I-HDHP vs. PPO: Uyini umehluko?

Inkampani

Ukukhetha uhlelo oluhle kakhulu lokunakekelwa kwezempilo kungaba inqubo ekhohlisayo. Ungaba nemibuzo eminingi kunezimpendulo ngemuva kokubuyekeza izinzuzo zakho zezempilo lapho uqala umsebenzi omusha noma ngesikhathi sokubhaliswa okuvulekile.

Izinhlelo zezempilo ezidonswa kakhulu (i-HDHP) nezinhlelo ezithandwayo zenhlangano yabahlinzeki (i-PPO) yizinhlelo ezimbili ezivamile abaqashi abanikeza ngazo umshuwalense wezempilo. Olunye lwalezi zinhlelo aluhlali lungcono ngaso sonke isikhathi kunolunye. Uma kukhulunywa ngokukhetha phakathi kohlelo lwe-HDHP vs. PPO, impendulo yohlelo oluhle kakhulu yehluka kumuntu ngamunye. Kungahluka ngisho unyaka nonyaka kumuntu ngokuya ngezimo zakhe.

Ukuqhathanisa ukumbozwa nezindleko zama-HDHP nama-PPOs kungakusiza wenze ukukhetha okungcono.

I-HDHP vs. PPO

Uhlelo oluphezulu oludonswayo luhlobo lomshuwalense wezempilo onama-deductibles aphezulu kepha ama-premium aphansi. Uzokhokha imali encane inyanga ngayinye kepha ube nezindleko ezingaphezulu kwezikhokhelwayo zezindleko zokwelashwa ngaphambi kokuqala kokutholakala komshuwalense.

TO inhlangano yabahlinzeki ekhethwayo (PPO) uhlobo lohlelo olunokudonswa okuphansi kepha amaphrimiyamu aphezulu enyanga. Uzokhokha imali ethe xaxa inyanga ngayinye kepha unezindleko eziphansi ezikhwameni zezinsizakalo zezokwelapha futhi ungakwazi ukufinyelela uhla olubanzi lwezinsizakalo noma abahlinzeki.

Ama-HDHP ajwayele ukuzuzisa abathengi abanempilo abalindele ukuthi badinge ukunakekelwa kakhulu onyakeni, futhi izinzuzo zibandakanya amaphrimiyamu aphansi nyangazonke, kuchaza uSusan Beaton, owayeyi-VP ye-Provider Services, i-Care Management, kanye neRisk eBlue Cross naseBlue Shield yaseNebraska .

I-PPO, ikakhulukazi ene-deductible ephansi, ingahle ivumelane nalabo abalindele ukuvakashelwa odokotela kaningi kanye nemiyalelo ngenxa yento efana nesimo esingalapheki, kusho uBeaton.

Izinzuzo nezingozi ze-HDHP nge-HSA

I-HDHP ilusizo kulabo abangacabangi ukuthi bazoba nezindleko eziningi zokwelashwa unyaka wonke. Imvamisa, ama-HDHP alusizo kubantu abasha, abantu abangenayo imindeni, nalabo abanempilo ejwayelekile. Khumbula ukuthi ungahle ungabi nayo imali ekhokhwayo ekuvakasheni kukadokotela ngohlelo lwe-HDHP uze uhlangane nokudonswa kwemali ephezulu .

Qiniseka ukuthi ubuza ukuthi ngabe umqashi wakho unikeza i-HDHP nge-Health Savings Account (HSA), weluleka uBeaton. Uma ukhetha i-HDHP, ungakwazi futhi ukukhetha ukusebenzisa i-HSA ngomnikelo womqashi. Ama-HSA kwesinye isikhathi awanikelwa ngezinhlelo ze-PPO ezixhaswe umqashi - kodwa, kungenjalo, ungakwazi ukusebenzisa i-akhawunti yemali eguquguqukayo ( I-FSA ) nezinhlobo zohlelo lwe-PPO.

An I-HSA yi-akhawunti yokonga yangaphambi kwentela esetshenziswa njengendlela yokukhokha yezindleko zezokwelapha ezivunyiwe. Imali ekule akhawunti yokonga iqhubeka unyaka nonyaka; nokho, kukhona unyaka nonyaka umnikelo omkhulu lokho kwehluka phakathi kwezinhlelo ngazinye ($ 3,550) nezinhlelo zomndeni ($ 7,100).

I-HSA inenzuzo ikakhulukazi ngoba isebenzisa amadola angaphambi kwentela futhi ithola imali engenayo yentela. Ama-HSA ahlanganisa izindleko ezahlukahlukene ezifanelekile, kufaka phakathi izinsizakalo zezokwelapha, umbono, ukunakekelwa kwamazinyo nemiyalo. Izimali zakho ze-HSA zizohlala kuwe noma ngabe ushintsha izinhlelo noma uhambisa imisebenzi. Zingabiwa futhi nomndeni wakho.

Ukusetshenziswa kwama-HDHP nama-HSA kuyaqala kuya ngokuya kuduma , ikakhulukazi kubantu abasha. Ngenkathi i-HSA ingabonakala njengenzuzo ekhangayo, lawa ma-akhawunti okonga angabandakanya imali yesondlo sanyanga zonke nokusebenzisa ikhadi lakho le-HSA debit ekhemisi noma ehhovisi likadokotela.

Ama-HSA afuna futhi ukuthi uhlale phezu kwamarekhodi akho bese uthumela amarisidi akho ukuze kuvunyelwe izindleko zokwelashwa ezifanelekile. Ezinye izimangalo kungenzeka zingakhokhelwa ngumlawuli we-HSA uma kungezona izindleko ezifanelekile. Buza umphathi wakho we-HSA ngaphambi kokwenza ukuthenga okungabazisayo ekhemisi noma kwenye indawo.

Futhi, uma usebenzisa i-HSA yakho ngezindleko ezingafaneleki ngaphambi kweminyaka yobudala engama-65, uzobhekana nentela nenhlawulo engu-20%, ngokuya ngezinguquko Umthetho Wokunakekelwa Ongabizi (ACA). Abanye abantu bacabanga nge-HSA njengesikhwama esiphuthumayo, kodwa ngalezi zinkinga, ungacabanga ngokucophelela mayelana nokuthi ubheka kanjani i-HSA.

Ubuhle nobubi be-PPO

Ama-PPO ngokuvamile angcono kulabo abalindele ukuba nezindleko eziningi zezokwelapha unyaka wonke. Lezi zinhlelo zivame ukuzuzisa abantu asebekhulile, labo abanemindeni, nabantu abanezimo zezempilo ezidinga ukwelashwa okuvamile.

Njengoba ukhula, uhlangabezana nezinkinga zezempilo, noma ukondla umndeni, i-PPO ingaqala ukwenza umqondo. Ama-PPO anama-premium akhokhelwa njalo ngenyanga, kepha angakusiza ukuthi ugcine ekugcineni uma udinga izinsizakalo zezempilo njalo. Ngokutshala imali ethe xaxa kumshuwalense wakho wezempilo unyaka wonke, ungaba nezindleko zakho eziningi zezokwelapha ezimbozwe umshwalense.

Ama-PPO nawo eza nezinzuzo ezengeziwe zokuguquguquka. Ohlelweni lwe-PPO, unenkululeko yokukhetha udokotela noma isibhedlela osithandayo. Noma bengekho kunethiwekhi yakho, umshwalense wakho njalo usazonikela ngokutholakala. Nge-PPO, ungabona uchwepheshe noma wenze inqubo noma ukuhlolwa kwenziwe ngaphandle kwemvume kudokotela wakho wokunakekela oyinhloko. Uma ukuguquguquka ekukhetheni kwakho kokunakekelwa kwezempilo kubalulekile kuwe, uhlelo lwe-PPO lungangcono kune-HDHP.

Yiluphi uhlelo olufanele?

Manje sizobuyekeza ukuthi unquma kanjani ukuthi ngabe i-HDHP noma uhlelo lwe-PPO luzoba ngcono kuwe. Okokuqala, cabanga ngale mibuzo elandelayo:

• Uya kangaki kudokotela?
• Ingabe unesimo sempilo esingapheli esidinga ukwelashwa njalo?
• Udinga kaningi kangakanani ukunakekelwa okuphuthumayo?
• Ingabe unokuhlinzwa okuhleliwe okuzayo?
• Ngabe ulindele ingane kulo nyaka?
• Ingabe uyamxhasa owakwakho noma izindleko zokwelashwa kwengane?
• Kubaluleke kangakanani ukuguquguquka ekukhetheni udokotela owuthandayo?
• Kubaluleke kangakanani ukuguquguquka kokubona uchwepheshe?

Uma uvakashela njalo udokotela, unesimo esingelapheki, uvame ukufuna ukunakekelwa okuphuthumayo, uhlele ukuhlinzwa, ulindele ingane, uxhase izindleko zokwelashwa zamalungu omndeni amaningi, noma unakekele ukuguquguquka, i-PPO izoba ngcono kune-HDHP. Kodwa-ke, uma kungekho okukodwa noma okumbalwa kokucatshangelwa okunendaba kuwe, cishe uzolungela kangcono i-HDHP.

Qaphela: Izinhlelo ze-HDHP ne-PPO akuzona izinketho zakho zomshuwalense wezempilo kuphela. Kukhona nezinhlangano zezeMpilo (HMO), i-Exclusive Provider Organisations (EPO), nezinhlelo zePoint of Service (POS).

OKUSHIWO: HMO vs. PPO

Okulandelayo, qiniseka ukuthi uyawaqonda amatemu ayisihluthulelo ahlotshaniswa nenye yalezi izinhlelo zomshuwalense wezempilo .

• I-Premium : Ukhokha malini ngenyanga ukuze ube nomshuwalense wezempilo.
• Iyadonswa : Malini okufanele ukhokhe ngaphambili ngonyaka ukuze uthole ukunakekelwa kwezokwelapha. Uma usuhlangabezane nemali yakho ekhishwayo, umshuwalense wezempilo uqala ukungena.
• Umkhawulo ophuma ephaketheni : Ngemuva kokuchitha le mali ngonyaka ukunakekelwa kwezokwelapha ngaphandle kwe-pocket (kungafaki ama-premium), umshuwalense wakho uzokhokhela izindleko eziyi-100% ezifanelekile.
• HSA: I-akhawunti yokonga ngaphambi kokukhokha intela engasetshenziswa ne-HDHP. Iminikelo ezinhlelweni ze-HSA iqhubeka minyaka yonke.
• ICopay : Imali ekhokhwayo oyikhokhela imiyalo, ukuhlolwa, nezinye izinsizakalo zezempilo.
• Coinsurance : Amaphesenti wezindleko ozikhokhela izindleko zezokwelapha ezihlanganisiwe ngemuva kokuhlangabezana nokudonswa kwakho.

HDHP vs. PPO wokubala

Ukuqonda imigomo engenhla kungakusiza ukuthi uzulazule ekubalweni kokuthi uzokhokha malini ngomshwalense wezempilo. Lapho uthatha isinqumo phakathi kwalokhu okubili, kufanele uqale ulinganise izindleko zakho zezokwelapha zonyaka. Umuntu ophilile kungenzeka angabi nezindleko eziningi ezilinganisiwe. Kodwa-ke, kufanele bacabangele ukuthi kungenzeka yini ukubanjwa umkhuhlane noma ukulimala.

Uma usuqagele izindleko zakho zokwelashwa, engeza imali ekhokhwa nyangazonke yohlelo ngalunye, kanye nemikhawulo yabo engaphandle ephaketheni. Uma ucabanga ukuthi usebenzisa ukwelashwa okuphakathi kwenethiwekhi, le nombolo kuzoba izindleko zakho eziphuma ngokuphelele ephaketheni zonyaka.

Njengesibonelo, uhlelo lwe-PPO lungakhokhisa imali engu- $ 1,250 ekhishwe nge-premium yenyanga engu- $ 600. Ngemuva kokuphindaphinda imali ekhokhwa njalo ngenyanga yezinyanga eziyi-12 ($ 600 x 12) futhi ungeze imali ekhishwayo yezindleko ezingaphandle kwezikhwama, lokhu kufinyelela ku- $ 8,450 ngonyaka, kungafaki ama-copays noma i-coinsurance. Kodwa-ke, umkhawulo ophuma ephaketheni we izinhlelo zeqembu ngo-2020 kungama- $ 8,150 wabantu ngabanye kanye nama- $ 16,300 emindenini. Izindleko zakho eziphuma ephaketheni zingalingana noma ngaphansi kwalomkhawulo.

I-HDHP ingakhokhisa imali engu- $ 3,000 ekhishwe nge-premium yenyanga engu- $ 400. Ngemuva kokuphindaphinda imali ekhokhwa njalo ngenyanga yezinyanga eziyi-12 ($ 400 x 12) futhi ungeze imali ekhishwayo yezindleko ezingaphandle kwephaketheni, lokhu kufinyelela ku- $ 7,800 isamba seminyaka yonke. Ngo-2020 , imikhawulo engaphandle kwesikhwama yama-HDHP ayikwazi ukudlula u- $ 6,900 kubantu ngabanye noma ngama- $ 13,800 emindeni. Ngakho-ke, ungalindela ukuthi izindleko zakho zokuphuma ephaketheni zilingane noma ngaphansi komkhawulo ophuma ephaketheni.

Esibonelweni sesibili, ukhokha imali engaphansi kwama- $ 200 inyanga ngayinye kwi-premium bese ugcine ama- $ 900 ezindlekweni zonyaka, kungafaki ama-copays noma i-coinsurance.

Uma uthola ukuthi izindleko zokuphuma ephaketheni ze-HDHP ziphansi kunenketho ye-PPO, kubonakala sengathi ukukhetha okuhle kungaba ukukhetha i-HDHP, kusho uBeaton. Kodwa-ke, ngaphambi kokwenza lokhu kukhetha, qiniseka ukuthi isabelomali sakho singakwazi ukusisingatha. Ngabe uzokwazi ukukhokha u- $ 250 ngokuvakashelwa ehhovisi ngosuku lokuvakasha kwakho, noma u- $ 800 egumbini lezimo eziphuthumayo, njalonjalo, kuze kube yilapho kuhlangatshezwa imali yakho? Uma isabelomali sakho samanje singenayo indawo yokukhokhela izindleko eziphakeme ngesikhathi senkonzo, kuzodingeka ucabange kabili ngaphambi kokukhetha uhlelo lwe-HDHP.

Kungaba nengqondo ngokuhamba kwesikhathi ukukhetha uhlelo lwe-PPO nge-premium ephezulu inyanga ngayinye kepha uthole ukumbozwa okungaphezulu komshuwalense. Lokhu kuyiqiniso ikakhulukazi kulabo izibalo zabo ezibonisa ukuthi i-HDHP izobiza kakhulu ukuphuma ephaketheni noma kulabo abangafuni ukubheja ngokungabi nezindleko zezokwelapha ezingalindelekile ezivela unyaka wonke.

Ezinye izinto okufanele uzicabangele

Ukukhetha uhlelo lomshuwalense wezempilo yisinqumo esizimele kakhulu esidinga ukukala izinto eziningi, kufaka phakathi:

• Isimo sempilo yakho
• Impilo yomndeni wakho
• Izintandokazi eziguquguqukayo zabahlinzeki bezempilo noma ongoti
• Isimo sakho sezimali
• Ukuthi ungakhokha ngaphezulu ngaphambili ngamaphrimiyamu ukuze uthole ukumbozwa okuningi
• Ungakanani imali ye-HSA ongayisebenzisa
• Isamba semali esetshenzisiwe esikhwameni kunqubomgomo ngayinye

Uma usadinga usizo lokukhetha uhlelo, thintana nomenzeli womshuwalense wezempilo noma abasebenzi bakwa-HR enkampanini yakho. Unethuba lokulungisa uhlelo lwakho minyaka yonke ngesikhathi sokubhaliswa okuvulekile noma esimweni sokushintsha kwesimo sempilo. Imicimbi yokuphila efanelekile ifaka umshado noma isehlukaniso, ukuzalwa kwengane, njll.

Gcina nge-SingleCare

Kungakhathalekile ukuthi umshwalense wakho wezempilo uthini, Amakhuphoni e-SingleCare ayatholakala kuwo wonke amakhasimende ekhemisi. Noma ungenawo umshuwalense wezempilo, ungasebenzisa i-SingleCare ukuthola izaphulelo kwimigomo eminingi.

I-SingleCare akuyona indlela yomshuwalense wezempilo, futhi ayinakusetshenziswa ngokuhlanganiswa nomshuwalense wakho wezempilo. Noma iziphi izindleko ezikhishwa ephaketheni zemiyalo ehliselwe isigqebhezana se-SingleCare azisetshenziswanga kudonsi yakho.