Inani le-Actuarial isilinganiso sephesenti yezindleko zokunakekelwa kwezempilo ezikhokhwa yipulani lomshuwalense wezempilo. Kubaluleke ngokukhethekile ngoba uMthetho Wokunakekelwa Ongenakusiza wawusungulwa, ngoba ukulandela i-ACA kudinga ukuthi izinhlelo zezempilo zeqembu ngalinye nezincane zibe ngaphansi kwamaphesenti athile ngokuvumelana nokubaluleka kwazo.
Umqondo ngokwawo ulula ngokwanele: Uhlelo lwezempilo lukhokhela amaphesenti athile ezindleko zokunakekelwa kwezempilo, futhi uhlele amalungu akhokhe konke okunye.
Kodwa kubalulekile ukuqonda ukuthi inani le-actuarial alibalwanga ngesisekelo sokubhalisa. Esikhundleni salokho, kubalwa ngaphesheya kwezinga elijwayelekile (inani elijwayelekile lisuselwa kudatha elihlanganiswe ezingaphezu kwezigidi ezingu-54 ezibhalisa kuzo zombili amapulani omshuwalense wezempilo). Ngamanye amazwi, uma uhlelo oluthile lunenani lama-70 elingu-actuarial, lizokhokha amaphesenti angama-70 ezindleko zokunakekelwa kwempilo ejwayelekile kuwo wonke umuntu ojwayelekile. Kodwa, ngeke ukhokhele amaphesenti angama-70 wezindleko zokubhalisa ngabanye .
Uhlelo olulodwa, Inani elilodwa lokubuyekeza, Imiphumela ehluke kakhulu kumalungu ngamunye
Njengesibonelo, cabanga ngohlelo olungama-$ 2,500 okudonswayo kanye no-$ 5,000 ngaphandle kwe-pocket esiphezulu, okufaka kuphela amasevisi okuvimbela ngaphambi kokudonswa kwe-deductible. Ake sithi uBob unomsebenzi ngaphansi kwalolu hlelo, futhi ukunakekelwa kwakhe kwezempilo kuphela phakathi nonyaka kungukuhamba kokunakekelwa okuphuthumayo ngokubambelela okuncane lapho elula isandla sakhe. Ukuze kube lula, sizosho ukuthi isikhwama sokunakekelwa okuphuthumayo singama $ 1,500.
Lokhu kungaphansi kwe-deductible yakhe, ngakho-ke uBob kuzodingeka akhokhe lonke i-$ 1,500. Ngamanye amazwi, ukhokhelwe amaphesenti angu-100 ezindleko zokunakekela impilo yakhe ngonyaka-kanti umshwalense wakhe ukhokhele amaphesenti angu-0 (ecabanga ukuthi akatholanga ukunakekelwa kokuvikela).
Manje ake sicabangele u-Alan, onomsebenzi ngaphansi kwepulani elifanayo. U-Alan uthola ukuthi unomdlavuza ngoFebhuwari, futhi uhlasela uhlelo lokuphuma ngaphandle kwepulani ngenyanga efanayo.
Ekupheleni konyaka, uhlelo lomshuwalense wezempilo luka-Alan lukhokhelwe u-$ 240,000, futhi u-Alan ukhokhelwe u-$ 5,000 (ukuphuma kwakhe kwepokhethi). Esimweni sika-Alan, umshwalensi wakhe ukhokhele amaphesenti angu-98 ezindleko zakhe, kanti u-Alan ukhokhele amaphesenti amabili nje kuphela.
Kodwa u-Alan noBob bobabili banecebo elifanayo, futhi ngalesi sibonelo, sizosho ukuthi uhlelo lwesiliva , okusho ukuthi linenani elilinganiselwayo elingamaphesenti angama-70. Ukubheka kulokhu kubonakala, kusobala ukuthi ngesinye isisekelo, kunokuhluka okubanzi ngokwemaphesenti ezindleko zombhalisi ngamunye ezihlanganiswa uhlelo lwezempilo, njengoba kuncike ekunakekeleni ukunakekelwa kwezempilo komuntu ngamunye ngonyaka. Kodwa jikelele, kunanoma yibaphi abantu abajwayelekile, uhlelo uBob no-Alan abakhuphule ngalo isilinganiso samaphesenti angaba ngu-70.
I-ACA ne-Actuarial Value
Ngaphansi kwemithethonqubo ye-ACA, wonke amasha (okusebenza ngoJanuwari 2014 noma kamuva) amapulani eqembu ngalinye namancane adingwa ukuba afinyelele kwelinye lezinsimbi ezine zensimbi, ezihlelwe ngezigaba ngokusekelwe kokubaluleka kwamanje (inothi ukuthi izinhlelo eziyingozi , ezingangena ensimbi izigaba ezingeni, nazo zivunyelwe emakethe ngayinye, kodwa zingathengwa kuphela ngabantu abangaphansi kweminyaka engama-30, noma labo abanenkinga yokukhululwa kanzima kumsebenzi ngamunye we-ACA ).
Izinga lensimbi lenziwe njengethusi, isiliva, igolide ne-platinum. Izinhlelo ze-bronze zinenani elilinganiselwa ku-60%, izinhlelo zesiliva ezingamaphesenti angama-70, izinhlelo zegolide ezenza amaphesenti angu-80, futhi amaplanethi amapulani angu-90. Ngenxa yokuthi kunzima kubaqhakambisi ukuklama izinhlelo ezinenani eliqondile le-actuarial, i-ACA ivumela u-de minimus uhla lwe- +/- 2. Lokhu kusho ukuthi, isibonelo, ukuthi uhlelo lwesiliva lungaba nenani elilinganiselwe noma yikuphi kusuka kwamaphesenti angu-68 kuya kumaphesenti angu-72, futhi uhlelo lwegolide lungaba nenani le-actuarial phakathi kwama-78% namaphesenti angu-82.
Ngo-December 2016, i-HHS yaqedela umthetho ovumela izinhlelo zethusi (isilinganiso samanje cishe amaphesenti angu-60) ukuba sibe ne-minimus range ye--2 / + 5, kusukela ngo-2018 (ngamanye amazwi, phakathi kwamaphesenti angu-58 namaphesenti angu-65).
Ngaleso sikhathi ngo-Ephreli 2017, i-HHS iphelelise imithethonqubo yokuqiniswa kwemakethe evumela ukuthi i-de minimis ibanga lande kuze kube yi -4 / + 2 ngezinhlelo zesiliva, igolide, ne-platinum, futhi iqhubeke nokwandisa ibanga elisha le-minimus ngezinhlelo zethusi -4 / + 5 .
Ngaphansi kwemithetho emisha, ukusebenza ngo-2018:
- Izinhlelo ze-bronze zingaba nezimiso ezikhona phakathi kwamaphesenti angu-56 namaphesenti angu-65.
- Izinhlelo zeSiliva zingaba nezimiso ezikhona phakathi kwama-66% namaphesenti angu-72.
- Izinhlelo zegolide zingaba nezimiso ezikhona phakathi kwamaphesenti angu-76 namaphesenti angu-82.
- Izinhlelo zePlatinum zingaba nemigomo yamanje phakathi kuka-86% namaphesenti angu-92.
Ukubala I-Value Actuarial: Kuphela Ku-EHB Ye-Inethiwekhi Kubalwa
Uhulumeni wesifunda udale i-actuarial value calculator-okuvuselelwa minyaka yonke-ukuthi abatshuwalense basebenzise ukunquma ukubaluleka kwamaphuzu abawaphakamisela unyaka olandelayo (nansi incazelo ye-2017 actuarial valu calculator).
Izinsizakalo kuphela ezibhekwa njengezinzuzo zezempilo ezibalulekile (EHBs) zibalwe ekubalweni. Abashuwalense bayavunyelwa ukumboza izinsizakalo ezengeziwe, kodwa lokho akubalanga ngokubaluleka kokuhlelwa kwecebo.
Ngaphezu kwalokho, ukubalwa kwamanani okusebenza okusebenzayo kusebenza kuphela ekusakazweni kwe-inthanethi, ngakho-ke ukuhlinzeka ngaphandle kwenethiwekhi ukuthi ihlinzeka-uma ikhona-ayiyona ingxenye yokunqunywa kokusebenza kwe-plan.
Iqembu Elikhulu Nezinhlelo Zokuzimela Ziba Nemithetho Ehlukile
I-actuarial value yezinga lezimfuneko zensimbi ku-ACA isebenzela amapulani eqembu ngalinye namancane. Kodwa iqembu elikhulu lihlela ( emazweni amaningi, lokho kusho abasebenzi abangaphezu kuka-50, kodwa emazweni ambalwa, kusho abasebenzi abangaphezu kuka-100 ) kanye nezinhlelo zokuzikhokhela zinemithetho ehlukile.
Ngeqembu elikhulu nezinhlelo ezizimele, inhloso yukuthi uhlelo luhlinzeka ngezinga elincane, elichazwa ngokuthi lihlanganisa okungenani amaphesenti angu-60 ezindleko zezinga elijwayelekile. Kunenani elilinganiselwe lokubala elifana ne-actuarial valu calculator elisetshenziselwa izinhlelo zeqembu ngalinye namancane, kepha ababalalayo banemibono eminingana eyinhloko .
Iqembu elikhulu nezinhlelo zokuzikhokhela akudingeki zihambisane nezigaba zensimbi zensimbi ezisebenza emakethe yeqembu ngalinye nelincane, ngakho-ke kungaba khona ukuhlukahluka okuningi kusuka kwelinye icebo kuya kwelinye eqenjini elikhulu kanye nemakethe yokuzimela. Lezo zinhlelo kufanele zibheke okungenani amaphesenti angama-60 ezindleko ezijwayelekile zesilinganiso esiphezulu, kodwa zingakwazi ukumboza noma yiziphi amaphesenti ezindleko ezingaphezu kwaleli zinga, ngaphandle kokubumba izinzuzo zazo ukuze zivumelane phakathi kwezingxenye ezichazwe kahle.
Amacebo Ngenani Elilinganayo Eliqhathaniswayo Ngokuvamile Unamaphuzu Ahlukene Okuhlela
I-actuarial value calculator ivumela ama-insurers ukuba ahlele izinhlelo eziyingqayizivele ukuthi zonke ziphelile ngaphakathi kwe-actuarial value range. Yingakho ungabheka izinhlelo eziyishumi zesiliva ezahlukene futhi ubone izinhlelo ezingu-10 ezahluke kakhulu, ezinama- deductibles amaningi , ama- copays, kanye ne-coinsurance .
Ukushintshaniswa komshuwalense wezempilo waseCalifornia kudinga ukuthi wonke amapulani amaqembu ngabanye namancane aqiniswe, okusho ukuthi ngaphakathi kwezinga elithile lensimbi, zonke izinhlelo ezikhona zifana ngokufanayo nezinzuzo ezivela kwelinye icebo ukuya kwelinye, nakuba bonke banezinethiwekhi ezahlukene zomhlinzeki . Kunezinye izifunda eziningana ezidinga izinhlelo ezithile eziqinisekisiwe kodwa futhi zivumela izinhlelo ezingezona eziqinisekisiwe, futhi i-HealthCare.gov yaqala izinhlelo ezifanele (ngaphezu kwamacebo angekho amisiwe) ngo-2017.
Kodwa kuhlelwa ukuhlelwa kwezinto akuyona into efanayo nokulinganisa okwamanje. Uma isimo noma ukushintshaniswa kudinga ukuthi izinhlelo zibekwe ngendlela efanele, zonke izinhlelo ezikhona ziyoba nezinzuzo ezifanayo ngqo kunoma yiziphi izimethrikhi ezisetshenziselwa ukulinganisa (ukudonsa imali, ukukopishwa kwemali, ukukhokhelwa kwemali, ukukhishwa kwemali ephaketheni, njll). Lokhu kuqhathaniswa nezidingo ze-actuarial value, okuvumela ukuhluka okuphawulekayo ngokwemigomo yokuhlelwa kwezinhlelo kanye nezinzuzo, ngisho nangezinhlelo ezinenani elifanayo le-actuarial.
Ukuhluka phakathi kwezinhlelo ezingeni elifanayo lezensimbi kungenzeka ngisho nangabe izinhlelo ziba nenani elifanayo le-actuarial (isib. Amapulani amabili anezinhlobonhlobo zokuhlomula ezahlukene zingaba nenani elilinganayo lama-80%). Kodwa uhla lwe-minimus luvumelekile ezingeni ngalinye lensimbi-nokwandiswa kobubanzi be-2018-ngokuqhubekayo kwandisa ukuhluka okuvunyelwe ngaphakathi kwezinga elilodwa lessimbi. Ngonyaka we-2018, uhlelo olunezinzuzo ezingu-56 lwamaphesenti angu-56 lunguhlelo lwebhusi, futhi kanjalo uhlelo oluhambisana namanani angu-65. Ngokusobala, lezo zinhlelo ezimbili zizoba nemiklamo enhle kakhulu, kepha zombili zizobhekwa njengezinhlelo zethusi.
> Imithombo:
> I-American Academy of Actuaries I-MV / AV Practice Note Note Group Group > Inani elincane kanye nokuQinisekisa kweZenani eliPhezulu ngaphansi koMthetho Wokunakekelwa Onganakekelwayo . April 2014.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Isikhathi sokugcina se-Final 2017 se-Actuarial Value Calculator . NgoJanuwari 21, 2016.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Ukuvikelwa kwesineke kanye noMthetho Wokunakekelwa Kwezinkinga, Ukuqiniswa Kwemakethe . April 2017
> I-Federal Register. Ukuvikelwa kwesineke kanye noMthetho Wokunakekelwa Kwezinkinga; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe futhi oluhlelekile. NgoDisemba 22, 2016.