Ukukhetha Umgaqo-nkqubo we-Inshurensi yezeMpilo ngeFlexible ngeZithintelo ezincinane
Iyiphi Isicwangciso seNtshumo ye-Intshumo yezempilo?
Isicwangciso senkonzo ye-inshorensi yempilo isicwangciso socwangco sezempilo esikuvumela ukuba ukhethe ugqirha, unonophelo lwezempilo, isibhedlele okanye umboneleli wenkonzo ozikhethile kwaye kukunika inani elikhulu lokuguquguquka kunye nenkululeko kwisicwangciso se-inshurensi yezempilo.
Izicwangciso zempilo ze-Indemnity ziyaziwa nangokuthi "isicwangciso senkxaso yendabuko" okanye "isicwangciso-ntlawulo-ntlawulo". Isicwangciso sinceda ukukhusela iindleko zeendleko zonyango.
Iinjongo zeNkqubo ye-inshurensi yempilo
Isici esibalulekileyo senkqubo yomshuwalense wezempilo yintlawulo kukuba ayikunyanzelisi ukuba ukhethe ugqirha wokunyamekela.
Umgaqo-nkqubo wezempilo wembuyekezo uhlukile kwiinkqubo ezinikezelwa yimibutho yokugcinwa kwempilo (i-HMOs) kunye nemibutho yokubonelela ngempilo (i-PPOs) kuba ikuvumela ukuba ufumane unyango lwempilo apho ukhetha khona kwaye umgaqo-nkqubo wezempilo wembuyekezo unikezela isinxephezelo kwisabelo esithile seendleko. Ukongezelela, iiprogram ze-inshorensi yezempilo yinto ekhethekileyo ngenxa yokukuvumela ukuba uzibhenelele kwiingcali, abafuni ukuba ufumane ukuhanjiswa ukuze uhlawulelwe xa ukhetha ukufumana ingcali.
Uhlobo lwenkululeko efumanekayo ngesicwangciso senkonzo yomshuwalense wezempilo unokuba luncedo ekuhambiseni unyango lwakho. Oku kuhluke kakhulu kunama- HMO, i-IPAs, kunye ne-PPOs esebenzisa ukunyamekelwa okulawulwayo kwaye unokukunyanzela ukuba ukhethe umboneleli oyintloko njengenxalenye yesicwangciso.
Izicwangciso ze-inshorensi yezempilo zemali azibandakanyi inethiwekhi yomboneleli.
Ngaba Isicwangciso se-inshurensi yempilo ye-Inememnity ye-Health Right to You and Your Family?
Izicwangciso ze-inshorensi zempilo zentlawulo zineenzuzo kakhulu xa ezi zinto zibalulekile kuwe:
- Awunayo okanye ufuna ukuzinikela kwigqirha lokunyamekela. Ngokungafani ne-HMO kunye ne-PPO isicwangciso sezempilo esingenakukunyanzelisa ukuba ukhethe ugqirha wakho wokunakekela ugqirha, ngoko ke kuya kuba nethuba lokufumana inkululeko yokuzikhethela.
- Awuyi kucinga ukuhlawula ezinye iindleko zeeinshorensi zezempilo okanye zichithwe
- Awunenkxalabo malunga nokukhetha ababoneleli abangabonakali kwiindleko. Kuthetha ukuba ngenxa yokuba awuyiyo inxalenye yentsebenziswano kwinkqubo ye-inshorensi yezempilo, indleko zoogqirha kunye neengcali ozikhethayo zinokwandisa ngaphaya kwencazelo ye-UCR. Uya kufuneka ubeke ingqwalasela indlela ukhetho lwakho oluchaphazela ngayo iindleko zakho.
- Uhlala kwindawo yommandla apho ufikelelo oogqirha kunye neenkonzo zonyango ozifunayo aziyi kufakwa kwi-HMO okanye iPPO plan.
I-inshurensi yempilo ye-inshorensi yeeNkoleko kunye namaDeductibles
Izicwangciso ze-inshorensi yokuzihlawula zihlawula inxalenye yeendleko zakho zonyango kumboneleli wenkonzo ozikhethile kodwa unakho ukuxhomekeka kwi-deductible.
Ngokucwangcisa isiza, uza kuhlawula isabelo sokuqala seendleko zonyango de ube uhlawule umda wengxenye yakho, eyaziwayo njenge-deductible. Ukuchithwa kwisicwangciso sokuhlawulela kunokuhlawula i-$ 100 kubantu ngabanye kwaye kufike kwi-$ 500 ngokwemilinganiselo kwiintsapho kwaye ziyahluka ngokusekelwe kumniki-nkonzo okanye kwinkampani yomshuwalense.
Emva kokuhlawula i-deductible, isicwangciso siya kuhlawulela intsalela ye-inshurensi yempilo yakho ukuya kwimida ephezulu kwisivumelwano sakho sesivumelwano.
Imigaqo-nkqubo yokuzibandakanya inokubandakanya i-co-pay or clauses insurance . Nangona iiprogram zomshuwalense yezempilo yesikhokelo ngamanye amaxesha inokuthi ihlawulwe ngaphezulu kwipokothini kubantu, inzuzo yokuzibiza ngokuzithethayo kwiingcali kunye nokuba nenkululeko yokufumana unonophelo naphi na ukufunayo, ngaphandle kokunciphisa i-geolocation kulungele ukutshala imali kubaninzi.
IziCwangciso ze-inshurensi zempilo ye-Indemnity kunye ne-HMO kunye ne-PPO Plans
Ngokungafani ne- HMO kunye ne-PPO yezicwangciso ze-inshorensi yezempilo, ezininzi iinkqubo zemvume zivumela ukuba ukhethe nawuphi na ugqirha , ochwepheshe kunye nesibhedlele onqwenelayo xa ufuna iinkonzo zonyango. Izicwangciso zentlawulo ziqwalaselwa njengezicwangciso ze-inshorensi zempilo zentlawulo-nkonzo apho unenkululeko yokukhetha iinkonzo zakho zononophelo lwempilo kwaye nje kuphela ukuba iinkonzo zakho zifanelekile ukuba unokuhlawulwa intlawulo kuxhomekeke kwindlela umgaqo-nkqubo wakho ubhaliweyo ngayo.
Ngamanye amaxesha iinjongo ze-inshorensi zempilo zonyango zibiza iindleko ezingaphezu kwama-HMO kunye nee-PPOs, kodwa umvuzo ukuguquguquka kokukhetha.
Ukufikelela kwiiNgcali ngeeNtsholongwane zeNtsholongwane yezempilo
Ikhono lokuzibhenela kwi-ingcali lingaba yinzuzo enkulu ekufumaneni uncedo olungcono lwezempilo kwaye kulula kakhulu ukuba luncedo olukhulu kunamalungiselelo enkonzo ye-inshorensi yezempilo.
4 Iimpawu ezibalulekileyo zokuqonda iSicwangciso seNtshumo yeNtshumo yeMpilo
Ukuba unethuba lokukhetha umgaqo-mali wokubambisa i- inshurensi yezempilo , nakhu amanqaku amane abalulekileyo ukukhumbula:
Izicwangciso zeNkxaso-mali kunye neCandelo eliQheleleyo, eliNkcubeko kunye nelingqiqo (UCR)
I-rates ye-UCR yimivuzo yokuba ababoneleli benkonzo yezonyango bahlala behlawula iinkonzo ngenxa yokuba izicwangciso zenkxaso-mali ziyi-inshorensi zempilo zonyango ezizimeleyo akukho nethiwekhi echaza iirhafu abaxhasi bakho abakhethiweyo abaza kuhlawula. Ngenxa yoko, uya kufuna ukuziqonda ngeendleko ezicwangcisiweyo isicwangciso sakho njengesiqhelo kunye nesithethe ngokwesiko kunokuba umnikeli wakho okhethiweyo uya kuhlawula iinkonzo ukwenzela ukuphepha iindleko ezingalindelekanga. Ngokukodwa, ukuba uye kwenye indawo. Ngokubanzi ababoneleli baninzi bahlangabeza imigaqo, nangona kubalulekile ukwaziswa xa usebenzisa isicwangciso esiziphetheyo njengesicwangciso se-inshurensi yezempilo.
2. Ukuqonda ama-Deductibles kunye neeNtlawulo zeeNkxaso-mali ze-Innsurance Health
Unokuba ne- deductible . I-deductible yimali oyimfuneko ukuba uyihlawule ngaphambi kokuba inzuzo yomgaqo-nkqubo inikwe. Ukuba ukuhlawulwa kweemali zakho zonyango, okanye uvumelekile ukuhlawulwa phantsi komgaqo-nkqubo, i-deductible yakho iya kusebenza.
Emva kokudityaniswa , unokufuneka uhlawule intlawulo-ntlawulo. Intlawulo yentsebenziswano yipesenti ohlawula ngayo iindleko ezisele emva kokutsalwa kwakho. Umzekelo: Ukuba iindleko zakho ezifanelekileyo ziyi-$ 800 kwaye unayo imali engamaRandi angama-200, oko kushiya i $ 600. Yithi intlawulo yakho yentsebenziswano i-20%. Oko kuthetha ukuba usadingeka ukuhlawula i-20% yemali eseleyo eyi-$ 600, eya kuba yi-$ 120. Fumana iimfuno ze-inshurensi kunye ne-inshurensi ye-insenity ye-inshurensi yempilo ye-inshorensi ukuqinisekisa ukuba uyakwazi ukuhlawula iindleko.
Eminye imigaqo-nkqubo yempilo yenkxaso-mali inika neyona mali ephezulu ekufuneka uyihlawule njenge-inshurensi. Le migaqo iya kuba yinzuzo kuba xa uthe wabuya uhlawule ukuhlawulwa, awuyi kuphinda uhlawule i-inshurensi. Ngokuxhomekeke kwimeko yakho yezokwelapha oku kunokukunceda ukulawula iindleko ezinkulu ozihlawula njengenxalenye yomgaqo-nkqubo.
Izicwangciso zeMpilo zeNkxaso-mali aziyikuMisela ukuFikelela ngokuSebenza kwiNgingqi yeNgingqi
Njengoko kuchazwe kwingcaciso yesicwangciso sezempilo esihlawulelwayo ngasentla, kwisicwangciso se-indemnity plan, unenkululeko yokukhetha ugqirha, ingcali, okanye isibhedlele, kunye nantoni na.
Kwezinye iimeko, i-HMO kunye ne-PPO zinganciphisa ukhetho lwakho ugqirha, ingcali, okanye isibhedlele ngokuthintela indawo, okanye indawo apho umniki-ndawo ekhoyo khona. Oku kunika inzuzo enkulu kwinkululeko enikezelwa isicwangciso sokuhlawulela abantu abaninzi.
IziCwangciso zoNcedo kunye neMisebenzi yokuNakekelwa kwezeMpilo
Ezinye iinjongo ze- inshorensi zempilo zonyango zingabandakanyi iinkonzo zokuthintela, ngelixa abanye benza. Iinkonzo zokunakekelwa kwempilo ezikhuselekileyo ziquka iimviwo zokuhlolwa konyaka kunye nezinye iindwendwe zee-ofisi ezilungiselelwe ukukhusela izifo. Ngaphambi kokuba ukhethe isicwangciso sezempilo, qiniseka kwaye uxoxe ngendlela iinkonzo zokuthintela eziqinisekisiwe ngayo, kwaye unjani umvuzo onokulindela. Oku kuya kukunceda wenze ukhetho kwisicwangciso esilungileyo. Kwezinye iimeko, iindleko zale nkonzo azinakubalwa kwi-deductible yakho.
Indlela yokukwazi ukuba yintoni efihliweyo yiNkqubo ye-inshurensi yempilo yesikhokelo
Incwadana yomgaqo-nkqubo wenzuzo yakho okanye incwadana yakho yenzuzo yempesheni iya kuchaza imimiselo kunye neemeko zento efunyenweyo noko kungagcinwanga. Funda incwadana yakho yomgaqo-nkqubo okanye inzuzo ngaphambi kokuba ufune iinkonzo zonyango lwezempilo kwaye ubuze i-inshente yezempilo yomshuwalense, inkampani yomshuwalense okanye umqeshi ukuba achaze into engacacanga.