Inkokhelo ye-inshorensi yempilo yintlawulo yemali ehlawulwa yinkampani yomshuwalense okanye isicwangciso sezempilo sokubonelela ngempilo. Ukunakekelwa kweenkonzo zezempilo kubandakanya konke okanye inxalenye yeendleko zeenkonzo ezinxulumene nempilo ezifana nokutyelela ugqirha, izibhedlele, imiyalelo kunye nemithi.
Ngamafutshane, i-premium yintlawulo oyenzayo kwinkampani yakho yomshuwalense yempilo egcina ingqalelo ngokugcweleyo.
Iintlawulo ze-Premium zinomhla ofunekayo kunye nexesha lobabalo. Ukuba i-premium ayihlawulwanga ngokupheleleyo ngethuba lobabalo, inkampani ye-inshurensi yezempilo inokumisa okanye ukurhoxisa inqaku.
Ezinye iindleko ze-inshorensi yezempilo zingabandakanya ukuhluthwa kwemali , i- coinsurance kunye ne- copayments . Ezi zixabiso olihlawulayo xa ufuna unyango. Ukuba awuyidingi nayiphi na unyango, awuyi kuhlawula i-deductible, copays, okanye i-coinsurance. Kodwa kufuneka uhlawule i-premium yakho nyanga zonke, kungakhathaliseki ukuba usebenzisa i-inshurensi yakho yezempilo okanye cha.
Ngubani ohlawula i-Premium yomshuwalense wezempilo?
Ukuba ufumana inkxaso yokunakekelwa kwempilo ngomsebenzi wakho, umqeshi wakho uya kuhlawula ngokuqhelekileyo okanye yonke i-premium yenyanga. Ngokuqhelekileyo, inkampani yakho iya kufuna ukuba uhlawule inxalenye ye-premium yenyanga, eya kutsalwa kwi-paycheck yakho. Emva koko baya kuhlanganisa yonke i-premium.
Ngokwe-survey ye-2016 ye-Employee ye-Kaiser Family Foundation, abaqeshi bahlawula umyinge wama-82 eepesenti yee-premium zabasebenzi abangatshatanga, kunye nomyinge wama-71 ekhulwini wee-premium zentsapho, kubaqeshwa abongeza amalungu entsapho kwisicwangciso.
Ukuba usebenza okanye uzithengela yakho yinshurensi yempilo, wena njengomntu uxanduva lokuhlawula i-premium yenyanga nganye ngenyanga. Nangona kunjalo, ukususela ngo-2014, uMthetho woNonophelo ongenakunqwenela unike iikhredithi zerhafu ye-premium (inkxaso-mali) ezifumaneka kubantu abathengayo ngabanye ukuthenga ngokutshintshiselana .
Ukuze ukwazi ukufumana inkxaso ye-premium, ingeniso yakho ayikwazi ukudlulela kuma-400 ekhulwini kwinqanaba lehlwempu, kwaye awukwazi ukufumana ukufikelela ngokukhawuleza, okubanzi kunomqeshi wakho okanye umqeshi womlingane wakho.
Izicwangciso zokungatshintshiswanga ngaphandle kokuthengwa ukususela ngo-2014 ziyahambelana ne-ACA, kodwa inkxaso-mali ye-premium ayinakusetyenziswa ukukhupha iindleko zabo. Oku kungatshintsha, nangona kunjalo, ukuba uMthetho weMpilo weMpilo yaseMelika uphathiswa .
Umzekelo weNkulumbuso
Masithi uphando ngeerhafu zempilo kunye nezicwangciso ukwenzela ukuba ufumane isicwangciso esithengekayo kwaye esifanelekileyo kuwe kunye nabathandekayo bakho. Emva kophando oluninzi, ekugqibeleni ugqiba ukukhetha isicwangciso esithile esibiza i-$ 200 ngenyanga. Imali ehlawulwa yenyanga engama-200 yintlawulo yomshuwalense wezempilo. Ukuze zonke iinkonzo zakho zonyango zihlale zisebenza, i-premium yomshuwalense wezempilo kufuneka ihlawulwe ngokugcwele inyanga nganye.
Ukuba uhlawula i-premium yakho ngokwakho, ibhilikhi yakho yenyanga iza kuza ngqo kuwe. Ukuba umqeshi wakho unikezela iqhinga le-inshurensi yezempilo, iiprayimari ziya kuhlawulwa kwisicwangciso se-inshurensi ngumqeshi wakho (okanye umqeshi u-insured-self), nangona kunjalo umzekelo kubaqeshi abaninzi kakhulu, nangona inxalenye ye-premium iyonke iya kungenzeka ukuba iqokelelwe kumqeshwa ngamnye ngokuchithwa kwe-payroll.
Ukuba unesicwangciso sezempilo somntu ngokwabelana kunye kwaye ufumana inkxaso-mali ye-premium, inkxaso iya kuhlawulwa nguRhulumente, ngqo kwiinkampani zakho ze-inshorensi. Ibhalansi eseleyo ye-premium iya kuhanjiswa kuwe, kwaye kuya kufuneka uhlawule isabelo sakho ukuze ugcine ukukhutshwa kwakho kusebenza. Ngaphandle koko, unokukhetha ukuhlawula imali epheleleyo ye-premium ngokwakho inyanga nganye kwaye ucele inkxaso-mali yakho ye-premium kwi-tax return emva kwentwasahlobo (oku akuyona inketho eqhelekileyo, kodwa iyafumaneka kwaye ukhetho luyakho).
IiDeductibles, iCopays kunye neNkxaso-mali
Iimali-ntlawulo zifakwe iintlawulo ezimele zihlawulwe rhoqo ngenyanga.
Ukuba ama-premium akho afike ngoku, u-insured. Nangona kunjalo, ukuba unikwe i-insured, kunjalo, akuthethi ukuba zonke iindleko zonyango zakho zihlawulwa.
Deductibles . I-Deductibles, ngokubhekiselele kwi-Healthcare.gov, "yimali oyihlawulayo kwiinkonzo zempilo yoncedo ngaphambi kokuba isicwangciso sakho se-inshurensi siqale ukuhlawula. Ngokwe-$ 2,000 ehlawulwayo, umzekelo, uhlawula i-$ 2,000 yokuqala yeenkonzo ezikhuselekileyo ngokwakho. , ngokuqhelekileyo ukhokhela kuphela ikhoyayili okanye uqinisekiso lwemali kwiinkonzo ezigutyungelwe. " Iindleko zeeprayimari zihlala zixhomekeke ngokuxhomekeke kwii-deductibles: uza kuhlawula ngaphezulu inqubomgomo yomshuwalense ene-deductibles ephantsi, kwaye ngokulandelanayo (phawula ukuba iiplani ezihambelanayo ze-ACA, eziquka izicwangciso ezixhaswe ngumqashi kunye nezicwangciso zorhwebo, zibandakanya iinkonzo ezithile zokukhusela akukho ndleko kwirejista, nokuba i-deductible ayifumanekanga).
Iintlawulo zentsebenziswano . Nangona umgaqo-nkqubo we-inshorensi yempilo uphantsi okanye awukho ncitshulwa, mhlawumbi uyacelwa ukuba uhlawule umrhumo ophantsi kakhulu unyango. Le ntlawulo ibizwa ngokuthi "intlawulo yentsebenziswano." Uninzi lwezicwangciso lubandakanya zombini i-deductible kunye nentlawulo-yentsebenziswano, kunye neentlawulo zentsebenziswano ezifaka kwizinto ezifana nokutyelela i-ofisi kunye nemigqaliselo, ngelixa i-deductible isebenza kwizibhedlele, umsebenzi webhu, ukuhlinzwa, njl. .
Coinsurance. I-Healthcare.gov ichaza i-coinsurance ngolu hlobo lulandelayo: "Ipesenteji yeendleko zemisebenzi yokunakekelwa kwempilo oyihlawulayo (20%, umzekelo) emva kokuhlawula imali yakho. i-coinsurance yakho i-20%. Ukuba uhlawule imali yakho: Uhlawula i-20% ye-$ 100, okanye i-$ 20. "
Ukuhlaziywa, ukuhlawulwa kweentsebenziswano kunye ne-coinsurance zisetyenziselwa kwisigxina esiphezulu se-post-pocket . I-exit-out-of-pocket esiphezulu yonyaka iphezulu okanye inani elipheleleyo lilonke inkampani yomshuwalense yempilo idinga isigulane ukuba ihlawule ngokwazo kwiindleko ezipheleleyo zonyango lwabo lwempilo.
Emva kokuncitshiswa kwezigulana, iikhowyithi, kunye ne-coinsurance ehlawulwa kunyaka othile, idibanisa ukuya kwi-out-of-pocket ephezulu, iimfuno zokwabelana ngeendleko zigqitywe kulo nyaka. Ukulandela ukuzaliseka kwe-out-of-pocket ephezulu, isicwangciso sezempilo sele sithatha zonke iindleko zokunakekelwa kwenethiwekhi kwintsalela yonyaka. Nangona kunjalo, iiprayimari maziqhubeke zihlawulwa, nyanga zonke, ukuze zigcinwe.
> Imithombo:
> Kaiser Family Foundation, 2016 Uphando lwezeMpilo lwaBasebenzi. NgoSeptemba 14, 2016.