Ixabiso elichanekileyo lilinganiso yepesenti zeendleko zonyango ezihlawulwa yi-inshurensi yezempilo. Kubaluleke ngakumbi kuba uMthetho woNonophelo ongenakuncediswa uphunyezwe, kuba ukuthotyelwa kwe-ACA kudinga ukuba izicwangciso zezempilo zeqela kunye namancinci zibe phantsi kwamacandelo athile ngokwexabiso lexabiso le-actuarial.
Ingqiqo ngokwayo ilula ngokwaneleyo: Isicwangciso sezempilo sihlawula ipesenti ethile yeendleko zonyango, kwaye amalungu amalungiselelo ahlawula abanye.
Kodwa kubalulekile ukuqonda ukuba ixabiso le-actuarial alibalwanga kubhaliso ngamnye. Esikhundleni salo, kubalwa kuwo wonke umgangatho oqhelekileyo ( uwonke-wonke usekelwe kwidatha ehlanganiswe kwiizigidi ezingama-54 ezibhalisayo kwizicwangciso ze-inshorensi yezempilo kunye neqela). Ngamanye amazwi, ukuba isicwangciso esithile sinexabiso le-actuarial lama-70 ekhulwini, liya kuhlawula iipesenti ezingama-70 zeendleko zokunakekelwa kwezempilo kwi-standard standard. Kodwa, ayiyi kuhlawula iipesenti ezingama-70 zeendleko zomfundi ngamnye .
IsiCwangciso esisodwa, esinye isiXhobo esiPhakamileyo, iziphumo ezihlukileyo kakhulu kumalungu ngamnye
Njengomzekelo, qwalasela icebo elinama-$ 2,500 e-deductible kunye ne-5,000 e-out-of-pocket ephezulu, egcina kuphela iinkonzo zokukhusela ngaphambi kokuba idibeneyo idibene. Masithi uBob unesigxina phantsi kwesi sicwangciso, kwaye unonophelo lwonyango kuphela kunyaka luhambo lokunyamekela ngokukhawuleza xa utyhola isandla sakhe. Ngenxa yokulula, siza kuthi i-bill yexesha elikhawulezayo yokunyamekela i-$ 1,500.
Le nto ingaphantsi kwe-deductible yakhe, ngoko ke uBob uya kufuneka ahlawule i-$ 1,500. Ngamanye amazwi, uhlawulelwa iipesenti ezili-100 zeendleko zakhe zokunakekelwa kwempilo zonyaka-kwaye i-insurer yakhe ikhokhe i-0 ekhulwini (ecinga ukuba akafumani naluphi na ukunakekelwa kokukhusela).
Ngoku makhe sicinge ngo-Alan, onobungcali phantsi kwesicwangciso esifanayo. U-Alan ufumanisa ukuba unomdlavuza ngoFebruwari, kwaye utshaya iplani ye-out-of-pocket ephezulu ngenyanga leyo.
Ekupheleni konyaka, isicwangciso se-inshurensi yempilo ka-Alan sihlawule i-$ 240,000 ukunyamekela kwakhe, kwaye u-Alan ukhokhe imali eyi-5,000 yee-$ (i-out-of-pocket maximum). Kwimeko ye-Alan, umgaqo-nkqubo wakhe we-inshorensi uye wahlawula iipesenti ezingama-98 zeendleko zakhe, kwaye u-Alan ukhokhe iipesenti ezi-2 kuphela zeendleko.
Kodwa u-Alan noBob bobabini banesicwangciso esifanayo, kwaye kulo mzekelo, siza kuthi siyicwangciso sesilivere , oko kuthetha ukuba inenani elilinganiselwa kuma-70 ekhulwini. Ukujonga kulo mbono, kuyacaca ukuba ngokwemntu ngamnye, kukho ukuhlukahluka ngokubanzi ngokwemali yeepesenti zomfundi ngamnye ezifakwe kwisicwangciso sezempilo, njengoko kuxhomekeke ekunakekeleni kunakekelwa ngumntu ngamnye emnyakeni. Kodwa ngokubanzi, ngokubanzi kwinqanaba labantu, isicwangciso sokuba uBob no-Alan bahlasele umyinge wama-70 ekhulwini kwiindleko.
I-ACA nexabiso elithengileyo
Ngaphansi kwemimiselo ye-ACA, yonke into entsha (ngoJanuwari 2014 okanye ngaphezulu) iiplani zeqela kunye namacinci amancinci zifuneka ukuba zifake kwizinga elilodwa lezinyithi, ezikwahlula ngokusekelwe kwixabiso lexabiso (inqaku lokuba izicwangciso ezinobungozi , ezingafaki kwisinyithi Iindidi zamanqanaba, nazo ziyavunyelwa kumashishini athile, kodwa zingathengwa kuphela ngabantu abangaphantsi kweminyaka engama-30, okanye abo banokuxhaswa kobunzima kwi- ACA ngamagunya ngamnye ).
Izinga zensimbi zenziwe njengethusi, isiliva, igolide kunye neplatinum. Izicwangciso zebhonze zinexabiso le-actuarial malunga nama-60 ekhulwini, iiplani zesilivere ezingama-70, iiplani zegolide ezi-80 ekhulwini, kunye neeplatinum ziceba amaphesenti angama-90. Ngenxa yokuba kunzima kubaqhankqalazi ukuyila izicwangciso ezinexabiso elichanekileyo le-actuarial, i-ACA ivumela i-minimus range ye +/- 2. Oko kuthetha ukuba, umzekelo, ukuba isicwangciso sesilivere sinokubaluleka kwimizuzu engama-68 ukuya kuma-72 ekhulwini, kwaye isicwangciso segolide sinokuxabiseka kwexabiso le-actuarial phakathi kwama-78 ekhulwini kunye nama-82 ekhulwini.
Ngo-Disemba 2016, i-HHS yagqiba umyalelo ovumela izicwangciso zobhedu (ixabiso elilinganiselwa kuma-60 ekhulwini) ukuba libe ne-minimus range ye--2 / + 5, ukususela ngo-2018 (ngamanye amagama, phakathi kwama-58 ekhulwini kunye nama-65 ekhulwini).
Emva koko ngo-Ephreli 2017, i-HHS iphelelise imimiselo yokuzinzisa imakethi evumela ukuba u-minimis uhlahlise ukuya kwi -4 / + 2 yesilivere, igolide, kunye neeplatinum, kunye nokwandisa i-new minimus ububanzi kwiiplani zethusi -4 / + 5 .
Ngaphantsi kwemithetho emitsha, ukusebenza ngo-2018:
- Izicwangciso zebhonze zingaba nexabiso elikhoyo phakathi kwama-56 ekhulwini kunye nama-65 ekhulwini.
- Izicwangciso zeSiliva zinokulinganiswa kwamaxabiso angama-66% kunye nama-72 ekhulwini.
- Izicwangciso zeGolide zinokulinganiswa kwamaxabiso angama-76 ekhulwini kunye nama-82 ekhulwini.
- Izicwangciso zePlatinum zinokulinganiswa kwexabiso eliphakathi kwama-86 ekhulwini kunye nama-92 ekhulwini.
Ukubala Ixabiso elichanekileyo: I-EHB ye-In-Network kuphela ibalwa
Urhulumente wesigqeba udale i-actuarial value calculator-ehlaziywa ngonyaka-ukuba abatshizi-bhorensi basebenzise ukucacisa ukubaluleka kweenjongo ezicetywayo kunyaka olandelayo (nantsi inkcazo ye-2017 yexabiso le-calculator value value).
Kuphela iinkonzo ezithathwa njengezibonelelo zezempilo ezibalulekileyo (i-EHBs) zibalwe ekubaleni. Abaqinisekisi bavunyelwe ukukhupha iinkonzo ezongezelelweyo, kodwa oko akubalanga ngokubaluleka kwexabiso le-planari.
Ukongezelela, ukubalwa kwamanani okusebenzayo kusebenza kuphela kwi-in-network coverage, ngoko ke ukukhutshwa kwangaphandle kwenethiwekhi apho isicwangciso sinikeza-ukuba nayiphi na-ayiyiyo inxalenye yokuzimisela kwexabiso lexabiso le-actuarial.
Iqela elikhulu kunye neMicrosoft Self-Insured Plans ineMithetho eyahlukileyo
Ixabiso lexabiso lexabiso lezetriki kwi-ACA lisebenza kwiiplani zeqela kunye namancinci. Kodwa izicwangciso zeqela elikhulu ( kwiindawo ezininzi, oko kuthetha ukuba abasebenzi abangaphezu kwama-50, kodwa kwiindawo ezimbalwa, kuthetha abasebenzi abangaphezu kwe-100 ) kunye nezicwangciso ezizimeleyo zineemigaqo eyahlukileyo.
Kwiqela elikhulu kunye nezicwangciso ezizimeleyo, umqathango wukuthi isicwangciso sinikeza inani elincinci, elichazwe njengento yokubamba okungenani ama-60 ekhulwini kwiindleko zomlinganiselo ophakathi. Kukho ubuncinane bexabiso lokubala elifana ne-actuarial value calculator esetyenziselwa izicwangciso zeqela ngalinye kunye namancinci, kodwa ababalawuli banokubaluleka kwamanani amaninzi .
Iqela elikhulu kunye nezicwangciso ezizimeleyo ezizimeleyo akufanele zihambelane neentlobo zentsimbi zisebenza kwiimakethe zecandelo ngalinye kunye nelincinci, ngoko kuya kuba nobuninzi phakathi kwesicwangciso esinye ukuya kwelinye iqela kunye neemarike ezizimeleyo. Ezi zicwangciso kufuneka zibandakanye ubuncinane ama-60 ekhulwini kwiindleko eziqhelekileyo zendawo yokuhlala, kodwa zingabandakanya nayiphina ipesenti zeendleko ezingaphezu kwelo nqanaba, ngaphandle kokubumba izibonelelo zazo ukuze zilungele kwiindawo ezichaziweyo.
Izicwangciso ezinexabiso eliqhelekileyo Ngokuqhelekileyo zinamacebo ahlukeneyo
I-actuarial value calculator ivumela abaqinisekisi ukuba baqulunqe izicwangciso ezizimeleyo zonke ziphelela kwi-samearial value range. Yingakho unokujonga kwiiplani ezili-10 zesilivere ezahlukeneyo kwaye ubone iiplani ezili-10 ezahlukileyo kakhulu, kunye neentlobo ezahlukeneyo zokudityaniswa, i-copays kunye ne-coinsurance .
I-inshurensi yempilo ye-inshurensi yempilo yaseCalifornia idinga ukuba zonke izicwangciso zamaqela ngabanye namaqela amancinci zilungelelaniswe, oku kuthetha ukuba ngaphakathi kwinqanaba lezakhiwo, zonke izicwangciso ezikhoyo ziyafana ngokufanayo kwizibonelelo ezivela kwisicwangciso esinye ukuya kwelinye, . Kukho ezinye iindibano ezininzi ezifuna ezinye izicwangciso ezilungeleleneyo kodwa zivumele iimpembelelo ezingezizo, kwaye i-HealthCare.gov iqalise izicwangciso ezilungelelanayo (ngokungekho kwizicwangciso ezingezizo) ngo-2017.
Kodwa ukucwangcisa ukulungelelanisa akukona into efanayo nexabiso lexabiso. Ukuba urhulumente okanye utshintshi kufuna ukuba izicwangciso zibe zilungelelwaniso, zonke izicwangciso ezikhoyo ziya kuba neenzuzo ezifanayo kunye naluphi na amamethrikhi asetyenziselwa ukulinganisa (ukuchithwa kwemali, i-copays, i-coinsurance, i-out-of-pocket maximum, njl). Oku kuhambelani neemfuno zexabiso le-actuarial value, ezivumela ukuhlukahluka okukhulu ngokucwangciswa kocwangciso kunye neenzuzo, nangenxa yezicwangciso ezinenani elifanayo lexabiso.
Ukuhluka phakathi kwezicwangciso kwinqanaba lezinyithi ezinokuthi lenzeke nangona iiplani zinexabiso elifanayo le-actuarial (umz., Izicwangciso ezimbini kunye neendlela eziza kuxhamla iintlobo ezahlukeneyo ziyakwazi ukuba nexabiso le-actuarial of 80 percent). Kodwa udidi lwe-minimus luvumelekile kwinqanaba ngalinye lesinyithi-kwaye ukwandiswa kwebala ngo-2018-kwandisa ngakumbi ukuhluka okuvunyelwe kwinqanaba lesinyithi. Ngo-2018, isicwangciso esinomlinganiselo we-actuarial wama-56 epesenti yiplani yebhedu, kwaye kunjalo isicwangciso esinenani lamaxabiso angama-65. Kucacile ukuba, ezo zicwangciso ezimbini ziya kuba neendlela ezahlukileyo zokuyila, kodwa ziza kuthathwa njengezicwangciso zobhedu.
> Imithombo:
> I-American Academy ye-Actuaries MV / AV Practice Note Note Group Working > Ixabiso elincinci kunye nokuQinisekisa kwexabiso lokuQinisekisa phantsi koMthetho wokuNakekelwa ongenakuncedo . Epreli 2014.
> Isebe Lempilo Neenkonzo Zoluntu. Ukugqibela kwe-2017 ye-Value Calculator Methodology . NgoJanuwari 21, 2016.
> Isebe Lempilo Neenkonzo Zoluntu. Ukukhuselwa komonde kunye noMthetho ononophelo loNonophelo, iMakethe yozinzo . Epreli 2017
> I-Register Register. Ukhuseleko lomonde kunye noMthetho woNonophelo ojongene noThathaka; Isaziso seNzuzo yeeNzuzo kunye neParameters yokuhlawula i-2018; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi. Disemba 22, 2016.