Iisiseko zokukhetha iSicwangciso seNtshumo yezeMpilo

Indlela yokuhlawula ukulingana phakathi koMgangatho wokuBaluleka kunye neBhajethi yakho

Uninzi lwethu kunye ne-inshorensi yempilo ihlanganiswe phantsi kwecwangciso leqela elinikezelwa ngumqeshi okanye umqeshi womlingane. Abanye bathenga iipolisi zabo ngokwabo okanye bafumane i-COBRA. Abanye abanakho ukukhutshwa konke. Ingaba utshatile, ungatshatanga, unabantwana, usemncinci okanye umdala, udinga inqanaba lomshuwalense wezempilo ukuze uzikhusele kwientlekele zemali xa kunokugula okanye ingozi enkulu.

Kungakhathaliseki ukuba ukhetha icebo leqela okanye isicwangciso ngasinye, kukho ukhetho olubalulekileyo olwenziwe luya kuthintela kuphela umgangatho wenkxaso yokunakekelwa kwezokwelapha kodwa kunye nekhredithi yakho. Makhe sihlele ezinye zezi zigqibo ukwenzela ukuba wenze isigqibo esicacileyo esifana neemfuno zakho ezithile kunye nebhajethi yakho.

Iintlobo zeeNtsholongwane ze-inshurensi yezempilo

Kukho iminyana emininzi yokudibana nokukhula kwokhula xa kuqwalaselwa izicwangciso ze-inshorensi yezempilo, kwaye zonke ziza neempembelelo zazo zokuqwalasela. Nangona kubalulekile ukwazi ukumahluko phakathi kwama- HMO, ii-PPOs, ii-POS Plans , kunye nezicwangciso zokuzihlawulela , ngokomzekelo, kunceda kakhulu ukuqala ngolu hlobo lwezinto eziqhelekileyo ze-inshorensi yezempilo. Iindidi eziqhelekileyo zinokufakwa kwiqela leentlobo ezintathu:

1. Izibonelelo zeMali-ye-iNkonzo
2. Imibutho yezoMpilo (ii-HMO)
3. Imibutho yabanikezeli abathandayo (ii-PPOs)

Makhe sithathe ididi ejulile kulezi zigaba zintathu, kunye neenzuzo zabo ezisisiseko kunye neentsilelo.

1. Izibonelelo okanye i-Fee-for-Service Plans

Izicwangciso zemveli ezivumela ukuba uye kunoma yimuphi ugqirha okanye ugqirha okhethayo ngaphandle kwesidingo sokuthunyelwa kuthiwa yi-indemnity, intlawulo-yenkonzo, okanye iinjongo zeenkonzo (POS). Ngezi cwangciso, inkampani yomshuwalense iya kuhlawula isahlulo esithile seentlawulo zakho kwaye uhlawule lonke.

Ezi zicwangciso zinika iimeko ezinokuba ziguquguqukayo njengoko zingayikhawulithinteli kubanikezeli onokuzisebenzisa kwaye ngokuqhelekileyo azidingi ukuba ukhethe ugqirha wezempilo oyintloko (PCP), kodwa bafumana nzima nakakhulu ukufumana kwaye ngokuqhelekileyo bafike ngexabiso eliphezulu ithegi.

Iingenelelo zeziCwangciso zoNcedo

Inzuzo ephambili kwisicwangciso sokuxhaswa kukuba unokukhetha ukunyamekelwa unyango lwakho naphi na ukufunayo ngaphandle kokudluliselwa okanye ukuvunyelwa kwangaphambili.

Iingxaki zeSicwangciso soNcedo

Ukulawula iindleko, iinkampani ze-inshorensi zishintsha iindleko ezininzi kuwe ngeeprayimari eziphezulu kunye neentengo ezidityanisiweyo, ukwenza izicwangciso zenkxaso ezixabisekileyo kuwe kunama-HMO kunye ne-PPOs. Ukongezelela, unokulindela ukuhlawula iinkonzo zakho zezokwelapha phambi kwaye ungenise ibango lakho kwiinkampani zomshuwalense ukubuyisela imali, edibanisa imali yakho kwaye ikubeka engozini yokungayifumani.

Imibutho yezoMpilo (ii-HMO)

I-HMO okanye iMpilo yokuLondolozwa kweMpilo ngumbutho wabasebenzi bezonyango kunye namaziko ezonyango athengisa ipakethe echanekileyo yeenkonzo zononophelo zempilo ngenani elimisiweyo. Kwisicwangciso se-inshurensi ye-HMO, isigulane ngasinye sinogqirha wokunakekelwa ngokusisiseko, obizwa ngokuba ngumgcini-masango kuba iinkonzo ezinikezelwa ngumphathi azihlanganiswa nesicwangciso ngaphandle kokuba umgcini-masango (PCP) enquma ukuba ingcali iyimfuneko kunye nemiba ukuthunyelwa kwempahla.

Ngaloo ndlela zonke iinkathalo zakho zilungelelaniswa nge-PCP yakho.

Izinzuzo ze-HMO

Inzuzo ephambili ye-HMO kukuba iindleko zakho ezingaphandle kwexesha zihlala ziphantsi kwaye ziqikelelwa ngakumbi. Enye inzuzo kukuba iifom zefowuni ayidla ngokuyimfuneko.

Iingxaki ze-HMO

Iinkonzo ezinikezelwa ngabaqeqeshi bezempilo ngaphandle komnatha ngokubanzi azihlanganiswa ngaphandle kwimeko yentlekele yokwenene. Enye inzuzo kwabanye kukuba iinkonzo ezibonelelwe ngcali zifuna ukudluliselwa kwicandelo lakho lonyango, elingadinga ukuba kuqeshwe ugqirha. Ngaphantsi kwesicwangciso se-HMO, ezinye iinkonzo zinokukhawulelwa kwiinkonzo zempilo yengqondo. Nangona le mngcipheko ikhona phantsi kwiprogram ye-inshurensi, kwi-HMO, unako ukufumana unyango oluluncedo okanye olufunyenweyo okanye ngenxa yokuba i-PCP yakho ayikhiphi ukuhanjiswa okufunekayo.

3. Iinkampani ezibonelela ngempahla (i-PPOs)

I-PPO okanye uMbutho Wezinto Ezixhaswa Ngayo iqulethe inkathalo elawulwayo ye-HMO kodwa kunye nokuguquguquka okungeziweko okukwazi ukuphuma ngaphandle kwenethiwekhi yabasebenzi bezempilo kunye nezibonelelo kunoma yimuphi umboneleli wezempilo ozikhethayo xa uziva ukuba kuyimfuneko. Xa uphuma ngaphandle kwenethwekhi, izibonelelo zakho zincinci kwaye uhlawula ngaphezulu kwipokhethi yakho kunokuba ungathanda ukuba uhlala ngaphakathi kwintanethi, kodwa usenokufumana inqaku (ngokungafani ne-HMO). Ukuba ukulungelelaniswa kunye nokukhetha kubalulekile kuwe, i-PPO ingaba yinto efanelekileyo xa ikhona kuwe.

Inzuzo yePPOs

Inzuzo ephambili ye-PPO kukuba unokuzilungelelanisa ngakumbi kunokuba ungayifumana kwi-HMO, kodwa kungekhona njengendleko ephezulu ehambelana nesicwangciso sohlawulelo.

Iingxaki zePPOs

Inzuzo engundoqo ye-PPO kukuba kunokuba nzima kunzima ukuqikelela iindleko zakho zokuphuma ngaphandle.

Ndingayifumana phi i-inshorensi yempilo?

Uninzi lwabantu bafumana i-inshorensi yabo yezempilo ngokusebenzisa icebo leqela elixhasiweyo (kwaye ngokukhawuleza lihlawulwe ngokukodwa) ngumqeshi okanye umqeshi womlingane. Kodwa abaninzi abaqeshi abancinci abanikeli ngomshuwalense wezempilo. Ukuba inkampani yakho ingomnye wabo, unokukwazi ukufumana i-inshurensi yeqela ngokusebenzisa ubulungu kwimanyano yabasebenzi, umbutho wobugcisa, iqela, okanye enye inhlangano enika i-inshurensi yempilo kumalungu.

Ukuba awukwazi ukufumana inkcazo yeqela, ungathenga umgaqo-nkqubo ngamnye, owawunqabile kakhulu ukubiza imali. Enye yeenjongo eziphambili ze-Care Affordable Act (eyaziwa nangokuthi i-ACA kunye ne-Obamacare) yayiyikugqithisa imarike yempilo ye-inshurensi yempilo kwaye yenza izicwangciso zomntu ngamnye. Ngoku ungaphangela uphando lwe-ACA ye-ACA (ekwabizwa ngokuba yii-marketplace) nge-HealthCare.gov apho unokukhangela uphinde uqhathanise imigaqo-nkqubo kwaye ubone ukuba uvumelekile naziphi na inkxaso. Unako ukukhetha iiplani ezizimeleyo ezinikezelwa ngqo kwi-inshurensi okanye i-arhente okanye umthengisi (obizwa ngokuba yi-plans exchange exchange-off).

Xa ukhetha isicwangciso se-inshurensi yezempilo, kulungile ukuthelekisa zonke iinketho zakho ngokucatshungisa iingenelo kunye neendleko kunye nokugqiba ukuba yiziphi iintlobo ezibalulekileyo kuwe. Kungenokuba luncedo ukusebenzisa i-inshente ye-inshurensi, ngubani na omele ujwayelane nemigaqo enikezelwa kwingingqi yakho kunye neenzuzo kunye neendleko nganye.