I-deductible ehlanganisiwe yinkqubo ehlanganisa amaducucbles omuntu ngamunye nomndeni kumgomo womshuwalense wempilo yomndeni. Izinhlelo zempilo ephakeme ezidonswa kakhulu zivame ukusebenzisa ama- deductibles ahlangene kunalokho kodwa ama-deductibles ahlanganisiwe ajwayelekile kuwo wonke amacebo lapho amalungu omndeni amaningi ebhaliswa ohlelweni ndawonye.
Uma uhlelo lwezempilo lufake amadokhumenti, lisho nje ukuthi ilungu elilodwa lomndeni akudingeki lihlangabezane nomndeni ogcwele owenzelwe imali eyothola izinzuzo emva kokudonswa.
Esikhundleni salokho, izinzuzo zomuntu emva kokudonswa kuzokwehliswa ngokushesha uma esehlangene nomuntu ngamunye, ngisho noma ngabe ukuhlinzekwa kulandela uhlelo lomndeni.
Kusukela ngo-2016, kunemithetho emisha efakazela izindleko eziphelele ezingaphandle kwe-pocket ukuthi noma ubani oyedwa ohlelweni angadingeka akhokhe izindleko ezingaphandle kwe-pocket ngonyaka. Ama- deductibles ahlangene namanje avunyelwe, kodwa zonke izinhlelo zomndeni kumele zibe nemigomo engaphandle ye-pocket. Lokhu kusho ukuthi ngo-2017, akukho ilungu lomndeni elilodwa elingadingeka ukukhokha okungaphezu kwamaRandi 7,150 ezindleko ezingaphandle kwe-pocket ngonyaka (in-network). Umkhawulo ongaphezulu ukhuphukela ku-$ 7,350 ngo-2018, nakuba izinhlelo eziningi zizoqhubeka zibe nemingcele ye-out-of-pocket engaphansi kwesilinganiso esivunyelwe umthetho.
Umsebenzi Owenziwe Deductible Ungasuswa Kanjani?
Nge-deductible ehlanganisiwe, uhlelo lwakho lwezempilo luzogcina ithrekhi yezinhlobo ezimbili ezahlukene zeminshuwalense yezempilo ezithintekayo kulungu ngalinye lomndeni: umuntu ngamunye owehliswayo kanye nomndeni onqunywe.
Umndeni odonswayo uvame ukuphindwe kabili ngaphezu komuntu ngamunye. Uma ilungu lomndeni linemali yokunakekelwa kwempilo, imali ekhokha kulowo muntu owenziwe ngabanye uyabhekiswa futhi emndenini owenziwe.
Kunezindlela ezimbili ezizokwehliswa kuzo, futhi uhlelo lwezempilo luzoqala ukukhokhela izindleko zokunakekelwa kwezempilo kwanoma yiluphi ilunga lomndeni:
- Ilungu lomndeni liye lathola izindleko zokunakekelwa kwempilo ngokwanele ayezihlangabezane nayo. Kulokhu, uhlelo lwezempilo luqala ukukhokhela izindleko zalowo muntu, kodwa hhayi izindleko zokunakekelwa kwezempilo kwamanye amalungu omndeni (ngaphandle uma kunakekelwa ukuthi kuhlanganiswe ngaphambi kokudonswa, njengokunakekelwa okuthile okuvimbela , noma ukwelashwa okuhlanganiswe ne- copay kunokubalwa kuya ekudonseni).
- Amalungu omndeni amaningana ahlukene akhokhele ngokwanele kumaducucbles ngamunye, ehlanganisiwe ndawonye, ukudilizwa komndeni kuye kwafinyelelwa. Kulokhu, uhlelo lwezempilo luqala ukukhokha izindleko zokunakekelwa kwezempilo kulo lonke umndeni, ngisho namalungu omndeni angazange akhokhe noma yikuphi ekuthengisweni komuntu ngamunye.
Imikhiqizo kanye Nezinzuzo Zomndeni Oxhunyiwe Deductible
Inkinga ngemindeni ehlanganisiwe ehlukaniswayo yukuthi yindlela kuphela ongayithola ngayo umndeni owehlisiwe futhi uthola ukukhokhelwa wonke umndeni ngokuhlanganisa izindleko zomuntu ngamunye ezidonswayo. (Lokhu akulona iqiniso nge-deductible eyonke.)
Ngokwe-deductible ehlanganisiwe, ngisho noma ilungu lomndeni elilodwa linezindleko zokunakekelwa kwempilo kakhulu, lezo zindleko zodwa ngeke zanele ukuhlangabezana nomndeni owenziwe.
Kungani? Ngoba ngokushesha nje lapho lowo muntu ehlangana nomuntu oyedwa osehlisiwe, izinzuzo zomshuwalense wezempilo zizoqala futhi ziqale ukukhokha. Kungenzeka ukuthi kumele akhokhe ezinye izinhlobo zokwabelana ngezindleko ezifana ne- copays noma i- coinsurance , kodwa lezo zindleko ezingaphandle kwezindleko azitholakali emndenini okhishiwe. Imali kuphela ekhokhelwe kumuntu ngamunye owehliswayo uyothola ukuhlonishwa kumndeni owenziwe. Njengoba i-deductible ngayinye encane kunomndeni ohlukanisiwe, umuntu oyedwa emndenini akakwazi ukwanelisa wonke umndeni ukuzitholela yena.
Lokho kusho ukuthi okungenani ilungu elinye lomndeni lizophinde lihlangabezane nomuntu ngamunye owehliswayo phakathi nenkathi yonyaka ukuze umndeni udonswe ukuze uhlangane nezinzuzo ezithathwe ngemuva kokukhawulwa kuwo onke amalunga omndeni.
Inzuzo yomndeni ohlanganisiwe owehlisiwe wukuthi izinzuzo zomshuwalense wezempilo emva kokudonswa zikhawulwa amalungu omndeni ogula kakhulu ngokushesha kunamanye amalungu omndeni. Ngenxa yokuthi la malungu omndeni ogulayo anezindleko zokunakekelwa kwempilo ephakeme, afinyelela ngokushesha ekunciphisweni kwabo kunokuba ngabe ngabe uhlelo lubekwe ngokugcwele, futhi umshuwalense wezempilo uqala ukukhokhela bonke noma eziningi zezindleko zabo zokunakekelwa kwezempilo. Kungenxa yesistimu ye-deductible ehlanganisiwe ukuthi izinzuzo zabo zomshuwalense ziqala futhi ziqale ukukhokha ngaphambi kokuba umndeni ususwe.
Izinguquko ezenze ukusebenza ngo-2016
Konke lokhu okungenhla kusasebenza, kodwa ngaphakathi kwemigomo emisha ukuthi akukho muntu oyedwa ongadingeka ukuba akhokhe ngaphezulu kwezindleko zangaphandle (in-network) kunesikhulu esingeke sikwazi ukuphuma esikhwameni salo nyaka. Kwakungu-$ 6,850 ngo-2016, i-$ 7,150 ngo-2017, kanye no-$ 7,350 ngo-2018.
Ngakho-ke, ngaphambi kuka-2016, kwakungenzeka ukuthi kube nehlelo lempilo elingazange libe ne-deductibles embedded noma ama-maximum e-out-of-pocket ahlanganisiwe. Ake sithi uhlelo lwalususwe umndeni wamaRandi ayi-10 000, bese kuthi amaphesenti angu-100 ahlinzekwe ngemuva kwalokho ( lolu hlobo lwendlela yokuhlela luvele luvame kwi-HDHPs ). Uma ngabe ilungu elilodwa lomndeni lithatha izindleko zezokwelapha phakathi nonyaka, ngabe kuzodingeka ukhokhe imali engu-R10 000 ngaphambi kokufakwa kwesikhangiso. Loluhlobo lwemiklamo yezinhlelo alisekho kuvunyelwe ngoba izindleko zokuphuma ngaphandle kwezimoto kuzodingeka zifakwe ku-$ 7,150 ngo-2017. Loluhlelo lungasenalo imali engama-dollar ayi-10 000, kodwa ngaphezu komuntu oyedwa kuzodingeka athole izindleko zezokwelapha ukuze afinyelele lokho okudonswe.
> Imithombo:
> UMnyango wezeMpilo kanye noHumana Services. Ukuvikelwa Kweziguli Nomthetho Wokunakekelwa Okungathintekiyo, Isaziso se-HHS Sokuhlomula Nezikhawulelo Zokukhokha zika-2015. February 2015.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Isivikelo Sokubekezela Nokunakekelwa Okunakekelwayo, Isaziso se-HHS Sokuhlomula Nezikhawulelo Zokukhokha Zonyaka ka-2018, Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi oluqhutshwa kanye nohlelo oluhlelekile . Disemba 2016.