Ukushintshela kumshuwalense wezempilo womngane wakho noma uhlelo lwezempilo lomlingani kungakusindisa imali.
Uma wena nomngane wakho noma umlingani wakho nonke nifaneleka izinzuzo zezempilo zomsebenzi, hlola izinketho zomshuwalense wezempilo yenkampani ngayinye ngesikhathi sokubhalisa okuvulekile ukuze ubone ukuthi yini engakubiza. Abaqashi bahluke kakhulu ngokwemiklomelo abayenzayo kuma-premiums ayonke, futhi ungakwazi ukulondoloza imali ngokushintshela komndeni womlingani wakho.
Ezikhathini zokubhalisa ezivulekile zenkampani yakho, bheka izinketho ezihlukahlukene zokuhlela umqashi wakho. Ungakwazi ukugcina imali ngokukhetha uhlelo oluhlukile, njenge-HMO efuna ukuthi ukhethe udokotela oyinhloko wokunakekela ukuze uqondise ukunakekelwa kwakho. Kwezinye izindawo zezwe, odokotela bendawo bangase babe khona noma kuningi lamanethiwekhi ezempilo futhi ungase ungakhathazeki ngokushintsha odokotela .
Thatha Inzuzo Yokubhalisa Okuvulekile
Izinkampani ezinkulu eziningi zinikeza izinhlelo ezihlukahlukene zezempilo. Phakathi nenkathi yokubhalisa yenkampani yakho evulekile, ungashintsha ukufakwa kwakho kusuka ohlelweni olulodwa lwezempilo ukuya ohlelweni oluhlukile (umlando wakho wezokwelapha awunendima ekufanelekeleni kwakho ukushintsha amapulani). Kuye ngokukhetha okukhethwa ngumqashi wakho, ungase ukwazi ukwenza ezinye izinqumo, ezifana nokwandisa noma ukunciphisa inani lemali yakho ekhishwe minyaka yonke. Ungakwazi futhi ukubhalisela ukuhlinzeka ngezempilo uma ungakaze ubhalise noma uphonsa ukufaka kwakho.
Iningi lezinkampani zibamba izikhathi zokubhalisa ezivulekile (ngokuvamile zihlala inyanga eyodwa) ekuwa konyaka ngamunye ukuvumela izinguquko ezinenzuzo zezempilo ngoJanuwari 1 wonyaka ozayo. Ezinye izinkampani zinezikhathi zokubhalisa ezivulekile ngezikhathi ezithile futhi ungalindela ukuthola isaziso esanele kusengaphambili.
Uma isikhathi sokubhalisa senkampani yakho siphelile futhi wenze izinqumo zakho zonyaka ozayo, ukuvalwa kwezempilo kwakho kuvaliwe kuze kube yisikhathi sokubhaliswa ngonyaka ozayo. Ngaphandle kokuba ube nolunye uhlobo lomcimbi ofanelekayo, ngeke ukwazi ukuguqula ukuhlinzeka ngempilo yakho unyaka ogcwele.
Uma ucabangela ukushintsha umshwalense wezempilo womlingani wakho noma ngokuphambene nalokho, qiniseka ukuthi izikhathi zokubhalisa ezivulekile zombili abaqashi zinokunye. Uzokwazi ukuhlakaza kusuka ohlelweni olulodwa phakathi nokubhaliswa kwalo oluvulekile, bese ubhalisa kwelinye uhlelo ngesikhathi sokubhalisa okuvulekile, kodwa ungaphetha ngegebe ekubhekiseni uma abaqashi ababili bengenalo ukubhaliswa okuvulekile ngesikhathi esifanayo .
Abaqashi abaningi baqala ukubhalisa okuvulekile ekwindla, nezinguquko zokufakazela ngoJanuwari 1. Kodwa kubalulekile ukuqonda ukuthi uma omunye umqashi ebamba ukubhaliswa okuvulekile phakathi nonyaka (unyaka omusha wokuqala oqala ngo-Agasti 1, isibonelo), futhi enye ibamba ukubhaliswa okuvulekile ekwindla ngonyaka wezinhlelo olandela unyaka wekhalenda, ungase ungaqinisekisiwe ezinyangeni ezimbalwa phakathi noshintsho. Uma unempilweni enhle, ungabhalisela uhlelo olude lokumboza kwakho ngesikhathi segebe, kodwa uma igebe liyizinyanga ezintathu noma ngaphezulu, uzobe usenkonzweni yesigwebo somuntu ngamunye we- ACA .
Imicimbi Yokufaneleka
Isimo esifanelekayo sikuvumela ukuthi ushintshe ukuhlinzekwa komshuwalense wezempilo okusekelwe emsebenzini noma kunini phakathi nonyaka. Lokho okufaneleka ngokuthi "umcimbi" kunqunywe yizimiso zomthetho futhi kufaka phakathi:
- Umshado
- Ukuzalwa noma ukutholwa kwengane
- Ukuhlukanisa noma ukwehlukaniswa ngokomthetho
- Ukufa komngane wakho womshado noma omunye wabaxhomekile bakho
- Ukulahlekelwa okungahleliwe kokufakwa
Ngesikhathi sokubhalisa okukhethekile okubangelwa umcimbi ofanelekayo, ungajoyina umshuwalense womlingani wakho noma ngokufanayo. Kodwa-ke, phawula ukuthi isimo esichazwe ngenhla (uma abaqashi bomshado banezinkathi zokubhalisa ezivulekile phakathi nohlelo lokuqala ngonyaka wokuqala) akubangeli isikhathi sokubhalisa esikhethekile.
Uma uphonsa ukuphawula kwakho ngesikhathi sokubhalisa okuvulekile, futhi oshade naye unezikhathi zokubhalisa ezivulekile kamuva, ukulahlekelwa kwakho kokusabalalisa akusho ukuthi kuyisenzakalo esifanelekayo, ngoba kwakunokuzithandela-kunokuba kulahlekelwe ukuzithandela.
Ukwengeza, uma unenhlelo lokunakekelwa ephethwe (njenge-PPO noma i-HMO) futhi usebenzisa inethiwekhi yomhlinzeki , ungakwazi ukushintsha izinhlelo zempilo uma uhambisa emphakathini ohlukile futhi awusasenkonzweni yenethiwekhi yasendulo yakho plan.
Ukunquma ukuthi yiluphi uhlelo olusekelwe kuJobe oluzosiza kakhulu
Nakuba kungakuthatha isikhathi, sebenzisa izinombolo ukuze ubone ukuthi kunengqondo kuwo wonke amalungu omndeni wakho ukuba ahlale ohlelweni lwezempilo olufanayo. Ungakwazi ukugcina imali ngokuthola ukwaziswa okuhlukile kwezempilo kwamanye amalungu omndeni. Ngokwesibonelo:
UDon noBarbara
UDon S., oneminyaka engu-46 ubudala, nomkakhe uBarbara S., oneminyaka engu-44 ubudala, bobabili banenkinga yomshwalense wezempilo ngokusebenzisa abaqashi babo. Banomsebenzi womndeni ngoDon, ohlanganisa ukubhalwa kwezingane zabo ezimbili, abaneminyaka engu-10 no-14. Don unamandla ngokweqile futhi uthayipha u-2 wesifo sikashukela, i-cholesterol ephakeme, nomfutho wegazi ophezulu; usebenzisa izinsiza eziningi zokunakekelwa kwezempilo. UBarbara kanye nezingane zisesimweni esihle kakhulu futhi zidinga kuphela ukuhlolwa kokujwayelekile eminyakeni edlule.
Ngenxa yezinkinga zezempilo zikaDoni, banesihlelo sempilo yomndeni esinqunyiwe esincane esinezikhwama eziphezulu kakhulu. Umndeni ungakwazi ukugcina imali ngokuthi uDon agcine uhlelo oluphansi lokubambisa ngomqashi wakhe futhi abe noBarbara akhethe uhlelo lomndeni oludonswe kakhulu ngaye kanye nabantwana ngokusebenzisa umqashi wakhe.
Kodwa lokhu ngeke kube yisinqumo esihle ngaso sonke isikhathi, ngoba kuncike ekubambeni okukhulu ukuthi umqashi ngamunye uzimisele ukumboza kangakanani. Ngokusho kokuhlaziywa kwe-Kaiser Family Foundation, umqashi ojwayelekile ohlinzeka ngezinzuzo zezempilo ukhokha cishe amaphesenti angu-70 ezinkampanini zemali yomndeni. Kodwa abanye abaqashi bafaka isandla kuphela kuma-premium kubasebenzi babo, hhayi emalungwini omndeni abengeziwe ohlelweni. Ngakho ukuze unqume ukuthi umndeni wakho kufanele uhlanganiswe ngaphansi kwepulani elilodwa noma usebenzise kokubili, kuzodingeka ukwazi ukuthi uzodinga ukufaka isandla esingakanani kuma-premium ngaphansi kokukhethwa kukho.
UMaria noJorge
UMaria G., oneminyaka engu-32, nomyeni wakhe uJorge G., oneminyaka engu-33 ubudala, bobabili basebenze isikhathi esigcwele futhi ngamunye unomshwalense wezempilo onikezwe abaqashi bawo. Zombili izinkampani zinezikhathi zokubhalisa ezivulekile kusukela maphakathi no-Okthoba phakathi noNovemba.
NgoSeptemba, uMaria wabeletha umfana, isenzakalo esifanele esabekezela ukuba bangeze umntwana, uJorge, Jr. kwenye yezinhlelo zabo zomshuwalense wezempilo. Kodwa-ke, ukwengeza umuntu othembekile kunoma yikuphi uhlelo kushintshela ukukhishwa komshuwalense kusuka kumsebenzi-kuphela uma kutholakala emndenini noma ukuhlinzekwa kwabasebenzi-kanye nabantwana (kuye ngokuthi izigaba eziqashiwe umqashi azisebenzisayo), okukhulisa kakhulu amaprimiyamu wenyanga.
Njengoba kubhekene nokwanda kwama $ 250 njalo ngenyanga kusuka kumqashi, lo mbhangqwana ubheke izinketho zabo. Enye indlela ukulinda kuze kufike ukubhaliswa okuvulekile futhi ufake wonke amalungu omndeni ohlelweni lwezempilo olulodwa kusuka kumqashi oyedwa. Lokhu kungase kuphelelwe ukugcina imali yabo, ikakhulukazi uma umqashi kaMaria esevele ekhukhumeze ukukhokhela kuze kube "amaphrimiamu" omndeni ngokungezwa kukaJorge, Jr. Uma kunjalo, u-Jorge, uSr. angeke akhulise amaphrimiyamu (ama-premiums ukwandisa, noma kunjalo, uma i-premium kaMaria okwamanje ihlelwe kubasebenzi-kanye nezingane, njengoba enezela uJorge, Sr. ezokhulisa ama-premium ezingeni eliphakeme lomndeni).
Enye indlela ukuthenga inqubomgomo yemakethe ngayinye yengane. Kuncike ekutheni abaqashi bakhokhela kangakanani ukungeza abaxhomekile, kungase kugcine kungabizi kakhulu ukuthenga inqubomgomo ehlukile yengane. Lokhu akunakwenzeka ukuba kube njalo uma umndeni unengane engaphezu kweyodwa, kodwa-ke, njengoba izinhlelo ezinkulu ezixhaswe ngumqashi ngokuvamile zikhokhisa intengo efanayo yomntwana oyedwa noma izingane eziningi, kanti izinhlelo zomakethe ngamunye zizokhokhisa i-premium ehlukile yengane ngayinye umndeni, kuze kube ngaphezu kwezintathu (ezingaphezu kwezingane ezintathu emndenini owodwa oneminyaka engaphansi kwengu-21, ayikho iphrimium eyengeziwe emakethe ngayinye).
Qonda i-Glitch yomndeni
Uma ucabangela uhlelo lomakethe oyedwa noma lamalungu omndeni, ngaphezu kokushicilelwa kumqashi komunye noma amanye amalungu omndeni, qaphela ukuthi uhlelo lokuthola uhlelo oluxhaswe ngumqashi luzophazamisa ukufaneleka kwamalungu omndeni uxhasomali lwe-premium emakethe ngayinye.
Kubantu abathengisa ukuthengiswa komakethe ngamunye, ukuxhaswa kwe-premium kuyatholakala ku-ACA exchange in state ngayinye, kuye ngokuthi ngenzuzo. Kodwa ngisho noma imali engenayo yomndeni wakho ikuvumela ukuthi uthole imvume, ukufinyelela kwakho kumqashi oxhaswe ngumqashi udlala indima futhi. Uma uhlelo oluphansi oluxhaswe ngumqashi luyatholakala emndenini wakho futhi izindleko zokumboza nje isisebenzi sithathwa njengabizi (hhayi amaphesenti angaphezu kuka-9,56 yenani lemali engenayo yomndeni ngo-2018), nanoma yimuphi omunye amalungu omndeni afanelekile ukungezwa Uhlelo oluxhaswe ngumqashi (kungakhathaliseki ukuthi luzobiza malini ama-premium ukuze abangeze ohlelweni) abafanelekile ukuthola izinsizakalo ze-premium ekushintsheni. Lokhu kubizwa ngokuthi i- glitch yomndeni , futhi kubalulekile ukukhumbula engqondweni yakho uma uthola izinombolo ukuze ubone ukuthi amanye amalunga omndeni angase abe ngcono nakwezinye izimakethe ezimakethe esikhundleni sokuqashwa okuxhaswe ngumqashi.
Ukuqhathaniswa kwabashadile
Ngaphansi koMthetho Wokunakekelwa Onganakekelwayo, abaqashi abakhulu kudingeka bahlinzekele ukuhlinzekwa kwabasebenzi besikhathi esigcwele nalabo abaxhomeke kubasebenzi. Kodwa akudingeki ukuba banikeze ukuxhaswa kwabashadile bomsebenzi. Abaningi abaqashi baye baqhubeka nokunikeza ukwaziswa kwabashadile kwabasebenzi, kodwa abanye baye baqaphela ukuthi abashadile abavumelekile ukuba babhalise ukuthi banokutholakala kubanikazi babo, futhi amanye amafemu manje engeza inkokhelo uma abashadile bezisebenzi bakhetha ukungezwa kwabashade babo 'uhlela lapho futhi bengakhetha ukungena ngemvume nezinhlelo zabaqashi babo.
Ukuqhubeka nokucindezela izindaba, amaphesenti angu-10 abaqashi abanikeza izinzuzo zomshuwalense wezempilo inikeza isinxephezelo esengeziwe kubasebenzi babo uma benqabela uhlelo oluxhaswe ngumqashi futhi kunalokho bakhethe ukubhalisa ohlelweni lwabo abashade nabo. Ngakho-ke abanye abaqashi bathatha izinyathelo ezisebenzayo zokunciphisa inani labashadile ababhalisela izinhlelo zabo, kuyilapho abanye abaqashi bethatha izinyathelo ezisebenzayo ukuze bakhuthaze abasebenzi babo ukuba babhalisele ukuxhaswa komlingani wabo kunokuba bahlele uhlelo lwabo oluxhaswe ngumqashi.
Ngakho-ke, cabanga ngoBob noSue, abashadile futhi ngamunye unomsebenzi oqashiwe ngumqashi otholakala kumqashi wabo. Bobabili abaqashi basebenzisa izindleko zokuqasha umlingani lapho oshade naye enenkinga yakhe yomshuwalense oxhaswe ngumqashi. Uma uBob ethatha isinqumo sokujoyina iSue ohlelweni lwezempilo lomqashi wakhe, umqashi wakhe uzongeza ngokukhokhwa kwemali-ngaphezu kwe-premium-ngoba u-Bob angakhetha esikhundleni sokuba ngumqashi wakhe.
Kungase kube nomqondo ozwakalayo ukwengeza umlingani wakho ohlelweni lomqashi wakho uma ubheka kuzo zonke iziguquko, kodwa uzofuna ukuqonda ukuthi umqashi wakho unakho yini ukukhokhela umlingani wakho womshado womshado owenqaba umqashi wakhe futhi ubhalise ohlelweni lomlingani esikhundleni salokho.
Ukucabangela okukhethekile Uma une HDHP
Uma wena noma umngane wakho womshado unenketho yeHSA ye-HSA- ephakeme ehloniphekile yezempilo plan (HDHP) emsebenzini, kuzodingeka uqaphele imigomo yokuba nelungu elilodwa lomndeni ohlelweni oluhambisana naphezu kokukodwa.
Uma ilunga lomndeni elilodwa lithengiswa ngaphansi kwe-HDHP, inani ongabamba iqhaza kwi-HSA liphansi kunalokho kungaba ngabe ngabe amalungu amabili noma ngaphezulu omndeni anikezwa ngaphansi kwe-HDHP. Kodwa ngakolunye uhlangothi, i-deductible kwi-HDHP ivame ukuphindwa kabili phezulu uma unemibiko yomndeni (ngokubhekisele kokushicilelwa komuntu oyedwa kuphela), futhi wonke umndeni owehliswayo kufanele uhlangane ngaphambi kokuba noma yikuphi amalungu omndeni afaneleke ukuthola izinzuzo zokuthunyelwa ngemuva (nge-caveat okungenayo ilungu lomndeni elilodwa elingadingeka ukuba lithole ngaphezulu kwezindleko ezingaphandle kwe-pocket konyaka kunomkhawulo ngamunye ongaphandle kwe-pocket owasungulwa uhulumeni wesifundazwe walo nyaka; ngo-2018, kungu- $ 7,350).
Ngakho-ke uma unayo noma ucabangela ukufakwa kwe-HDHP kanye neminikelo ye-HSA, uzofuna ukugcina lezi zici engqondweni uma unquma ukuthi umndeni wonke kufanele ube kuhlelo olulodwa, noma kumacebo ahlukene.
> Imithombo:
> Cornell Law School, Legal Information Institute. 29 CFR 2590.701-6 - Izinkathi zokubhalisa ezikhethekile.
> Isevisi yangaphakathi yeNgeniso. Inqubo Yokuthola Imali 2017-36 .
> Kaiser Family Foundation. Izinzuzo zezempilo zomqashi 2016 Ukufingqa kokuthola. Septemba
> Kaiser Family Foundation. Izinzuzo zezempilo zomqashi 2017 Ukufingqa kokuthola. September 2017.
> I-Society for Human Resource Management. Iminyaka engu-2017 ehambisana no-2018 ye-HSA Yokunikezela. May 2017.