Iyini Umshuwalense WezeMpilo?
Umshuwalense wezeMpilo wenkampani iyinqubomgomo yomshuwalense wengeze eklanyelwe ukwandisa umshwalense wakho wezempilo ophelele , omkhulu-wezempilo. Kuyasiza ukugcwalisa izikhala ekuvikelweni kwezezimali ozithola kumshwalense wakho wezempilo omkhulu.
Izinhlobo zoMshuwalense wezeMpilo ezengeziwe
Kunezinhlobo eziningi zemishuwalense yezempilo eyengeziwe, futhi uhlobo ngalunye lusebenza ngokuhlukile.
Ezinye zezinhlobo zomshuwalense wempilo ejwayelekile kakhulu yilezi:
Izicabango Ezicacile Ngezifo
Izinhlelo zempilo yomshuwalense wezempilo ezihambisana nezifo zikhokha isamba semali emva kokuba uthola ukuthi unesifo esithile. Isibonelo, umshuwalense womdlavuza uzokhokhelwa uma uthola ukuthi unomdlavuza obala ohlwini lomgomo.
Ngokungafani nomshwalense wezempilo noma izinhlelo ze- Medigap , uhlelo oluthize isifo luveza inzuzo yemali ngokuqondile kuwe, hhayi kumhlinzeki wakho wezempilo. Ungayisebenzisa noma yini oyifisayo futhi awuphoqelekile ukuyisebenzisa ukuze ukhokhe izikweletu zezokwelapha. Abantu abaningi basebenzisa lokhu ukusiza ngezindleko ezihambisana nokugula njengama-copays, ama-deductibles, nezokuthutha nezindleko zokufaka lapho beya esikhungweni seyunivesithi noma esikhungweni sokunakekelwa kwezingane eziphakeme kakhulu. Kodwa-ke, uma ufuna ukuyisebenzisa ukuthenga i-Harley Davidson esikhundleni, ukukhetha kungokwakho.
Izinhlelo eziphathelene nezifo ziwuhlobo lomshwalense okhokhelwayo okhokhelwayo, okusho inani lemali umshwalense ozokhokhwa ngalo; ayifani ngokususelwa ngobukhulu bezinkokhelo zakho zezokwelapha.
Uma inqubomgomo yakho ithi uthola u-$ 20,000 uma uthola ukuthi unomdlavuza, ukhokhelwe u-$ 20,000 ukuze uthole ukuthi ngabe izikweletu zakho zezokwelapha ziyi $ 500 noma $ 500,000 (nakuba izinqubomgomo ezithile eziphathelene nezifo ngokuvamile zikhokha kuphela umdlavuza uma zihlasela, okusho ukuthi izikweletu kungaba okuphawulekayo; i-basal cell carcinoma isuswe ngesilonda sokugula futhi ayidingi ukwelashwa okungeke kuholele ekukhokheni ukukhokha kusuka ohlelweni lwakho lokugula olubucayi).
Umshwalense Wokugula Okubalulekile
Umshuwalense wokugula obalulekile ufana nezinhlelo ezithile eziphathelene nesifo ngaphandle kokuthi ngokuvamile zihlanganisa izinhlobo eziningi zezifo. Isibonelo, inqubomgomo yokubhekelela yokugula ebaluleke kakhulu ingakhokha inzuzo yemali uma uthola ukuthi unesifo senhliziyo, isifo, isifo somdlavuza, isifo se-renal sokuphela, noma udinga ukufakelwa komzimba. Izifo ezithile ezihlanganisiwe ziyahlukahluka kusuka kumgomo kuya kwenqubomgomo. Izinkokhelo zenqubomgomo yokugula ezibucayi zingase zibe ngaphezu kwama-premium ngenzuzo efanayo efana nenqubomgomo ethize ngenxa yesifo ngoba umshuwalense uthola ingozi enkulu ngenxa yenani lezifo inqubomgomo ezokhokhelwa yona.
Umshuwalense Wokukhokhela Isibhedlela
Umshwalense Wesikhwama Sezibhedlela ukhokhela inani elilinganiselwe uma usubhedlela. Ezinye izinhlelo zikhokhisa imali yokuhlala esibhedlela uma ngabe usebhedlela izinsuku ezimbili noma izinsuku ezingu-20. Ezinye izinhlelo zikhokha isilinganiso sansuku zonke ngosuku oluthathwa esibhedlela, isibonelo, $ 100 ngosuku. Kunoma yikuphi, inani elikhokhwayo libekwe ngumgomo wakho womshuwalense wesibonelelo esibhedlela; akuhlangene nalokho okungakanani imali yesibhedlela sakho esibhedlela. Ungasebenzisa imali noma ngabe ubona kufanelekile.
Ezinye izinhlelo zokukhokhela izibhedlela zihlanganisa nezinzuzo zokuhlinza iziguli.
Lokhu kungabi isamba semali esincane esincane kakhulu kunani lemali elikhokhelwa esibhedlela esibhedlela.
Umshwalense Wengozi
Umshuwalense wengozi ukubuyisela izindleko zezokwelapha ngaphandle kwe-pocket ezihlobene nengozi noma ukulimala. Ezimweni eziningi, kuzodingeka ukhombise izikweletu zezokwelapha, amarisidi, kanye / noma incazelo yezinzuzo ezivela kumshuwalense wakho wezempilo ukuze uqinisekise izindleko zezokwelapha ezingaphandle kwezokwelapha.
Izindleko ze-Accident ngokuvamile zinomvuzo ophansi ($ 5,000 ovamile), njengoba zenzelwe ukumboza imali yakho kanye nenkokhelo yakho uma ulimazekile futhi udinga ukuthola usizo lwezokwelapha.
Kodwa ngokuvamile zizokubuyisela kuphela inani langempela lezindleko ozenzile, uma izindleko zakho ziphansi kunanzuzo enkulu. Isibonelo, uma unemali engama-$ 6,000 ekhishwa umshwalense wakho wezempilo bese ugcina uzinquma futhi udinga ukugxila okubiza amaRandi angu-1,500, ukwesekwa kwengozi kuzokubuyisela kuphela imali engu-$ 1,500 (ngaphansi kokuncishiswa okuncane, uma uhlelo lwezingozi ludedelwa), ngisho uma inzuzo enkulu ingu $ 5,000.
Ukufa Nokungalahlwa Kwephutha
Ukufa ngengozi okuyingxenye yomgomo we-AD & D ukhokhela inzuzo enkulu kumuntu oye wabiza ngokuthi ungumzuzi uma ubulawa engozini. Kungenzeka kube nezinye izizathu ezifana nokuthi kwenzeka ingozi ngenkathi wenza okuthile okungemthetho.
Inzuzo yokufa kwenqubomgomo ye-AD & D ihluke kumshuwalense wokuphila ngoba imbangela yokufa kumele ihlobaniswe ngokuqondile nengozi yomgomo we-AD & D, kodwa inqubomgomo yesikhathi esizayo iyokhokha inzuzo noma ukufa kungenxa yengozi, umdlavuza, ukuhlaselwa yinhliziyo, noma into efana ne-Ebola. Uma unomshuwalense wokuphila kanye nomshwalense we-AD & D futhi ushona engozini, umzuzi wakho uthola izinkokhelo kuzo zombili izinqubomgomo.
Ukuqedwa kwenqubomgomo ye-AD & D kuhlawulela inzuzo enkulu uma kwenzeka ingozi ikushiya ngaphandle kwesilungu, ingxenye yendima, noma ishiya imbopho. Ukufunda inqubomgomo ye-AD & D kuwumsebenzi omubi kakhulu njengoba ubhala inani elithile lama dollar lokulahlekelwa umlenze owodwa, imilenze emibili, unyawo olulodwa, izinyawo ezimbili, ingalo eyodwa, izingalo ezimbili, iso elilodwa, kokubili amehlo, nokunye.
I-sum-sum eyakhokhwa yinkambiso ye-AD & D ingasetshenziswa nganoma iyiphi indlela wena (noma umzuzi wakho uma kwenzeka ushona) ukhetha.
Umshuwalense wamazinyo
Ngezinye izikhathi umshuwalense we-Dental uthathwa njengomhlobo womshuwalense wezempilo owengeziwe. Ihlawula izinzuzo ngqo kumamazinyo wakho wamazinyo uma uthola izinsizakalo zamazinyo ezihlanganisiwe. Izinhlelo eziningi zamazinyo zilawulwa izinhlelo zokunakekelwa futhi zidinga ukuthi usebenzise abahlinzeki abasenethiwekhi kanye nohlelo. Abanye bahlinzekela ukunakekelwa kwamazinyo okungaphandle kwe-inthanethi , kepha isabelo sakho semali ekhokhwayo sizoba ngaphezulu.
Njengomshwalense wezempilo ophelele, ungase ube nezindleko zokukhokha, ukukhokha imali, noma u-coinsurance ngecebo lamazinyo. Ngaphezu kwalokho, izinhlelo eziningi zamazinyo zinezilinganiso ezingaphezulu zonyaka. Isibonelo, inqubomgomo yamazinyo ingasho ukuthi izinzuzo zilinganiselwa ku-$ 2,000 ngonyaka. Uma kunjalo, uhlelo luyeka ukukhokha uma lukhokhelwe u-$ 2,000 kumaqondana nokunakekelwa kwamazinyo wakho ngonyaka. Uzobe unesibopho kunoma yiziphi izinkokhelo zamazinyo ezishiywe zingakhokhwa ngemuva kokuthi ufinyelele umkhawulo wokukhokha wonyaka wakho omkhulu wenqubomgomo.
I-Care Affordable Care Act ekhethwe amazinyo njengenzuzo ebalulekile yezempilo, kodwa ukutholakala kwamazinyo kubantu abadala akugunyaziwe. Ezinye izinkampani zomshuwalense wezempilo manje zifaka ukufakwa kwamazinyo ezinsana ezenzweni zabo ezinkambisweni zabo, kanti ezinye ziqondisa amalungu ukuba athenge ukuvikelwa kwamazinyo okuhlukene kwabantwana.
Umbono Womshuwalense
Umshuwalense wombono uphawula izinzuzo zombono wecebo eliphelele lempilo. Iningi lemishanguzo yempilo yomshuwalense wezempilo kumele ikhokhele ukunakekelwa okuhlobene nokuxilongwa nokuphathwa kwezifo zamehlo afana ne-glaucoma noma i-macular degeneration, kanye nokulimala iso. Kodwa-ke, izinhlelo eziningi zomshuwalense wezempilo ngeke zikhokhelwe ukulungiswa kombono.
Umshuwalense wombono owanzelayo uthatha isikhwama lapha futhi usiza ukukhokhela izibuko, amalensi okuxhumana, kanye nezivivinyo zokuqhathaniswa ezidingekayo ukuze zibalulwe ngendlela efanele. Amanye amaphuzu omshwalense wombono nawo asiza ukukhokhela ukuhlinzwa kokulungisa umbono njengokufana ne- LASIK .
Njengokuqashwa kwamazinyo, ukunakekelwa kombono wezingane kuyimfuneko ebalulekile yezempilo ngaphansi koMthetho Wokunakekelwa Onganakekelwayo, kodwa ukumbozwa kombono omdala akuyona.
I-Medigap
I-Medigap iyiqembu lezinhlelo zempilo ezongezwayo ezenzelwe ngqo labo abane-United States Medicare Part A kanye ne- Medicare Part B inshuwalense. Abantu abangenawo i-US Medicare abafanelekile ukuthenga uhlelo lwe-Medigap.
I-Medigap icebo lisiza abahlomuli be-Medicare bakhokhela izinto ezinjengama- deductibles , ama- copays , u- coinsurance , nokukhathazeka okuphuthumayo ngenkathi beya phesheya. Ngaphandle kokuthola usizo lokunakekelwa kokuphuthumayo kwamanye amazwe, izinzuzo ze-Medigap ziboshwe ekusebenziseni umshuwalense wakho we-Medicare. I-Medigap ikhokha ezinye zezindleko zokwabelana ngokwezindleko ezidingekayo emva kokuthi uMedarele akhokhe imali yakhe yezindleko zezokwelapha. Isibonelo, i-Medigap ingakhokhela i-deductible yakho uma usubhedlela.
I-Caveat Emptor Ne-Assuranceal Health Insurance
Umshuwalense wezempilo owengeziwe awukhiphi esikhundleni somshwalense wezempilo ophelele njenge- Obamacare , uhlelo lwezempilo lweqembu oluthola kumqashi wakho, i-Medicare, i-Medicaid, noma i-Tricare. Kusho njengokungeza kwiplanethi yezempilo evamile, hhayi njengengxenye esikhundleni esisodwa.
Umshuwalense wezeMpilo ehambisanayo awuhlanganisi zonke izinzuzo ezibalulekile zezempilo, futhi awubhekwa njengokubambisana okubalulekile, ngakho ngeke ukwanelise isidingo soMthetho Wokunakekelwa Okungenakusiza ukuze ube nomshuwalense wezempilo futhi ngeke kukusize ugweme inhlawulo yentela yokungabi nasiqinisekiso (inothi ukuthi nakuba inkokhelo yentela ye-GOP eyenziwe ngasekupheleni kuka-2017 ekugcineni isuse isigwebo somuntu ngamunye, esingenzeki kuze kube ngo-2019; abantu abangaqinisekisiwe ngo-2018 bazophinde bakhokhele inhlawulo uma befaka intela zabo ekuqaleni kuka-2019, ngaphandle uma bafanele ukuthola ukukhululwa ).
Ezinye izinhlobo zomshuwalense wezempilo zingathinta izinzuzo zentela ozijabulelayo ngokuba ne- Akhawunti Yokulondoloza Impilo ehambisana neHlelo Eliphezulu lezeMpilo eDeductible. Uma une-HSA, hlola umhleli wakho wentela ngaphambi kokuthenga noma yiluphi olunye uhlobo lomshwalense wezempilo ukuze uqiniseke ukuthi uyaqonda umthelela ongabawo kwi-HSA yakho. Ungafunda kabanzi ngalokhu ku-Publication ye-IRS 969.
Amalungiselelo ezempilo ezengeziwe angeke alawulwe njengamapulani omshwalense wezempilo. Ukuvikelwa komthengi kufakwe inqubomgomo yomshuwalense wezempilo eyengeziwe kungashintsha kuye ngokuthi uthenga inqubomgomo ngomsebenzi wakho, noma njengomuntu ngamunye. Izinhlelo eziningi zomshuwalense wezempilo angeke zibe nokuvikeleka okufanayo komthengi osetshenziselwa umshwalense wezempilo ophelele.
Isibonelo, ezinye izinhlobo zomshuwalense wezempilo ezongezwayo azibandakanyi izimo ezikhona ngaphambili noma zinezinkathi zokulinda ngaphambi kokubhalwa kwemibandela ekhona ngaphambili. Kukhona ngokuvamile imali yokukhokha yonyaka yonke noma yokuphila, futhi ijwayele ukuba ibe ngaphansi kakhulu kunani eligcwele elidingekayo ukuze ukuphatha izifo ezihlukahlukene noma ukulimala (yingakho lezi zinhlelo kufanele zibhekele omunye umshuwalense wezempilo, kunokuba kube nomunye umshuwalense wezempilo). Ukubhekwa akuqinisekisiwe okuvuselelwa, okusho ukuthi ngeke ukwazi ukubhalisa unyaka nonyaka. Ezinye izinhlobo zezinqubomgomo zingase zingabi nesiqiniseko esiqinisekisiwe , okusho ukuthi umshuwalense angenqaba ukukuqinisekisa uma ucabanga ukuthi ubeka ingozi kakhulu.
Okokugcina, izinkampani zomshuwalense zivunyelwe ukwenza inzuzo emikhulu kumshuwalense wezempilo owengeziwe kunezo zomshuwalense wezempilo ophelele. Izinhlelo eziningi zezempilo ezithengisiwe e-United States kumele zisebenzise imali engama-80-85% yemali abayiqoqa kuma-premium ekukhokheleni ukunakekelwa kwezempilo noma imisebenzi yokuqinisekisa ikhwalithi, ishiye kuphela ama-15-20% ngezindleko zokuphatha, ukukhangisa, nezinzuzo. Amalungiselelo e-Supplemental awalawulwa ngaleyo ndlela. Bangase bachithe ingxenye encane kakhulu yemali ethathwe njengama-premium ekukhokheleni izinzuzo, beshiya ingxenye enkulu yamakhomishana e-agent, ukukhangisa, ukuphatha okuphezulu, kanye nezinzuzo.
> Imithombo:
> Cornell Law School, Legal Information Institute. 45 CFR 148.220, Izinzuzo ezingeziwe.
> Jost, uThim. Izindaba zezeMpilo. Ukusetjenziswa kweNtuthuko yezeMpilo: Iinzuzo ezingekho ngaphandle kweMtsetfo wokugcina. Ngo-Septhemba 29, 2014.