga enye) ekupheleni konyaka ukwenzela ukuvumela utshintsho kwiintlawulo zempilo ngoJanuwari 1 wonyaka ozayo. Ezinye iinkampani zinamaxesha okubhalisa avulekile ngamanye amaxesha kwaye unokulindela ukufumana isaziso esaneleyo kwangaphambili.
Xa ixesha lokubhalisa kwenkampani yakho liphela kwaye sele wenze ukhetho lwakho kunyaka ozayo, ukufihla impilo yakho kuvaliweyo kuze kufike ixesha lokubhalisa ngonyaka ozayo. Ngaphandle kokuba unomhlobo othile wesiganeko esifanelekileyo, awuyi kukwazi ukuguqula i-coverage yakho yempilo ngonyaka opheleleyo.
Ukuba ucinga ukutshintshela i-inshorensi yempilo yakho yeqabane okanye nenye indlela, qiniseka ukuba ixesha lokubhalisa elivulekileyo labaqeshi linalo. Uyakwazi ukutshatyalaliswa kwisicwangciso esinye ngexesha lokubhalisa okuvulekile, kwaye ubhalise kwesinye isicwangciso ngexesha lokubhalisa okuvulekile, kodwa unokuphelisa ngesithuba sokubhengezwa ukuba ngaba ngabaqeshi ababini abanabhaliso oluvulekile ngexesha elifanayo .
Uninzi lwabaqeshi libala ukubhaliswa okuvulekileyo ngokuwa, kunye neenguqu zokungena ngoJanuwari 1. Kodwa kubalulekile ukuqonda ukuba ukuba omnye umqeshi unobhaliso oluvulekile phakathi konyaka (kunye nesicwangciso esitsha sonyaka oqala ngo-Agasti 1, umzekelo), kwaye enye ibambe ukubhaliswa okuvulekileyo ngokuwa ngesicwangciso sonyaka esilandela unyaka wekhalenda, unganokuqinisekiswa ngeenyanga ezimbalwa ngexesha lokutshintsha. Ukuba unempilweni enempilo, ungabhalisela isicwangciso sexesha elifutshane ukugubungela ngexesha lesithuba, kodwa ukuba isithuba seenyanga ezintathu okanye ngaphezulu, uya kuba kwi-hook ye- ACA .
Iziganeko zokuQinisekisa
Isiganeko esifanelekileyo sikuvumela ukuba utshintshe i-inshorensi yempilo yakho esekelwe kwimisebenzi nanini na ngexesha lonyaka. Yintoni efanelekileyo ukuba "isiganeko" imiselwe yimimiselo yomthetho kwaye iquka:
- Umtshato
- Ukuzalwa okanye ukwamukelwa komntwana
- Ukwahlukana okanye ukwahlukana ngokomthetho
- Ukufa komlingane wakho okanye omnye oxhomekeke kuyo
- Ukulahlekelwa ngokuthe ngqo komsebenzi
Ngexesha lokubhalisa okhethekileyo elibangelwa isiganeko esifanelekileyo, unokujoyina i-inshurensi yomlingane wakho okanye ngokuthe ngqo. Kodwa ke, phawula ukuba imeko echazwe ngasentla (xa abaqeshi baqeshwe ngamaxesha avulekileyo kunye nokucwangcisa umhla wokuqalisa unyaka) akubangeli ixesha lokubhalisa okhethekileyo.
Ukuba ulahla ixesha lokubhalisa ngexesha lakho lokubhalisa elivulekileyo, kwaye iqabane lakho linalo ixesha lokubhalisa lokugqibela, ukulahlekelwa kwakho kwenkxaso-mboleko ayibonakali njengesiganeko esifanelekayo, kuba bekukuzikhethela-kunokuba kulahlekelwe ngumsebenzi wokubhengezwa.
Ukongezelela, ukuba unesicwangciso sokunyamekela (njengePPO okanye i-HMO) kwaye usebenzise inethiwekhi yomboneleli , unokukwazi ukutshintsha izicwangciso zempilo ukuba uhamba kwintlalo eyahlukileyo kwaye awusekho kwinkonzo yenethiwekhi yakho endala cwangciso.
Ukugqiba ukuba yeyiphi iSicwangciso esiSebenzayo esiya kuJob esiza kubonelela
Nangona kunokuthabatha ixesha, sebenzisa amanani ukuba ubone ukuba kunengqondo ukuba onke amalungu entsapho akho ahlale kwisicwangciso esifanayo sempilo. Unokwazi ukugcina imali ngokuthi ube negalelo lempilo eyahlukeneyo kwamanye amalungu entsapho. Umzekelo:
UDon noBarbara
UDon S., oneminyaka engama-46, kunye nomfazi wakhe uBarbara S., oneminyaka eyi-44 ubudala, bobabini banokhetho lwe-inshurensi yezempilo ngokusebenzisa abaqeshi babo. Banobuhlobo bentsapho ngoDon, obandakanya ukukhutshwa kwabantwana babo ababini, abaneminyaka eyi-10 kunye no-14. UDon ukhuluphele kwaye uthayipha i-2 yeswekile, i-cholesterol ephakamileyo kunye negazi eliphezulu; usebenzisa ezininzi iinkonzo zempilo. UBarbara kunye nabantwana basemgangathweni yempilo kwaye bafuna ukuhlolwa rhoqo kwimiba embalwa edlulileyo.
Ngenxa yeengxaki zezempilo zikaDon, zinecebo elincinci lezempilo lempilo elincinci elinama-premium aphezulu. Intsapho inokukwazi ukugcina imali ngokuthi uDon agcine isicwangciso esincinci esinqunyiwe ngokusebenzisa umqeshi wakhe kwaye uBarbara wakhethe icebo losapho oludityanisiweyo kakhulu yena kunye nabantwana ngokusebenzisa umqeshi wakhe.
Kodwa oku akuyi kuba yinto ekhethekileyo ngaso sonke isikhathi, kuba kuxhomekeke kwinxalenye enkulu kwinqanaba le-premium ngamnye umqeshi ekulungele ukumboza. Ngokutsho kohlalutyo lwe-Kaiser Family Foundation, umqeshi oqhelekileyo onika iingenelo zempilo ukhokhe malunga neepesenti ezingama-70 zeeprayimari zentsapho. Kodwa abanye abaqeshi banegalelo kuphela kwiiprayimenti zabasebenzi babo, kwaye kungekhona amalungu omndeni afakwe kwisicwangciso. Ngoko ukuze unqume ukuba ngaba usapho lwakho kufuneka lufakwe phantsi kwelinye icebo okanye lisebenzise zombini, uya kufuneka ukwazi ukuba uza kuba negalelo kwiiprayimali phantsi kwekhetho ngalinye.
UMaria noJorge
UMaria G., oneminyaka engama-32, kunye nomyeni wakhe uJorge G., oneminyaka engama-33, bobabini basebenze ixesha elipheleleyo kwaye ngamnye unomshuwalense wezempilo owenzelwa ngabaqeshi bawo. Zombini iinkampani zinexesha lokubhalisa elivulekileyo ukususela ngo-Okthobha ukuya phakathi koNovemba.
NgoSeptemba, uMaria wazala umntwana osencinaneni, isiganeko esifanelekileyo esabanika ukuba bandise umntwana, Jorge, Jr. kwesinye sezicwangciso ze-inshorensi yezempilo. Nangona kunjalo, ukongeza umntu oxhomekeke kuyo okanye isicwangciso sitshintsha utshintsho lwe-inshorensi evela kumqeshwa-kuphela kwimiba yokufumana intsapho okanye umsebenzi-kunye nabantwana abaxhamlayo (kuxhomekeke kwiziqendu zokuqala eziqashwe ngumqeshi), okwandisa kakhulu iipriyamu zenyanga.
Ejongene nokunyuka kwama-$ 250 ngenyanga nganye ukusuka kumqeshi, isi sibini sijonge iindlela zabo. Enye inketho kukulinda de ubhaliso oluvulekile kwaye ufake onke amalungu osapho kwisicwangciso esisodwa sempilo evela kumqeshi omnye. Oku kungagcina kubasindisa imali, ingakumbi ukuba umqeshi kaMaria sele sele ekhupha i-premium ukuya kwi-"premium" yamaphepha-mboleko kunye nokudibanisa kukaJorge, Jr. Ukuba kunjalo, ukongeza uYorge, uSr. akayi kunyusa iiprayimari ukwanda, nangona kunjalo, ukuba i-premium kaMaria isetyenziswe kubasebenzi-kunye nabantwana, ekubeni ukongeza uJorge, uSr. uya kukhulisa iiprayimari kwizinga eliphezulu leentsapho).
Enye inketho kukuthenga umgaqo-nkqubo womthengiso ngamnye lomntwana. Ngokuxhomekeke kubangakanani abaqeshi abahlawulisayo ukunyusa abaxhomekeke kuyo, kunokuphela kokungabibizi kakhulu ukuthenga umgaqo ohlukeneyo wengane. Oku akunakwenzeka ukuba kunjalo ukuba intsapho inabantwana abangaphezu komnye, nangona kunjalo, ekubeni izicwangciso ezinkulu ezixhaswe ngumqeshi zihlawula ixabiso elifanayo kumntwana omnye okanye kubantwana abaninzi, kanti izicwangciso zorhwebo nganye ziya kuhlawula i-premium ehlukeneyo kumntwana ngamnye intsapho, ukuya kwiindawo ezintathu (ngaphaya kwezingane ezintathu kwintsapho enye engaphantsi kweminyaka engama-21, akukho ntlawulo ye-premium kumakethi athile).
Qonda i-Family Glitch
Ukuba ucinga ngesicwangciso somntu omnye okanye ngaphezulu kwintsapho, ngaphezu kwenkcazo evela kumqeshi omnye okanye amanye amalungu omndeni, qaphela ukuba ukufikelela kwisicwangciso esixhaswe ngumqeshi kuya kuthintela amanye amalungu omndeni ukuba afaneleke inkxaso ye-premium kumakethi nganye.
Kubantu abathengayo ukuthengwa kwemakethe nganye, inkxaso-mali ye-premium iyatholakala kwi-ACA exchange in state ngalinye, kuxhomekeke kwimali engenayo. Kodwa nangona intsapho yakho engenayo yenza ukuba ufumane inkxaso-mali, ukufikelela kwakho kwisicwangciso esixhaswe ngumqeshi kudlala indima. Ukuba ubuncinci becebo elixhaswe ngumqeshi lufumaneka kwintsapho yakho kunye neendleko zokugubungela umqeshwa nje uthathwa njengento efikelelekayo (engekho ngaphaya kwe-9.56 pesenti yemali yengeniso yekhaya ngo-2018), nayiphi na ilungu lamalungu afanelekileyo ukuba afakwe kwi Isicwangciso esixhaswe ngumqeshi (kungakhathaliseki ukuba kuya kuba nexabiso elingakanani kwiimali-mali ukuze zidibanise kwisicwangciso) abavumelekanga ukufumana inkxaso-mali ye-premium. Oku kubizwa ngokuba yi- glitch yentsapho , kwaye kubalulekile ukugcina engqondweni xa unamanani okuqhawula ukuze ubone ukuba amanye amalungu omndeni angaphumelela ngokubhekiselele kwimarike yomntu ngamnye endaweni yokuxhaswa ngumqeshi.
Surcharges for Spouses
Ngaphantsi koMthetho woNonophelo olungabonakaliyo, abaqeshi abaqingqiweyo kufuneka banikezele ukuxhaswa kwabasebenzi bexesha elipheleleyo kunye nabaxhomekeke kubaqeshwa. Kodwa akudingeki ukuba banikezele ngokubhengezwa kwabafazi bomqeshwa. Abaninzi abaqeshi baye baqhubeka nokubonelela ngokubambisana kwabatshatileyo, kodwa abanye baye bafumanisa ukuba abatshatiweyo abavumelekanga ukuba babhalise kwi-postage etholakalayo ngabaqeshi babo, kwaye ezinye iifemu zidibanisa umrhumo xa abasebenzi bomtshato bakhetha ukongezwa kubo 'izicwangciso xa banakho ukhetho lokusayinela kunye neenjongo zabo zabaqeshi.
Ukuqhubela phambili ukuxubusha imiba, iipesenti ezili-10 zabaqeshi ezinika iinshurensi zempilo zonyango zibonelela ngembuyekezo eyongezelelweyo kubaqeshwa xa behla isicwangciso esixhaswe ngumqeshi kwaye kunoko bakhethe ukubhalisa kwisicwangciso sabo somlingane. Ngoko abanye abaqeshi bathabatha amanyathelo asebenzayo ekunciphiseni inani labalingani ababhalisayo kwizicwangciso zabo, ngelixa abanye abaqeshi bethatha amanyathelo asebenzayo ukukhuthaza abo baqeshwa ukuba babhalise iifowuni zabo ngaphandle kwecebo labo elixhaswe ngumqeshi.
Ngokomzekelo, cinga uBob noSue, abatshatileyo kwaye ngamnye unenkxaso yokuxhaswa ngumqeshi evela kumqeshi wabo. Bobabini abaqeshi basebenzisa intlawulo yomtshato xa umlingane enekhefu lakhe elixhaswa ngumqeshi. Ukuba uBob wenza isigqibo sokujoyina iSue kwisicwangciso sezempilo somqeshi wakhe, umqeshi wakhe uya kwongeza kwi-intlawulo-ngaphezu kwe-premium-kuba uBol unokukhetha ukuba abe kwisicwangciso somqeshi wakhe.
Kusenokuba nengqiqo ngakumbi yokongeza umlingane wakho kwisicwangciso somqashi wakho xa ucinga kuzo zonke iinguqulelo, kodwa uya kufuna ukuqonda ukuba ngaba umqeshi wakho ongenakho ukutshatyalaliswa kwabatshatileyo abashiya isicwangciso sabo esixhaswe ngumqeshi kwaye ubhalise kwisicwangciso somlingane esikhundleni sakho.
Ukuqwalaselwa okhethekileyo Ukuba unayo iHDHP
Ukuba wena okanye umlingane wakho unenketho ye-HSA- uphuhliso oluphezulu oluchanekileyo lwezempilo (HDHP) emsebenzini, kuya kufuneka ukuba uqaphele iinjongo zokuba nelungu linye lentsapho kwisicwangciso esiphathelene naphezulu.
Ukuba elinye ilungu lentsapho lijongene ne-HDHP, isixa onokufaka isandla kwi-HSA sincinci kunokuba ngaba ngaba ababini okanye ngaphezulu amalungu omndeni anikezelwa phantsi kwe-HDHP. Ngakolunye uhlangothi, i-deductible kwi-HDHP iphindwe kabini phezulu xa unobuncwane bentsapho (ngokubhekiselele kwenkcazo yomntu omnye kuphela), kwaye yonke intsapho echithwayo kufuneka idibene phambi kokuba nayiphi na ilungu lentsapho lifanele ukufumana izibonelelo ezinokutsalwa (kunye ne-caveat engekho ilungu lentsapho elingafunekayo ukuba lifumane ngaphezulu kwiindleko zokuphuma ngaphandle kwe-year kunomda ngamnye ongaphandle kwe-pocket owenziwe nguRhulumente wombuso waloo nyaka, ngo-2018, i-$ 7,350).
Ngoko ukuba unayo okanye uqwalasela i-HDHP kunye negalelo kwi-HSA, uya kufuna ukugcina ezi zinto engqondweni xa unquma ukuba yonke intsapho kufuneka ibe kwisicwangciso esinye, okanye kwizicwangciso ezihlukeneyo.
> Imithombo:
> I-Cornell Law School, i-Legal Information Institute. 29 CFR 2590.701-6 - Izihlandlo ezizodwa zobhaliso.
> INkonzo yeNgeniso yangaphakathi. Inkqubo yeNgeniso 2017-36 .
> Kaiser Family Foundation. Izinzuzo zezeMpilo zabaSebenzi 2016 Isishwankathelo seziFundo. EyoMsintsi
> Kaiser Family Foundation. Izinzuzo zezeMpilo zabaSebenzi 2017 Isishwankathelo seziPhulo. Septemba 2017.
> Umbutho woLawulo lwaBasebenzi. 2017 ngokumalunga no-2018 I-HSA Yokunikezelwa kwemida. Meyi 2017.