Inkokhelo yomshuwalense wezempilo yikhokhwa yanyanga zonke ekhokhelwa inkampani yomshuwalense noma uhlelo lwezempilo lokuhlinzeka ngempilo. Ukuhlinzeka ngempilo kwezempilo kunamalungu amaningi noma ingxenye yezindleko zezinsiza ezihlobene nempilo ezifana nokuvakashelwa udokotela, ukuvakasha izihambi, iziqondiso kanye nemithi.
Ngamafuphi, i-premium yinkokhelo oyenzayo enkampanini yomshuwalense wezempilo ogcina ukusebenza ngokusebenza ngokugcwele.
Izinkokhelo ze-Premium zinosuku olufanele kanye nesikhathi somusa. Uma i-premium ingakhokhwa ngokugcwele ngesikhathi sokuphela kwesikhathi somusa, inkampani yomshuwalense wezempilo ingamisa noma ikhansele ukufakwa.
Ezinye izindleko zomshuwalense wezempilo zingabandakanya ama- deductibles , u- coinsurance , kanye nama- copayments . Lezi yimali oyikhokhela uma udinga ukwelashwa. Uma ungadingi noma yimaphi ukwelashwa, ngeke ukhokhe i-deductible, i-copays, noma i-coinsurance. Kodwa kufanele ukhokhe premium yakho njalo ngenyanga, kungakhathaliseki ukuthi usebenzisa umshwalense wakho wezempilo noma cha.
Ngubani obeka i-Premium Insurance Premium?
Uma uthola ukunakekelwa kwezempilo ngemisebenzi yakho, umqashi wakho uyokhokha ngokujwayelekile noma yonke inkokhelo yenyanga. Ngokuvamile, inkampani yakho izofuna ukuthi ukhokhe ingxenye ethile ye-premium yenyanga, ezokwehliswa kusuka ekukhokhweni kwakho. Bese bezohlanganisa konke okukhokhelwayo.
Ngokwenhlolovo yezinzuzo zomqashi ka-2016 kaKaiser Family Foundation, abaqashi bakhokhela isilinganiso sama-premium angu-82 abasebenzi abangabashadile, futhi isilinganiso samaphesenti angu-71 emishayisomali yomndeni, kubasebenzi abangeze amalungu omndeni ohlelweni.
Uma usebenza ngokweqile noma uthenge umshuwalense wakho wezempilo, wena njengomuntu unesibopho sokukhokha i-premium yenyanga nyanga nenyanga. Kodwa-ke, kusukela ngo-2014, uMthetho Wokunakekelwa Onganakekelwayo unikeze izikweletu zentela ye-premium (izinsizakalo) ezitholakalayo kubantu abathenga ukuthengwa ngabanye ngokushintshaniswa .
Ukuze ufanelekele izinsizakalo ze-premium, imali yakho engenayo ayikwazi ukudlula amaphesenti angu-400 wezinga lobuphofu elisemthethweni, futhi awukwazi ukuthola ukuthengwa okungabizi, okuphelele okuvela kumqashi wakho noma kumqashi womlingani wakho.
Amalungiselelo okushintshaniswa okuthengwa kusukela ngo-2014 ahambisana ne-ACA, kodwa izinsizakalo ze-premium azikwazi ukusetshenziselwa ukwehlisa izindleko zabo. Lokhu kungashintsha, noma kunjalo, uma umthetho we-American Health Care Act usungulwa .
Isibonelo se-Premium
Ake sithi uhlolisise amazinga okunakekelwa kwezempilo kanye nezinhlelo ukuze uthole uhlelo olungabizi futhi olufanele wena nabathandekayo bakho. Ngemuva kokucwaninga okuningi, ekugcineni ugcina ukukhetha uhlelo oluthile olubiza amaRandi angu-200 ngenyanga. Imali ekhokhwa njalo ngenyanga engu-$ 200 yi-premium yomshuwalense wezempilo. Ukuze zonke izinsizakalo zakho zezempilo zizuze ukusebenza, i-premium yomshuwalense wezempilo kumele ikhokhwe ngokugcwele njalo ngenyanga.
Uma ukhokha i-premium yakho ngokwakho, ibhilidi yakho yenyanga izofika ngqo kuwe. Uma umqashi wakho enikezela uhlelo lwe-inshuwalense yezempilo, ama-premium azokhokhwa kuhlelo lomshuwalense ngumqashi wakho (noma umqashi ungumuntu obhekene nesibambisensi, okuyinto evame ukuba ngumqashi omkhulu kakhulu), nakuba ingxenye ye-premium iyonke kungenzeka ukuthi iqoqwe kumsebenzi ngamunye ngokukhishwa kwe-payroll.
Uma unesipiliyoni sezempilo ngabanye ngokubambisana futhi bathola usizo lwemali ye-premium, insizakalo izokhokhwa uhulumeni, ngokuqondile enkampanini yakho yomshuwalense. Ibhalansi esele ye-premium izokhokhiswa kuwe, futhi kuzodingeka ukhokhe isabelo sakho ukuze ugcine ukufakwa kwakho kusebenza. Ngaphandle kwalokho, ungakhetha ukukhokha inani eligcwele le-premium ngokwakho inyanga ngayinye bese ucela imali yakho yokukhokhela imali ye-premium ekubuyiseni kwentela entwasahlobo elandelayo (lokhu akuyona inketho evamile, kodwa iyatholakala futhi ukukhetha kungokwakho).
Ama-Deductibles, ama-Copay, no-Coinsurance
Amaphrimiyamu asethelwa imali okufanele ikhokhwe ngenyanga.
Uma ama-premium akho asesikhathini, u-insured. Ukuthi u-insured, noma kunjalo, akusho ukuthi zonke izindleko zakho zezempilo zikhokhwa.
Ama-Deductibles . I-Deductibles, ngokusho kwe-Healthcare.gov, "imali oyikhokhayo yokuhlinzekwa ngezinsizakalo zokunakekelwa kwezempilo ngaphambi kokuba uhlelo lwakho lomshuwalense luqale ukukhokha. Ngokwe-$ 2,000 ekhishwe, isibonelo, ukhokhela izinsizakalo zokuqala ezikhokhelwa u-$ 2,000 ngokwakho. , uvame ukukhokhela kuphela ikhodi noma imali yokukhokhela izinsizakalo ezihlanganisiwe. " Izindleko zama-premium zivame ukuhlanganiswa nakancane kumadoladethi: uzokhokha ngaphezulu inqubomgomo yomshuwalense onokunciphisa okuncane, futhi ngokuphambene nalokho (inothi ukuthi izinhlelo ze-ACA ezivumelanisiwe, ezibandakanya izinhlelo ezixhaswe ngumqashi namasu omakethe ngamunye, zihlanganisa izinsizakalo ezithile zokuvimbela akukho izindleko kubhalise, ngisho noma i-deductible ingakafiki).
Izinkokhelo ze-Co . Ngisho noma inqubomgomo yakho yomshuwalense wezempilo ine-deductibles ephansi noma ayikho, cishe uzocelwa ukuthi ukhokhe imali ephansi kakhulu yokunakekelwa kwezempilo. Le mali ibizwa ngokuthi "ukukhokha ngokubambisana." Izinhlelo eziningi zihlanganisa kokubili ukukhokha kanye nokukhokha ngokuhlanganyela, ngokukhokha okusebenzayo okufaka izinto ezifana nokuvakashelwa kwehhovisi kanye nemigomo, kanti ukukhishwa kwesikweletu kusebenza ekliniki, emsebenzini webhulegi, ukuhlinzwa, njll. .
Coinsurance. I-Healthcare.gov ichaza ukuqinisekiswa kwemali ngendlela elandelayo: "iphesenti yezindleko zemisebenzi yokunakekelwa kwempilo oyikhokhayo (20%, isibonelo) emva kokukhokha imali enikezwe yona. Ake sithi imali yakho evunyelwe yomshuwalense wezempilo yesikhulu sokuvakasha i-$ 100 futhi imali yakho engu-20%. Uma ukhokhele imali yakho: Ukhokha u-20% we $ 100, noma i-$ 20. "
Ukunciphisa, ukukhokhelwa ngokubambisana, nokuqinisekiswa kwezimali kusetshenziselwa ukuphelelwa yisikhathi esiphezulu se-patient. I-out-of-pocket esiphezulu yonyaka yonke inani eliphakeme kakhulu noma eliphelele inani lenkampani yomshuwalense wezempilo idinga isiguli ukuba sizikhokhele ngokuqondene nezindleko eziphelele zokunakekelwa kwezempilo.
Uma usuqedile isiguli, ama-copayments, kanye ne-coinsurance ekhokhwa unyaka othile wengeze kuze kube sekuphumeni kokuphuma kwepokhethi, izidingo zokwabelana ngezindleko seziguli ziphelile kulowo nyaka. Ukulandela ukugcwaliseka kwe-out-of-pocket esiphezulu, uhlelo lwezempilo lube seluthatha zonke izindleko zokunakekelwa kwe-in-network okusele konyaka. Noma kunjalo, izinkokhelo kumele ziqhubeke zikhokhwa, njalo ngenyanga, ukuze zigcinwe.
> Imithombo:
> Kaiser Family Foundation, 2016 Ucwaningo lwezeMpilo lwaBasebenzi bezeMpilo. Ngo-September 14, 2016.