Ukwabelana ngezindleko kubhekisela ekutheni wena nomkampani wakho wezinkampani zempilo bobabili bakhokhela ingxenye yezindleko zakho zezokwelapha phakathi nonyaka. Umshwalense wakho wezempilo ufuna ukuthi ukhokhe ingxenye yezindleko zezindleko zakho zokunakekelwa kwezempilo ukuze uvimbele ukusetshenziswa kakhulu kwezinsizakalo zezempilo, futhi ukugcina ama-premium yomshuwalense wezempilo kuhlolwa (nakuba umqondo wezokukhushulwa ngamaphesenti angu-100 ungase uzwakale ukhulu, kungase kuholele kubantu abafuna ukwelashwa kaningi, kanti ama-premium ayengeke avele).
Amafomu avamile kakhulu okwabelana ngezindleko yi- deductibles , i- copayments , ne- coinsurance . Izinkokhelo zenyanga zonke ozikhokhayo ukuze uthole ukukhokhelwa komshuwalense wezempilo azibhekwa njengendlela yokwabelana ngezindleko.
Ukwabelana ngezindleko kusindisa imali yakho yenkampani yomshuwalense wezempilo ngezindlela ezimbili. Okokuqala, ukhokha ingxenye yesikweletu; njengoba uhlanganyela izindleko nabo, bakhokha kancane. Okwesibili, njengoba kufanele ukhokhe ingxenye yalomthethosivivinywa, kungenzeka ukuthi uzofuna ukunakekelwa kuphela uma udinga ngempela.
I-Cost-Sharing & Out-Of-Pocket Maximum
Ngenxa yokuthi ukwabelana ngezindleko kungabiza uma unayo izindleko ezinkulu zezokwelapha, zonke izinhlelo zezempilo (ngaphandle uma zizalwa kakhulu noma zizukulu ) ezidinga ukwabelana ngezindleko futhi zinokuphuma okungaphezulu kwe-pocket okufaka i-cap ukuthi ingakanani ukwabelana ngezindleko unesibopho sonyaka ngamunye (kule ngxoxo, zonke izinombolo zibhekisela ku-cap ngaphandle kwezindleko ze-pocket ngokucabanga ukuthi uthola ukunakekelwa ngaphakathi kwenethiwekhi yakho yomshuwalense wezempilo; uma uya ngaphandle kwenethiwekhi, ukuphuma ngaphandle kwepokhethi ukuphakama kuzoba ngaphezulu, noma kwezinye izimo, okungenamkhawulo).
Ngaphambi kuka-2014, bekungekho imithethonqubo elawula ukuthi izinga eliphezulu lezempilo elingaphandle kwe-pocket lingabe liyiqiniso ngempela, ezinye izinhlelo azizange zithinte izindleko ze-pocket nhlobo, nakuba lokho kwakungavamile. Kodwa uMthetho Wokunakekelwa Onganakekelwayo ushintshile ukuthi, futhi izinhlelo ezintsha zezempilo azikwazi ukuba ne-out-of-pocket esiphezulu ngaphezu kwezingu-$ 6,850-kumuntu oyedwa-ngo-2016 (lelo cap elingaphezulu liya ku-$ 7,150 ngo-2017).
Ngaphezu kwalokho, kusukela ngo-2016 , umuntu oyedwa angakwazi ukukhokha imali engaphezulu kwezindleko ezingaphandle kwe-out-of-pocket esiphezulu kulowo nyaka, noma ngabe uhlanganiswe ngaphansi kohlelo lomndeni esikhundleni wecebo lomuntu ngamunye.
Ngemuva kokuba ukhokhe ngokwanele ekudonsheni kwamakhokhelo, ukukhokhelwa kwama-copayments, nokuqinisekiswa kwemali ukuze ufinyelele ekuphumeni kwepokhethi, uhlelo lwakho lwezempilo luyimisa okwesikhashana ukwabelana ngezindleko zakho futhi lithatha amaphesenti angu-100 akhokhelwa ngemali ekhokhwayo yonke unyaka, ekucabangeni qhubeka nokusebenzisa izibhedlela ezingaphakathi nohlelo nodokotela.
Ukwabelana Ngezindleko kanye noMthetho Wokunakekelwa Onganakusiza
I-Care Affordable Act yenza inani elibalulekile lokunakekelwa kwezempilo okuvimbela ekunikezeni izindleko. Lokhu kusho izinto ezinjengama-mammograms afanelekayo ubudala, ukuhlolwa kwe-cholesterol, nemithi eminingi yokugoma ayikho ngaphansi kwe-deductible, i-copayments, noma i-coinsurance.
I-ACA iphinde idale insizakalo yokwabelana ngezindleko ukuze isebenzise umshwalense wakho wezempilo okungabizi kakhulu uma unomholo ophansi. Insizakalo yokwabelana ngezindleko inciphisa inani olikhokhayo kuma-deductibles, ama-copays, kanye nokuqinisekiswa kwezimali njalo ngesikhathi usebenzisa umshuwalense wakho. Izinsizakalo zokwabelana ngezindleko zifakwe ngokuzenzakalelayo ezinhlelweni zesiliva ekushintsheni uma imali yakho engenayo ingadluli amaphesenti angu-250 ezingeni lobuphofu (ngo-2017, umkhawulo ongenayo engenayo ukuze ufanelekele ukunikezwa ngezinkokhelo zezindleko ungamaRandi angu-29,700 kumuntu oyedwa $ 60,750 emndenini wezine).
Kuthiwani ngezinto ezingabheki umshuwalense?
Izindleko zokwabelana ngezindleko kanye nezindleko zangaphandle zisetshenziswa ngezikhathi ezithile, kodwa abantu bavame ukusebenzisa "ngaphandle kwepokhethi" ukuchaza noma yiziphi izindleko zezokwelapha abazikhokhela zona, kungakhathaliseki ukuthi ukwelashwa kuhlanganiswe nhlobo ngumshuwalense wezempilo . Kodwa uma ukwelashwa kungahlanganiswa nhlobo, inani oyisebenzisayo alithathwa njengokwabelana ngezindleko ngaphansi kwepulani lakho, futhi ngeke libalwe ekuphumeni kweplanethi yakho.
Isibonelo, izinqubo zezimonyo ezifana ne-liposuction ngokuvamile azihlanganiswa nomshuwalense wezempilo, ngakho-ke uma uthola ukwelashwa okunjalo, kuzodingeka ukhokhele ngokwakho.
Ngokufanayo kuyafana nokunakekelwa kwamazinyo omdala, ngaphandle uma unenqubomgomo yomshuwalense wamazinyo ehlukile. Nakuba ungase ucabange ngalezi zindleko ngokuthi "ngaphandle kwepokhethi" (futhi empeleni, ziphuma ephaketheni lakho), imali oyisebenzisayo ayibala kuhlelo lwakho lwezempilo olungaphandle kwepokhethi, futhi kwakubheka ukwabiwa kwezimali ngaphansi kwecebo lakho.
Ngenxa yokuthi ukwabelana ngezindleko kuyahluka kakhulu kusuka kwelinye uhlelo lomshwalense wezempilo kwenye, uzofuna ukuqinisekisa ukuthi uyaqonda imininingwane yesiphakamiso sakho ngaphambi kokuthi usebenzise ukusebenzisa kwakho, ukuze imali oyikhokhele ukwelashwa kuza njengamangalisa.