I-deductible edibeneyo yinkqubo edibanisa iinqununu zomntu kunye nentsapho kwi-inshorensi yempilo yentsholongwane yempilo. Izicwangciso zezempilo ezidityanisiweyo zisoloko zisebenzisa ama -deductibles amaninzi kunoko kodwa iidroductions ezihlanganisiweyo ziqhelekileyo kuzo zonke ezinye izicwangciso xa amalungu amaninzi entsapho abhalise kwisicwangciso kunye.
Xa isicwangciso sempilo singene kwiidroductions, ithetha nje ukuba ilungu elinye lentsapho alinakudityaniswa neentsapho ezipheleleyo ezichithwe kwiintlawulo emva kokukhawulwa.
Endaweni yoko, iinzuzo zomntu emva kokunciphisa ziza kukhawuleza ngokukhawuleza ukuba udibane nomntu ngamnye ochithwayo, nangona ukuba i-coverage isicwangciso seentsapho.
Ukususela ngo-2016, kukho imigaqo emitsha esetyenziswa kwiindleko zokuphela kwee-pocket zokuba umntu onye kwisicwangciso angafuneka ukuba ahlawule kwiindleko zangaphandle kwixesha. Amadalucate ahlukeneyo ayavunyelwa , kodwa zonke izicwangciso zeentsapho kufuneka zibe neefom ephumayo eziphuma ngaphandle. Oko kuthetha ukuba ngo-2017, akukho ilungu lentsapho linye lingafuneka ukuba lihlawule ngaphezu kwama-7,150 kwiindleko ezingaphandle kwe-in-year (in-network). Umda ophezulu unyuke kwi-$ 7,350 ngo-2018, nangona iiplani ezininzi ziya kuqhubeka ziba nemida engaphantsi kwee-pocket ezingaphantsi kobukhulu obuvunyelwe ngumthetho.
Umsebenzi onokuThuthukiswa oKhutshwayo?
Nge-deductible ehlanganisiweyo, isicwangciso sakho sezempilo siya kugcina iindidi ezimbini ezahlukeneyo ze-inshorensi yezempilo kwilungu ngalinye losapho: umntu ochithwayo kunye nentsapho echithwayo.
Ukutshatyalaliswa kweentsapho ngokuqhelekileyo kudla ngokuphindwe kabini ukuphakanyiswa komntu ngamnye. Xa ilungu lentsapho linemali yokunakekelwa kwempilo, imali ehlawula yona kwi-deductible yakhe iyabhalwa kwintsapho echithwayo.
Kukho iindlela ezimbini zokukhawulela, kunye nesicwangciso sezempilo siya kuqala ukuhlawula iindleko zonyango lweliphi na ilungu losapho:
- Ilungu lentsapho lineenkcitho zokhathalelo zempilo ngokwaneleyo edibene nayo. Kule meko, isicwangciso sezempilo siqala ukuhlawula iindleko zomntu, kodwa kungekhona iindleko zonyango zamanye amalungu entsapho (ngaphandle kokuba iyakhathalela ngaphambi kokuba ichithwe, njengokhathalelo oluthile lokukhusela , okanye unyango oluhlanganiswe ne- copay kunokubalwa kwi-deductible).
- Amalungu omalungu ahlukeneyo entsapho ahlawulele ngokwaneleyo kwiintlawulo ezixhomekeke kumntu ngamnye, ezidibene kunye, ukudibaniswa kweentsapho kuye kwadibana. Kule meko, isicwangciso sezempilo siqala ukuhlawula iindleko zonyango lonke kwiintsapho, kwanamalungu entsapho awazange ahlawule nayiphi na into ekubhekiselele kuyo.
Iimveliso kunye neNgcembelelo yoNtsapho ephumayo
Ingxaki kunye neentsapho ezinqamlekileyo ezidityanisiweyo kukuba yindlela kuphela enokudibana ngayo nentsapho echithwayo kwaye ufumane inkcazo yentsapho yonke ngokubandakanya iindleko ezichithwa ngabanye amalungu entsapho. (Oku akuyiyo inyaniso kwi-deductible.)
Ngomdaka odibeneyo, nangona ilungu lentsapho linye lineendleko eziphezulu zonyango lwezempilo, ezo ndleko zodwa aziyi kukwanela ukuhlangabezana nentsapho echithwayo.
Ngoba? Kuba kungekudala loo mntu edibana nomntu ongezantsi, uncedo lwe-inshorensi yezempilo lukhawuleza kwaye luqale ukuhlawula. Ngako oko kufuneka ukuba ahlawule ezinye iintlobo zokwabelana ngeendleko ezifana ne- copays okanye i- coinsurance , kodwa ezo zindleko zingaphandle kweefowuni azizukuzuzwa kwintsapho echithwayo. Imali kuphela ehlawulwayo kwi-deductible yakhe yodwa inokubongwa ngokubhekiselele kwintsapho echithwayo. Ekubeni i-deductible nganye incinci kunokuba intsapho ichithwe, omnye umntu kwintsapho ayinako ukuwanelisa yonke intsapho iyancitshiswa.
Oko kuthetha ukuba ubuncinane elinye ilungu lentsapho liza kufuneka lidibanise nomntu ngamnye owenyulwayo kunyaka-mali ukuze usapho oluchithwe lube ludibanise kunye neentlawulo ezinokukhawuleza emva kokukhawulwa kuwo onke amalungu asekhaya.
Inzuzo yentsapho echitshiweyo edibeneyo kukuba inzuzo ye-inshorensi yezempilo emva kwe-deductible ikhatyelwe kumalungu amaninzi kakhulu entsapho kwangoko kunamanye amalungu entsapho. Ngenxa yokuba la malungu omzimba ogulayo aneendleko zonyango eziphezulu, baya kufinyelela ngokukhawuleza kwabo kunokuba babenokwenza ukuba i-plan isine-deductible, kwaye i-inshurensi yezempilo iqala ukuhlawula zonke okanye ezininzi zeendleko zonyango. Siyabulela kwinkqubo edibeneyo ye-deductible ukuba izinzuzo zabo ze-inshorensi zikhawuleza kwaye ziqale ukuhlawula ngaphambi kokuba udibene nentsapho.
Iinguqu ezathatha ukusebenza ngo-2016
Zonke ezi ngasentla zisasebenza, kodwa ngaphakathi kwimiqathango emitsha yokuba akukho mntu omnye onokufuneka ukuba akhokhe ngaphezulu kwiindleko ze-pocket (in-network) kunomlinganiselo ovumelekileyo wokuphuma kwipokethi kuloo nyaka. Kwakuyi-6,850 yezigidi ngo-2016, i-$ 7,150 ngo-2017, kunye ne-$ 7,350 ngo-2018.
Ngokomzekelo, phambi ko-2016, kwakunokwenzeka ukuba ube nesicwangciso sezempilo esingenayo i-deductibles embedded okanye i- maximally out-of-pocket. Masithi isicwangciso sineentlawulo zeeRhafu ezili-10 000, kwaye emva koko i-100% igalelo emva koko ( olu hlobo lwesicwangciso soyilo luqhelekileyo kwi-HDHPs ). Ukuba kuphela ilungu elinye lentsapho lenze iindleko zonyango ngexesha lonyaka, kwakufuneka lihlawule i-R10 000 ngaphambi kokuba kuqhotyoshelwe ingqalelo. Lohlobo lwesicwangciso soyilo alisayi kuvunyelwa ngenxa yokuba iindleko zakhe zokuphuma ngaphandle ziza kubanjwa i-$ 7,150 ngo-2017. Isicwangciso sinokuthi sinokutsalwa kwintsapho ye-R10 000, kodwa ngaphezu komntu omnye kufuneka ukuba athathe iindleko zonyango ukuze afinyelele kuloo mali.
> Imithombo:
> Isebe lezeMpilo kunye neeNkonzo zeHumanana. Isiqinisekiso soMonde kunye noMthetho woNonophelo ojongene noThathaka, iSaziso seHHS soNcedo kunye neParameters yokuhlawula i-2015. Fe bruwari 2015.
> Isebe Lempilo Neenkonzo Zoluntu. Isiqinisekiso soMonde kunye noMthetho woNonophelo ojongene noThathaka, iSaziso seHHS soNcedo kunye neParameters yokuhlawulwa ngo-2018, izilungiso kwixesha elizodwa lokuBhalisa kunye neNkqubo yokuSebenza yabasebenzi . Disemba 2016.