I-HDHP vs. PPO: Uyintoni umahluko?

Inkampani

Ukukhetha esona sicwangciso silungileyo sokhathalelo lwempilo kunokuba yinkqubo enobuqhetseba. Unokuba nemibuzo engaphezulu kuneempendulo emva kokuphonononga izibonelelo zakho zempilo xa uqala umsebenzi omtsha okanye ngexesha lokubhalisa okuvulekileyo.

Izicwangciso eziphakamileyo zempilo (HDHP) kunye nezicwangciso zombutho ezikhethiweyo (PPO) zizinto ezimbini eziqhelekileyo abaqeshi ababonelela ngazo kwi-inshurensi yezempilo. Enye yezi zicwangciso ayisoloko ingcono kunenye. Xa kuziwa ekukhetheni phakathi kwesicwangciso se-HDHP ngokuchasene nesicwangciso se-PPO, impendulo yesona sicwangciso silungileyo yahlukile kumntu ngamnye. Inokwahluka unyaka nonyaka kumntu ngokuxhomekeke kwiimeko zakhe.

Ukuthelekisa ukugubungela kunye neendleko ze-HDHPs kunye nee-PPO kunokukunceda wenze ukhetho olungcono.

HDHP vs. PPO

Isicwangciso esiphakamileyo sokutsalwa luhlobo lweinshurensi yezempilo enezinto ezitsaliweyo eziphezulu kodwa iipremiyamu ezisezantsi. Uya kuhlawula imali encinci inyanga nenyanga kodwa ube neendleko ezingaphezulu kweepokotho zeendleko zonyango ngaphambi kokuba i-inshurensi iqale.

UKUYA umbutho womboneleli okhethiweyo (PPO) Uhlobo lwesicwangciso olunezitsali ezisezantsi kodwa iipremiyamu eziphezulu zenyanga. Uya kuhlawula imali eninzi inyanga nenyanga kodwa ube neendleko ezingaphantsi kweepokotho zeenkonzo zonyango kwaye unokukwazi ukufikelela kuluhlu olubanzi lweenkonzo okanye ababoneleli.

Ii-HDHP zihlala zixhamla abathengi abasempilweni abangalindelanga ukuba bafune unyango oluninzi kunyaka, kwaye izibonelelo zibandakanya iipremiyamu ezisezantsi zenyanga, uyachaza uSusan Beaton, owayekade eyi-VP yeeNkonzo zoMboneleli, uLawulo loKhathalelo, kunye nomngcipheko eBlue Cross naseBlue Shield yaseNebraska .

I-PPO, ngakumbi enye enesitsali esisezantsi, inokuhambelana nabo balindele ukutyelelwa rhoqo ngugqirha kunye nemigqaliselo ngenxa yento efana nesifo esinganyangekiyo, utshilo uBeaton.

Iinkonzo kunye neengxaki ze-HDHP kunye ne-HSA

I-HDHP iluncedo kwabo bangalindelanga ukuba neendleko zonyango unyaka wonke. Ngokwesiqhelo, ii-HDHPs ziluncedo kubantu abancinci, abantu abangenazintsapho, kwaye abo basempilweni ngokubanzi. Gcina ukhumbula ukuba ngekhe ubenakho ukuhlawulwa ngedipozithi kutyelelo logqirha ngesicwangciso se-HDHP ude udibane nokutsalwa okuphezulu .

Qiniseka ukuba ubuza ukuba umqeshi wakho unikezela nge-HDHP ngeakhawunti yokonga iMpilo (HSA), ucebisa uBeaton. Xa ukhetha i-HDHP, unokukwazi ukukhetha ukusebenzisa i-HSA kunye negalelo lomqeshi. Ii-HSA ngamanye amaxesha azinikezelwa kwizicwangciso ze-PPO ezixhaswa ngumqeshi-kodwa, kungenjalo, unokukwazi ukusebenzisa iakhawunti yenkcitho eguqukayo ( FSA ) Ngeentlobo zesicwangciso se-PPO.

An HSA yi-akhawunti yokonga irhafu yangaphambi kokuba isetyenziswe njengendlela yokubhatala iindleko zonyango ezivunyiweyo. Imali ekule akhawunti yokonga iqengqeleka unyaka nonyaka; Nangona kunjalo, kukho unyaka max igalelo eyahlukileyo phakathi kwezicwangciso ezizodwa ($ 3,550) kunye nezicwangciso zosapho ($ 7,100).

I-HSA iluncedo ngakumbi kuba isebenzisa irhafu yangaphambi kwerhafu kwaye ifumana umvuzo ngaphandle kwerhafu. Ii-HSA zigubungela uluhlu lweendleko ezifanelekileyo, kubandakanya iinkonzo zonyango, umbono, ukhathalelo lwamazinyo, kunye nemigqaliselo. Imali yakho ye-HSA iza kuhlala nawe nokuba utshintsha izicwangciso okanye uhambisa imisebenzi. Banokwabelana nentsapho yakho.

Ukusetyenziswa kwee-HDHPs nee-HSAs kuya kusiba ngokuya ithandwa , ngakumbi kubantu abancinci. Ngelixa i-HSA isenokubonakala njengenzuzo enomdla, ezi akhawunti zogcino zingabandakanya imirhumo yolondolozo lwenyanga kunye nokusebenzisa ikhadi lakho lokuhlawula kwi-HSA kwikhemesti okanye kwiofisi kagqirha.

Ii-HSA zikwafuna ukuba uhlale ngaphezulu kweerekhodi zakho kwaye ungenise iirisithi zakho ukuze zamkelwe iindleko zonyango ezifanelekileyo. Amanye amabango awanakuhlawulwa ngumlawuli we-HSA ukuba ayizizo iindleko ezifanelekileyo. Jonga umlawuli wakho we-HSA ngaphambi kokuba uthenge izinto ezithandabuzekayo kwikhemesti okanye kwenye indawo.

Kwakhona, ukuba usebenzisa i-HSA yakho kwiindleko ezingafanelekanga ngaphambi kweminyaka engama-65, uya kujongana neerhafu kunye nezohlwayo ezingama-20%, ngokweenguqulelo Umthetho woKhathalelo ongenakufikeleleka (ACA). Abanye abantu bacinga nge-HSA njengengxowa-mali engxamisekileyo, kodwa ngezi ngqwalaselo, unokucinga ngenyameko malunga nendlela ojonga ngayo i-HSA.

Iinkonzo kunye neengozi zePPO

Ii-PPO zihlala ziba bhetele kwabo balindele ukuba neenkcitho zonyango ezingaphezulu kunyaka wonke. Ezi zicwangciso zihlala ziluncedo kubantu abadala, abo baneentsapho, kunye nabantu abaneemeko zempilo ezifuna unyango rhoqo.

Njengoko uneminyaka yobudala, udibana nemicimbi yezempilo, okanye uxhasa usapho, i-PPO inokuqala ukwenza ingqiqo. Ii-PPO zineeprimiyamu eziphezulu zenyanga zeinshurensi, kodwa zinokukunceda ugcine ixesha elide ukuba ufuna iinkonzo zokhathalelo lwempilo rhoqo. Ngokutyala imali kwi-inshurensi yakho yezempilo unyaka wonke, unokuba neendleko zonyango olugqithisiweyo kwi-inshurensi.

Ii-PPOs nazo ziza nezibonelelo zokuguquguquka. Kwisicwangciso se-PPO, unenkululeko yokukhetha ugqirha okanye isibhedlele osithandayo. Nokuba abekho kwinethiwekhi yakho, i-inshurensi yakho iya kuhlala inika ingxelo. Nge-PPO, ungabona ingcali okanye wenze inkqubo okanye uvavanyo lwenziwe ngaphandle kwemvume kugqirha wakho ophambili. Ukuba ubhetyebhetye kukhetho lwakho lokhathalelo lwempilo lubalulekile kuwe, isicwangciso se-PPO kunokuba ngcono kune-HDHP.

Sisiphi isicwangciso esifanelekileyo?

Ngoku siza kuqwalasela indlela ogqiba ngayo ukuba ingaba i-HDHP okanye isicwangciso se-PPO singangcono kuwe. Okokuqala, cinga ngale mibuzo ilandelayo:

• Uya kangaphi kwagqirha?
• Ngaba unempilo engapheliyo efuna unyango rhoqo?
• Ufuna kangaphi ukhathalelo olungxamisekileyo?
• Ngaba unalo utyando olucwangcisiweyo oluzayo?
• Ngaba ulindele umntwana kulo nyaka?
• Ngaba uyalixhasa iqabane lakho okanye iindleko zonyango zomntwana ngokunjalo?
• Kubaluleke kangakanani ukuba bhetyebhetye ekukhetheni ugqirha omthandayo?
• Kubaluleke kangakanani ukuba bhetyebhetye ekuboneni ingcali?

Ukuba uhlala umtyelela ugqirha, unesifo esinganyangekiyo, uhlala efuna ukhathalelo olungxamisekileyo, ucwangcise utyando, ulindele usana, uxhase iindleko zonyango zamalungu osapho amaninzi, okanye ukhathalele ubhetyebhetye, iPPO iya kuba ngcono kune-HDHP. Nangona kunjalo, ukuba akukho nanye okanye ezimbalwa kwezi zinto zibalulekile kuwe, uya kuba ulunge ngakumbi kwi-HDHP.

Qaphela: Izicwangciso ze-HDHP kunye ne-PPO ayisiyiyo kuphela i-inshurensi yakho yempilo. Kukwakho nemibutho yoLondolozo lwezeMpilo (HMO), Imibutho yababoneleli abakhethekileyo (EPO), kunye nezicwangciso zePoint of Service (POS).

Ezinxulumene: HMO vs. PPO

Emva koko, qiniseka ukuba uyawaqonda amagama aphambili ahambelana nayo nganye yezi izicwangciso zeinshurensi yezempilo .

• INkulumbuso : Uhlawula malini ngenyanga ukuba neinshurensi yezempilo.
• Ukutsalwa : Yimalini ekufuneka uyihlawule kwangaphambili ngonyaka kunyango. Nje ukuba udibane nokutsalwa kwakho, i-inshurensi yezempilo ikukhahlela.
• Umda wokuphuma epokothweni : Emva kokuchitha le mali ngonyaka ukhathalelo lonyango ngaphandle kweepokotho (kungabandakanywa iipremiyamu), i-inshurensi yakho iya kuhlawula i-100% yeendleko ezifanelekileyo.
• HSA: Iakhawunti yokonga impilo yangaphambi kwerhafu enokusetyenziswa ne-HDHP. Igalelo kwizicwangciso ze-HSA ziqengqeleka minyaka le.
• ICopay : Umrhumo othe tyaba owuhlawulela imigqaliselo, ukuhlolwa, kunye nezinye iinkonzo zokhathalelo lwempilo.
• UQinisekiso : Ipesenti yeendleko ozihlawulela iindleko zonyango emva kokuba udibene nokutsalwa kwakho.

HDHP vs. PPO sokubala

Ukuqonda le migaqo ingentla kunokukunceda uhambe ekubaleni ukuba uza kuhlawula malini kwi-inshurensi yezempilo. Xa uthatha isigqibo phakathi kwezi zimbini, kuya kufuneka uqikelele iindleko zonyango zakho zonyaka. Umntu osempilweni usenokungabi neendleko ezininzi eziqikelelweyo. Nangona kunjalo, kufuneka baqwalasele ukubanjwa komkhuhlane okanye ukonzakala.

Nje ukuba uqikelele iindleko zonyango, yongeza ipremiyamu yenyanga yesicwangciso ngasinye, kunye nemida yabo engaphandle kwepokotho. Ucinga ukuba usebenzisa unyango lwenethiwekhi, eli nani liya kuba lelona xabiso liphezulu lokuphuma epokothweni lonyaka.

Njengomzekelo, isicwangciso se-PPO sinokuhlawulisa i-1,250 yeedola kwi-premium yenyanga engama-600. Emva kokuphindaphinda i-premium yenyanga ngeenyanga ezili-12 (i-600 x 12 yeedola) kwaye ungeze i-deductible yeendleko zokuphuma epokothweni, oku kufikelela kwi- $ 8,450 iyonke ngonyaka, kungabandakanywa iipopay okanye i-coinsurance Nangona kunjalo, ubuninzi bepokothweni obuphezulu be izicwangciso zeqela Ngo-2020 yi- $ 8,150 yabantu kunye ne- $ 16,300 yeentsapho. Inkcitho yakho epokothweni inokulingana okanye ibe ngaphantsi kwalo mda.

I-HDHP inokuhlawulisa imali engama- $ 3,000 nge-premium yenyanga engama-400. Emva kokuphindaphinda ipremiyamu yenyanga ngeenyanga ezili-12 ($ 400 x 12) kunye nokudibanisa okutsalwayo kweendleko zokuphuma epokothweni, oku kufikelela kwi- $ 7,800 iyonke ngonyaka. Ngo-2020 , imida engaphandle kwe-HDHPs ayinakudlula i-6,900 yeedola kubantu okanye kwi-13,800 yeedola kwiintsapho. Ke ngoko, unokulindela ukuba iindleko zakho zokuphuma epokothweni zilingane okanye ngaphantsi komda wokuphuma epokothweni.

Kumzekelo wesibini, uhlawula i-200 engaphantsi kwinyanga nganye kwi-premium kwaye ugcine i-900 yeedola kwiindleko zonyaka, kungabandakanyi ii-copays okanye i-coinsurance.

Ukuba ufumanisa ukuba iindleko zokuphuma epokothweni ze-HDHP zingaphantsi kunokhetho lwe-PPO, kubonakala ngathi ukhetho oluhle iya kuba kukukhetha i-HDHP, utshilo uBeaton. Nangona kunjalo, ngaphambi kokwenza olu khetho, qiniseka ukuba uhlahlo-lwabiwo mali luyakwazi ukujongana nalo. Ngaba uya kuba nakho ukuhlawula i-250 yeedola kutyelelo lwe-ofisi ngomhla wokundwendwela kwakho, okanye i-800 yeedola kwigumbi likaxakeka, njalo njalo, de kube kudityanisiwe? Ukuba uhlahlo-lwabiwo mali lwakho alunandawo yokuhlawulela iindleko eziphezulu ngexesha lenkonzo, kuya kufuneka ucinge kabini ngaphambi kokukhetha isicwangciso se-HDHP.

Inokuba sengqiqweni ekuhambeni kwexesha ukukhetha isicwangciso se-PPO ngeprimiyamu ephezulu inyanga nenyanga kodwa ufumane ukhuselo olungaphezulu lweinshurensi. Oku kuyinyani ngakumbi kwabo ukubala kwabo kubonisa ukuba i-HDHP iya kuba neendleko ezingakumbi epokothweni okanye kwabo bangakulungelanga ukubheja ngokungabinazo iindleko zonyango ezingalindelekanga ezivela kunyaka wonke.

Ezinye izinto ekufuneka ziqwalaselwe

Ukukhetha isicwangciso seinshurensi yezempilo sisigqibo esizimeleyo esifuna ubunzima bezinto ezininzi, kubandakanya:

• Imeko yakho yempilo
• Impilo yosapho lwakho
• Ukukhetha ukuguquguquka kubanikezeli bezempilo okanye iingcali
• Imeko yakho yezemali
• Nokuba ungahlawula ngaphezulu kwangaphambili ngeeprimiyamu zokugubungela ngakumbi
• Zingaphi iimali ze-HSA ongazisebenzisa
• Inkcitho epokothweni epokothweni kumgaqo-nkqubo ngamnye

Ukuba usafuna uncedo ekukhetheni isicwangciso, nxibelelana nommeli weinshurensi yezempilo okanye abasebenzi beHR kwinkampani yakho. Unethuba lokuhlengahlengisa isicwangciso sakho rhoqo ngonyaka ngexesha lobhaliso oluvulekileyo okanye kwimeko yeenguqu zobomi. Iziganeko zobomi ezifanelekileyo zibandakanya umtshato okanye uqhawulo-mtshato, ukuzalwa komntwana, njl.

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