Ukwabelana ngeendleko kubhekiselele ekubeni wena kunye nenkokhelo yakho ye-inshorensi zihlawula inxalenye yeendleko zakho zonyango phakathi nonyaka. Umshwalense wakho wezempilo ufuna ukuba uhlawule iindleko zeendleko zonyango lwakho ukuze ukhusele ukusetyenziswa kweenkonzo zononophelo lwezempilo, kunye nokugcina ii-premium zentsholongwane yezempilo (nangona i-100% yeengxelo ze-100% ingabonakala ikhulu, mhlawumbi kunokukhokelela kubantu abafuna unyango rhoqo, kwaye iiprayimenti zaza kuphazamiseka).
Iifom eziqhelekileyo zokwabelana ngeendleko zidityanisiweyo, iipayili , kunye ne- coinsurance . Iipresimenti zanyanga zonke ozihlawulayo ukuze ufumane i-inshorensi yezempilo ayithathwa njengoluhlobo lokwabelana ngeendleko.
Ukwabelana ngeendleko kugcina inkampani yakho yenkampani yomshuwalense ngemali ngeendlela ezimbini. Okokuqala, uhlawula inxalenye yowiso-mthetho; ekubeni ulwabelana ngeendleko kunye nabo, bahlawula ngaphantsi. Okwesibini, ekubeni kufuneka uhlawule inxalenye yelwayo-mali, mhlawumbi uya kufuna unyango kuphela xa uludinga ngempela.
Ukwabelana ngeendleko kunye ne-Out-Of-Pocket Maximum
Ngenxa yokuba ukwabelana ngeendleko kunokubiza xa unayo iindleko ezinkulu zonyango, zonke izicwangciso zempilo (ngaphandle kokuba zizalwe okanye zizukulu ) ezifuna ukwabelana ngeendleko nazo zinokuphuma ngaphandle kwenqwelo-mali ebeka inqwelo malunga nokwabelana ngeendleko Unomthwalo wonyaka ngamnye (kule ngxoxo, zonke iinombolo zibhekisela kwi-cap kwi-out-of-pocket cost ucinga ukuba ufumana unyameko kwinethiwekhi yakho yomshuwalense; ubuninzi buya kuba phezulu, okanye kwezinye iimeko, unlimited).
Ngaphambi ko-2014, kwakungekho migaqo elawula indlela ephakamileyo iplani yezempilo ye-out-of-pocket ibe yinyaniso, ezinye iiplani azizange zikhuphe iindleko ze-pocket kuzo zonke, nangona oko kwakungekho mnqabile. Kodwa uMthetho ojongene noNonophelo ongenakunqwenela utshintshile ukuba, kwaye izicwangciso zezempilo ezintsha azikwazi ukuba ne-out-of-pocket ephezulu ngaphezu kwe-$ 6,850-ngomntu omnye-ngo-2016 (eso sikhundla esiphezulu sanda kwi-$ 7,150 ngo-2017).
Ukongeza, ukuqala ngo-2016 , umntu ongenamntu akayi kufunwa ukuba akhokhe ngaphezulu kwiindleko ezingaphandle kwe-pocket ngaphezu komntu ngamnye ongaphandle kwepokethi kuloo nyaka, nokuba ngaba uhlanganiswe phantsi kwenkqubo yentsapho endaweni kwisicwangciso ngasinye.
Emva kokuba uhlawule ngokwaneleyo kwii-deductible, i-copayments, kunye ne-coinsurance ukufikelela kwi-out-of-pocket ephezulu, isicwangciso sakho sezempilo siphazamisa ukwabelana ngeendleko zakho kwaye uthabathe iipesenti eziyi-100 zemali yakho yonyango efunyenwe kuyo yonke loo nyaka, ecinga ukuba qhubeka nokusebenzisa izibhedlele kunye noogqirha.
Ukwabelana ngeendleko kunye noMthetho woKhathalelo ongenakunciphisa
Umthetho ononophelo loNonophelo wenza umlinganiselo obalulekileyo wokunakekelwa kwezempilo okhuselekileyo ekukhutshweni kweendleko. Oku kuthetha izinto ezinjengamammograms afanelekileyo ubudala, ukuhlolwa kwe-cholesterol, kunye neentsholongwane ezininzi azixhomekeke kwi-deductible, copayments, okanye coinsurance.
I-ACA nayo idale inkxaso -mali yokwabelana ngeendleko ukwenza i-inshorensi yakho yempilo enokuhlawulekayo xa unemivuzo ephantsi. Inkxaso-mali yokwabelana ngeendleko iyancipha inani olihlawulayo kwii-deductibles, i-copays, kunye ne-coinsurance rhoqo ngexesha usebenzisa i-inshorensi yakho. Inkxaso-mali yokwabelana ngeendleko zifakwe ngokuzenzekelayo kwizicwangciso zesilivere ekutshintshiseni ukuba ingeniso yakho ingadluli kuma-250 ekhulwini kwinqanaba lehlwempu (ngo-2017 umyinge, umyinge ophezulu wokufumana inkxaso-mali unama-29,700 ayi- $ 60,750 kwiintsapho ezine).
Kuthiwani ngezinto ezingabonakaliyo i-inshurensi?
Iindleko zokwabelana ngeendleko kunye neendleko zangaphandle zisebenza ngamanye amaxesha, kodwa abantu basoloko basebenzisa "ngaphandle kwe-pocket" ukuchaza nayiphi na iindleko zonyango abazihlawula zona, kungakhathaliseki ukuba unyango luhlanganiswe konke nge-inshorensi yempilo . Kodwa ukuba unyango alufihliwe konke, isixa osichithayo asinakuthathwa ngokwabelana ngeendleko phantsi kwesicwangciso sakho, kwaye asiyi kubalwa kwisicwangciso sakho esiphezulu sepokethi.
Ngokomzekelo, iinkqubo zokucoca iimpahla ezifana ne-liposuction ngokuqhelekileyo azihlanganiswa yinshuwalense yezempilo, ngoko ke ukuba ufumana unyango olunjalo, kufuneka uhlawule yona.
Ngokufanayo kunjalo ngokunyamekela kwamazinyo omdala, ngaphandle kokuba unenqubomgomo yomshuwalense wamazinyo ohlukeneyo. Nangona unokuba ucinge ngalezi zindleko njenge "ngaphandle kwe-pocket" (kwaye ngokwenene, ziphuma ephaketheni lakho), imali oyichithayo ayiyi kubalwa kwisicwangciso sakho sezempilo esingaphandle kwipokethi, kwaye yaqwalasela ukwabelana ngeendleko phantsi kwesicwangciso sakho.
Ngenxa yokuba ukwabelana ngeendleko kuyahluka kakhulu kwiprogram yomshuwalense wezempilo kwenye, uya kufuna ukuqinisekisa ukuba uyaziqonda iinkcukacha zesicwangciso sakho phambi kokuba ufune ukusebenzisa i-coverage yakho, ukuze imali ofuneka uyihlawule ngayo unyango kuza kumangaliswa.