Uhlelo olufanelekile lwezempilo lweDeductible Plan

Ukwenza Umshuwalense Wezempilo Unganakwa Ne-HDHP

Eminyakeni embalwa eyedlule kusukela ohlelweni oluphezulu olufanelekile lwezempilo (HDHP) lwasayinwa ngomthetho ngo-2003 njengengxenye yomthetho weMedricare Modernization Act, uye yasiza izigidi zabantu baseMelika ukuba zikhokhele izinyanga zamakhomishana zenyanga zemishwalense yezempilo. Inhloso yokuqala ye-HDHP kwakungenxa yokunciphisa izindleko zokunakekelwa kwempilo ngokuxosha amalunga okuhlela ukuhlaziya izinqumo zabo zokunakekelwa kwezempilo ngenkathi ukwenza amaphrimiumshuwalense angabizi kakhulu kubo bonke abantu.

I-HDHP efanelekile yizinhlelo ezihlangabezana nezidingo zamalungu apulani futhi ukusebenzisa uhlelo lokulondoloza impilo noma i-akhawunti yokubuyiselwa kwezempilo ukusiza ukwelula amadola wezempilo ngaphezulu. Abanye abagxeki bakholelwa ukuthi izinhlelo zokunakekelwa kwezempilo eziphakeme kakhulu zilimaza abathengi ngoba azikhokheli ngokugcwele imali ekhishwe minyaka yonke ngaphambi kokuba umnyaka wezinhlelo uphele, ngakho-ke bathola ukufinyelelwa okunciphile kuze kube yilapho.

Kodwa-ke, iningi labaqashi linikeza ukukhethwa kwezinhlelo zokunakekelwa kwempilo emithathu, kanti i-HDHP ngokuvamile yizinhlelo ezikhethiwe, ngaphandle kwama-HMO kanye nezinketho ezikhethiwe zokunikela.

Izinhlelo ze-HDHP zisebenza kanjani?

Abaqashi bangakhetha uhlobo lwe-HDHP olunikezwa abasebenzi. I-HDHP ingavumela kuphela ukusakazwa kwe-inthanethi, okufana ne-HMO, noma kuvumela ukukhishwa kwe-out-of-network, okufana ne-POS noma i-PPO plan. Uma uhlelo lunezinzuzo eziku-inethiwekhi kuphela, amalunga akakwazi ukuphuma ngaphandle kwenethiwekhi uma kutholakala ukukhishwa kwezimali.

Ukuze uthole uhlelo oluvumela kokubili izinzuzo ezingaphandle nangaphandle, amalungu ngokuvamile athola izinzuzo ezingcono ngokuhlala ku-inethiwekhi. Zonke izinzuzo ezingenayo kanye nezinsizakalo ezinikezwa ngecebo le-HDHP, kufaka phakathi ukuthengiswa kwezidakamizwa zemithi uma kuhlinzekwa, kumele kufake isicelo sokuthi kutholakale.

Eziningi, kodwa hhayi zonke, izinhlelo ze-HDHP empeleni zizokwelapha udokotela wokuzivikela wokuvimbela futhi oyinhloko ukuvakashelwa kwe-copayment encane, nakuba lokhu kungadingekile.

Izinhlelo ze-HDHP azihloselwe ukumboza izindleko zokuqala zokunakekelwa kwezempilo njengezokuvimbela, izivakashi kanye nezivakashi. Esikhundleni salokho, zenzelwe ukumboza izenzakalo ezinzima ezifana nezifo ezingapheli noma ukuvakashelwa esibhedlela. Hlela abanikazi bezinqubomgomo kulindeleke ukuthi bakhokhele ihhovisi lezokwelapha kanye nezinkokhelo zesikhungo kuze kutholakale imali ekhishwayo. Uma amalungu efinyelela ekuphumeni okukhulu kwe-pocket, zonke izinsizakalo zezokwelapha zihlanganiswa ngaphandle kwezindleko.

Iyini iHDHP Deductible ne-Out-of-Pocket Maximum?

Amalungu epulani ye-HDHP anezindleko ezidlulile zonyaka zokudonswa kwezempilo, njengoba igama lepulani libonisa. I-deductible yinani lemali ilungu lepulani okumelwe lichithe kusuka ephaketheni lakhe ngaphambi kokuba kukhishwe ukukhokhelwa. Okungenani ingxenye yalesi samba esinqunyiwe ihlanganiswa yi-HSA noma i-HRA. Njengengxenye yomthetho, kunemingcele encane eyenziwe ngokukhipha imali ehlelwe njalo ngonyaka futhi ihlelelwe ukukhuphuka kwamanani emali, ngenhloso yokufaneleka njengeHDHP.

I- Internal Revenue Service (i-IRS) inquma umkhawulo wonyaka wezinhlelo zokunakekelwa kwempilo ezidonswe kakhulu.

I-Minimum Deductible:

• Umuntu ngamunye: 2016 - $ 1,300
• Umndeni: 2016 - $ 2,600

I-out-of-pocket esiphezulu yonyaka yiyona imali esiphezulu yelungu elikhokhela ngaphambi kokuba izinsizakalo zezokwelapha zinikezwe ngaphandle kwezindleko.

I-out-of-pocket esiphezulu yonyaka ihlanganisa amadokhumenti kanye nokukhokhelwa kwemali yezimali. Akufakiwe ku-out-of-pocket esiphezulu yizibonelelo eziphezulu zokuphila, okuvamile, okwezifiso nezokwezifiso (UCR), imingcele ekhona ekhona kanye nezidingo zangaphambi kokuqinisekiswa. Njengezinga le-HDHP elincishisiwe, ukukhishwa kwe-pocket okungaphezulu kushintshwe ngonyaka ngemali ye-inflation.

I-Out-of-Pocket Isikhulu:

• Umuntu ngamunye: 2016 - $ 6,550
• Umndeni: 2016 - $ 13,100

Kukhona ne-IRS evunyelwe ukubamba iqhaza labo abaneminyaka engu-55 noma ngaphezulu kwe $ 1,000 ngabanye.

Izinzuzo zabaqashi

Njengoba i-HDHPs inganikeli ngokugcwele impilo, inikeza amaphrimiyamu aphansi kakhulu kumthengi. Ngama-deductibles aphezulu, kucatshangwa ukuthi amalunga amalungiselelo aphansi kakhulu ukubona udokotela ngaphandle kokuthi kudingekile ngokwemithi. Kucatshangwa ukuthi iziguli zizofuna izinsizakalo zezempilo ezinikeza inani elihle le dollar.

Ukusebenzisa i-HSA noma iHRA nge-HDHP kungasiza izindleko ze-premium eziphansi, noma ufune izinketho zokuzikhokhela ngabanikezeli abanikeza izaphulelo. Uhlelo lwe-HDHP lusho ukuthi abasebenzi bakhokhela ingxenye yengonyama yesamba esinqunyiwe, ukugcina izindleko phansi wonke umuntu.