Isicwangciso seplatinum luhlobo olumiselweyo lwe-inshorensi yempilo ehlawula, ngokwesilinganiso, malunga neepesenti ezingama-90 zeendleko zonyango zempilo. Amalungu ahlawula elinye iipesenti ezili-10 zeendleko zabo zononophelo zempilo ngendlela yokuhlawulwa kwemali, ukuthengiswa kwemali kunye nokuxothwa .
Imvelaphi
Ukwenza kube lula kuwe ukuthelekisa ixabiso ofumanayo imali oyisebenzisayo kwiimali-mali ze-inshorensi yezempilo, uMthetho ojongene noNonophelo ongenakunqunyiwe wamanqanaba exabiso le-actuarial value kwizicwangciso zempilo kwikarhwebo ngalinye kunye neqela elincinci .
Ezi nqanaba, okanye emithathu, ibhedu, isilivere, igolide kunye neplatinum. Zonke izicwangciso zempilo ngaphakathi kwinqanaba elinikeziweyo zilindeleke ukuba zinikeze ngokulinganayo inani elifanayo.
Izicwangciso ze-platinum-tier, ixabiso leepesenti ezingama-90 (kunye ne-minimus range ye +/- 2, eya kwandisa ukuya ku-2 / -4 ngo-2018, oko kuthetha ukuba isicwangciso seplatinum ngo-2018 siza kuba nexabiso le-actuarial kwibanga ama-86 ukuya kuma-92 ekhulwini). Izicwangciso zebhondi, zesilivere negolide zinikeza ubungakanani bee-60, 70 ne-80 ngokwepesenti ngokulandelana.
Ixabiso lini malunga neNtshuwalense yeMpilo
Ubungakanani, okanye ixabiso le-actuarial , likuxelela ukuba yeyiphi ipesenteji yeendleko zonyango ezikhuselekileyo isicwangciso silindele ukuhlawula ubulungu balo lonke. Oku akuthethi ukuba wena, ngokwakho, uya kuba neepesenti ezingama-90 zemali yokunakekelwa kwezempilo yakho ehlawulwa yicebo lakho leplatinum. Ixabiso eliqhelekileyo lisasazeka kwizinga eliphakathi. Ngokuxhomekeke kwindlela osebenzisa ngayo i-inshorensi yakho yezempilo, unokufumana ngaphezulu okanye ngaphantsi kwama-90 eendleko zeendleko zakho ezihlawulwe.
Iindleko zonyango ezingabandakanywayo azibandakanyi xa kuqikelelwe ixabiso leprogram yezempilo. Ngokomzekelo, ukuba isicwangciso sakho sezempilo seplatinum asiboneleli ngogqirha ngamachiza angaphezu kwee-counter, iindleko zezo zinto azibandakanyi xa zibala ixabiso lecebo lakho. Iindleko ze-out-of-network azibandakanyi ekuqinisekiseni ixabiso le-actuarial value, kwaye akukho zibonelelo ezingapheli phantsi kweyodwa yeentlobo zoncedo zezempilo (phantse zonke iinkathalo eziyimfuneko zonyango zibhekwa njengenzuzo ebalulekileyo yezempilo, nangona kunjalo)
Iintlawulo zeeNyanga
Uya kufuneka uhlawule iimali-mali zenyanga ukuze ufumane isicwangciso sezempilo. Isicwangciso seplatinum seplanium sibiza kakhulu kunezicwangciso zexabiso eliphantsi kuba izicwangciso zeplatinum zihlawula imali eninzi kwiimali zonyango.
Njalo xa usebenzisa i-inshorensi yakho yempilo, uya kufuneka uhlawule ukwabelana ngeendleko ezifana nokuncitshiswa , uxanduva lwe- coinsurance kunye ne-copays . Indlela nganye iplatinum icebo yenza ukuba uhlawule isabelo sakho sepesenti e-10 siyahluka. Ngokomzekelo, isicwangciso esisodwa seplatinum sinokuba ne-$ 1000 echithwe ngokubambisana kunye ne-5% ye-coinsurance ephantsi. Isicwangciso seplatinum esincintisanayo sinokuba ne-$ 400 engaphantsi echithwe nge-coinsurance ephezulu kunye ne-copay ye-$ 10 yemimiselo.
Iinkonzo
Khetha iplani yezempilo yeplatinum ukuba into ebaluleke kakhulu kuwe iindleko ezingaphantsi kwee-pocket xa usebenzisa i-inshorensi yakho yempilo. Ukuba ulindele ukusebenzisa i-inshorensi yakho yezempilo, okanye ungakhathazeki ngeeprayimari zenyanga eziphezulu zesicwangciso seplatinum, isicwangciso sezempilo seplatinum sinokuzikhethela kakuhle.
Ukuba usebenzisa i-inshorensi yakho yezempilo, mhlawumbi ngenxa yokuba unesifo esibi kakhulu, qwa lasele iplatinum plan out-of-pocket . Ukuba uyayazi kwangaphambili ukuba iindleko zakho ezingaphandle kwee-pocket ziza kudlulela oku ngaphandle kwe-pocket ephezulu, unokukwazi ukugcina imali ngokukhetha icebo elingaphantsi-mali kunye neepasimali eziphambili eziphambili kodwa eziphantsi kweeprayimari.
Umxhasi
Ungakhethi isicwangciso sezempilo seplatinum ukuba awukwazi ukufumana iiprayimari eziphezulu zenyanga. Ukuba ulahlekelwa ngumshuwalense wakho wezempilo ngenxa yokuba awukwazi ukuhlawula iipriyamu, unokufumana kwindawo enzima.
Ukuba unelungelo lokunika inkxaso ngeendleko kuba imali yakho engenayo ingaphantsi kwama-250 ekhulwini kwinqanaba lehlwempu, kufuneka ukhethe isicwangciso se-silver-tier kwishintsho ukuze ufumane inkxaso. Awuyi kufumana inkxaso-mali yokwabelana ngeendleko xa ukhetha isicwangciso sempilo kunoma yiphina enye intsimbi, okanye ukuba uthengisa ngaphandle kwechitshintshi ( inkxaso-mali ye-premium itholakala kuphela ekutshintshisweni, kodwa ingasetyenziselwa izicwangciso nakwephi na isinyithi nqanaba).
Ukwabelana ngeendleko zenkxaso-mali kunciphisa i-deductible yakho, i-copays, kunye ne-coinsurance ukuze uhlawule ngaphantsi xa usebenzisa i-inshorensi yakho yempilo. Enyanisweni, inkxaso-mali yokwabelana ngeendleko kwandisa ixabiso lentsebenzo yesicwangciso sakho sezempilo ngaphandle kokuphakamisa i-premium. Kufana nokuphucula ukukhululeka kwinshuwalense yezempilo. Ngeke ufumane ukuphuculwa kokukhululeka xa ukhetha icebo le-platinum-tier.
Ukufumaneka
Ngaphantsi kwe-ACA, i-insurers ezithengisa izicwangciso ekutshintshisweni zifunwa kuphela ukuba zinikezele ngokukhawuleza kumanqanaba esiliva negolide. Izicwangciso zePlatinum zithandwa kakhulu kunamanye amanqanaba ensimbi (izicwangciso zeplatinum zibalwa ngaphantsi kwe-1 ekhulwini lokubhaliswa kwabathengiweyo ngexesha lokubhaliselwa kwe-2017), kwaye banamathenda aphezulu kubabambisense, njengokuba abantu banokuzikhetha bathambekele ngaba abo baneemeko zempilo abalindele ukusetyenziswa okubalulekileyo kwezempilo kunyaka.
Ngenxa yobhaliso oluphantsi lwabantu bonke kunye neendleko eziphezulu, abaqhankqalazi kwezinye iindawo baye bayeka ukulungiselela izicwangciso zeplatinum. Oku kuthetha ukuba awukwazi ukuthenga isicwangciso seplatinum, nangona iiplani zegolide ziya kuqhubeka zifumaneka.
> Imithombo:
> Isebe Lempilo Neenkonzo Zoluntu. Isiqinisekiso soMonde kunye noNonophelo ojongene noNonophelo olungabonakaliyo: I-Market Stabilization . Epreli 2017.
> Kaiser Family Foundation. 2017 Ukhetho lweMakethe yeMakethe yiNqanaba leMatriki (Novemba 1, > 2016, > ukuya kuJanuwari 31, 2017) >.