Indlela yokuhlawula i-Co-Payments, i-Deductibles kunye nezinye zeeNkxaso-nkqubo ze-Inshorensi ye-Insurance Policy
Uncedo Ukuqonda Imigaqo-siseko Yomshuwalense Wezempilo Yakho
Imigaqo-nkqubo ye-inshorensi yempilo kunye neemeko zomgaqo-nkqubo ingadideka, nolu uluhlu lwamagama e-inshorensi yempilo ephezulu kakhulu echazwe ngokucacileyo kunye nemizekelo ukwenzela ukuba ngexesha elizayo uza kuzibuza "Kuthetha ukuthini oko?" malunga nomgaqo-nkqubo we-inshurensi okanye iimeko, unempendulo yakho apha.
Uluhlu lweenkcazo zemigaqo-nkqubo ye-Inshorensi yezempilo
Ngezantsi uluhlu lwemigaqo-nkqubo ye-inshorensi yempilo eqhelekileyo ukunceda wonke umntu ukuba aqonde ngakumbi malunga neprogram ye-inshurensi yezempilo.
Sisalokhu ufuna ulwazi olungaphezulu kunoluhlu olukhawulezayo apha, unokukhafaza kwiikhonkco ukuze ubone okungakumbi ulwazi olusisiseko malunga nemigaqo nganye.
Inkcazo ye-Co-inshurensi
I-inshurensi ye-Co-insurance iyindleko ebelwanayo phakathi kwe-insured kunye nenkampani yomshuwalense kwiinkcazo zokunakekelwa kwezempilo. Ipesenti yentlawulo emva kokudityaniswa. I-inshurensi yoqhagamshelwano iboniswa njengokwahlukana, apho umntu okhuselayo ehlawula ipesenti ethile kunye nenkampani yomshuwalense ihlawula lonke ixesha. I-co-inshorensi eqhelekileyo yohlupheko yi-80/20. Oku kuthetha ukuba inkampani yomshuwalense iya kuhlawula i-80% yenkqubo kwaye i-insured iyafuneka ukuhlawula enye i-20%. Isigatshana se-inshurensi yomshuwalense akufanele sidideke kunye ne-deductible leyo yinxalenye yomshuwalense ukuba i-inshorensi iya kuhlawula yona ngaphambi kokuba inkampani yomshuwalense ihlawule inzuzo.
Umzekelo wendlela intsebenziswano ye-inshurensi isebenza ngayo: UMariya unomhlathi we-inshorensi ka-80/20. Uhlawula i-20% yeendleko kwaye inkampani yomshuwalense iya kuhlawula i-80% yeendleko.
I-Co-inshurensi isebenza njani neDeductible?
Umzekelo wendlela intsebenziswano ye-inshurensi esebenzayo ngayo i-deductible iya kuba ngolu hlobo lulandelayo: Uthatha inani elipheleleyo leendleko, ngaphantsi kwe-deductible. Isixa oshiywe kuso isixa esiqhotyoshelwe kuyo umhlathi we-inshurensi. Ngoko, umzekelo ukuba unayo i-bill ye-1200 yeyonyango kunye ne-200-deductible kunye ne-80/20 yecandelo le-inshurensi ye-inshurensi, iya kudlala njengale: Inani leenkonzo zonyango (i-$ 1200) ngaphantsi kwe-deductible (i-$ 200) = $ 1000 ehlala.
Ngokusekelwe kwi-inshorensi ye-80/20, uza kufikelela kwi-20% (i-$ 200) kunye neprogram yenkxaso-ntle yempilo yenkampani yomshuwalense iza kubandakanya i-80% (i-$ 800). Ekupheleni kosuku uhlawule i-$ 400 kunye neentlawulo ze-inshorensi zempilo zihlawula i-$ 800 ukuze zihlawule iindleko eziyi-1200 zamaxabiso.
Inkcazo yoHlangano lweeNzuzo
Ulungelelaniso lweeNzuzo xa i-inshurensi yezempilo inokufumaneka kumntu ovela kwimithombo eyahlukeneyo, umboneleli we-inshorensi yempilo uza kuhlaziya iindidi ezahlukileyo ezikhoyo kwaye emva koko uzilungiselele iintlawulo ngokufanelekileyo. Ukuba kukho omnye umthombo winshuwalense yezempilo ngoko ulungelelaniso lwezibonelelo alusebenzi ukususela kuba akukho esinye isicwangciso sezempilo "sokulungelelanisa" kunye.
Imizekelo yokuHlanganiswa kweeNzuzo
Umzekelo 1: Ulungelelwaniso lweeNzuzo kunye noMyinge oMinyaka
Isicwangciso se-inshurensi yempilo kaMariya sikhokhelela umda wonyaka we-$ 1000 we-physiotherapy, ngelixa isicwangciso sakhe somyeni uJohanathan esabandakanya ukuxhaswa kukaMariya phantsi kwesicwangciso se-inshurensi yezempilo kunye nomsebenzi wakhe uhlawula u-$ 500. UMariya uhlanganiswe yiplani yesibini. Kule meko inkampani ye-inshurensi yezempilo iya kulungelelanisa izibonelelo ukuqinisekisa ukuba isicwangciso ngasinye sihlawulela inxalenye yenkonzo. Xa isicwangciso esinye siphelile kwaye siphumelele umda wonyaka, uMariya usenokukwazi ukufumana ingxelo phantsi kwesicwangciso sikaYohanathan.
Umzekelo wesi-2: Ulungelelaniso lweeNzuzo kunye ne-Co-inshurensi
Umphathi we-inshorensi yempilo yonyango kaMary unomhlathi we-80/20 we-inshorensi ye-inshorensi kwiinzuzo zamazinyo. Ngenxa yokuba unomshuwalense we-double phantsi kwesicwangciso sikaYohanathan, umphathi wakhe oyintloko uyakuhlawula i-80% yeendleko ze-inshurensi kwaye uza kufumana i-20% eseleyo kumniki-nshurensi wecandelo lezempilo. Ngenxa yokuba ihlanganiswe phantsi kwepasiti emibini, ngenxa yokulungelelanisa kwezibonelelo phakathi kwezi zicwangciso ezimbini, iphelela ekuhlawuleni into ngaphandle kwepokothini.
Umzekelo wesi-3: Ulungelelaniso lweeNzuzo kunye nokungabikho ngokuphindaphinda kweziNzuzo
Umshuwalense we-inshurensi yempilo ka-Mary inomshuwalense we-80/20, kunye nomshuwalense wakhe wesibini ngokusebenza kukaJohnathan.s unomhlathi we-80/20 we-inshorensi ye-inshurensi. Emva kokuba icebo likaMariya lihlawule i-80%, umphathiswa wesibini akayikhaba ekuhlawuleleni nayiphi na ibhalansi kuba bebeya kuhlawula i-80% kuphela.
Ukuba umphathi wokuqala kaMary unomshwalense we-50/50 kunye necebo likaJohanathan li-inshurensi ye-80/20, ngoko ulungelelaniso lweenzuzo luya kubangela ukuhlawulwa kwe-50% kwisicwangciso sikaMariya, ngoko ke ukuhlukana okuseleyo kwe-30% yentlawulo I-inshurensi yempilo yonyango kaYohanathan (okanye umboneleli we-inshurensi yesibini yeenzuzo zezempilo). UMariya opheleleyo uya kuhlala ephela ngo-80% kunye negatya elingaphindaphindi, kwaye akukho kuphinda kwaphinda kuxhamle.
Inkcazo yeentlawulo zentsebenziswano
Intlawulo yokubambisana iyimali echanekileyo ukuba kufuneka uhlawule ngexesha lokufumana iinkonzo ezithile zonyango. Umgaqo-nkqubo we-inshorensi yempilo uza kuchaza ukuba zeziphi iinkonzo zonyango zifuna iintlawulo zentsebenziswano. Iintlawulo ze-Co-ordination ayifuni ukusetyenziswa kuzo zonke iinkonzo ezijongene nesicwangciso socwangciso lwezempilo. Kutheni kufuneka uzifundele ngolwazi malunga nomgaqo-nkqubo wakho, ukwazi ukuba yiziphi iintlobo zeendleko oza kuhlawula ngokupheleleyo okanye ngokukodwa. Iintlawulo zentsebenziswano zixhaphake ngokuqhelekileyo ekutyelele ugqirha kwaye xa kuthengwa amayeza enyango. Abanye abantu bacinga ukuba inkokhelo yentsebenziswano iyafana ne-deductible kodwa indlela yokuhlawula ngokubambisana kunye nomsebenzi onokutshatyalaliswa uhlukile.
Inkcazo yeDeductible kwiNtshuwalense yezeMpilo
I-deductible ibhekisela kwimali yemali ehlawulwa ngumntu ohlawulelwayo ngaphambi kokuba i-inshorensi yezempilo iza kuqala ukuhlawula iindleko.
Umzekelo we-Deductible kwiNtshurensi yezeMpilo
UJohn unedola eyi-50 echithwe kwiinxalenye zeenzuzo zezinyo zomgaqo-nkqubo wakhe. Ibhilidi yakhe i-$ 475, xa ehambisa ibango kwinkampani yomshuwalense, bayayibhawula kuphela i-$ 425 ngenxa yokuba unembopheleleko ye-$ 50 yokuqala yeendleko. Inyanga kamva unesinye isabelo kunye nomnyozinyo wamazinyo. Ibiza enye i $ 475. Nangona kunjalo, ngenxa yokuba sele ehlawule i-deductible yonyaka, bayimbuyisela i-$ 475. Lo mzekelo awuqwalasele i-co-inshurensi ye-akhawunti kuba uthetha ukubonisa kuphela isahlulo esinqunyiwe. Xa i-deductible ihlawulwa, ayiyi kusebenza kwakhona kwaze kube yithuba elide lomgaqo-nkqubo.
Izidumbu ezinokuthi zisebenzise kuzo zonke iinkcazo kwi-inshorensi yempilo ngendlela efanayo kwaye iyakwazi ukuhluka phakathi kweengxelo ezifanayo kumgaqo-nkqubo ofanayo. Ngokomzekelo umntu unokufumana i-zero echithwe kumbono, kodwa i-$ 50 ichithwe kwizentengiselwano, kwaye ayikho into echithwayo kwiyeza. I-deductible ivame ukubhekiswa njengemali yonyaka ukwenzela ukuba umgaqo-nkqubo uphinde uvuselele, i-deductible iya kusetyenziswa kwakhona. Ezinye iinkonzo, ezifana nokutyelelwa koogqirha, zifumaneke ngaphandle kokudibana neyokuqala. Ngokuqhelekileyo kukho izixa ezihlukeneyo ezithengiswayo kunye nexabiso elipheleleyo lemali.
Inkcazo yoPhuculo lwesiBini
Ukubhengezwa kabini xa uhlanganiswe zicwangciso ezimbini ze-inshorensi yempilo, okanye iinjongo ze-inshorensi zempilo ezinjengezilenge, umzekelo. Umntu unokugqitywa phantsi kweeprogram ezimbini ze-inshorensi yempilo kodwa ngokuqhelekileyo uya kuba ngumfundi oyintloko. Ubhaliso oluphambili ngumgaqo-nkqubo ogqityiweyo obizwa nge-insured kumgaqo-nkqubo. Umphathiswa oyintloko uyinkampani ye-inshorensi yempilo eqinisekisa ukuba uyabhalisa. Ukwahlula ukuba ngubani umboneleli oyintloko oba kubalulekile ekuququzaneni kweenzuzo kuba phantsi kokulungelelaniswa kwezibonelelo eziphathekayo eziphambili ziza kuthwala uxanduva oluphambili lweendleko. Ukuba umntu ubhalisele kwisicwangciso esiphantsi kwesibonelelo esisodwa, ngoko imigaqo phantsi kokulungelelaniswa kwezibonelelo kuya kufaka isicelo sokufumana umyalelo apho ngamnye umshwalense uya kuhlawula. Funda kwakhona: Ulungelelaniso lweeNzuzo kumzekelo.
Inzuzo yoPhuculo oluBini
Njengoko kuboniswe kumzekelo wesi-3 ngasentla, ukuba umntu uhlanganiswe phantsi kweeprogram ezimbini ze-inshorensi yezempilo, baya kuzuza ngenxa yokuba apho umphathiswa oyintloko oyeka ukuhlawula, umzekelo wecandelo le-inshorensi yomshuwalense, ke umphathiswa wesibini angangena kwaye ahlawule umahluko. Oku kungashiya umntu obhalise ukuba angayikhokheli, enenzuzo enkulu.
Inkcazo yezinto ezingabandakanyiyo
Izibhengezo zizinto eziyimfihlo yomshuwalense.
Inkcazo yexesha loBomi
I-inshurensi yezempilo Ixesha leNkcazo yoBomi yimalini yenkampani ye-inshorensi iya kunika umnikazi wepolisi ukuba akhokhe i-premium yomshuwalense wezempilo emva komhla obekwenzileyo ngaphambi kokuba i-inshorensi ikhutshwe okanye ithathwa njengento engekho nto. Umgaqo-nkqubo ngamnye we-inshorensi yempilo iyahluke, qiniseka kwaye ukhangele imimiselo kwisivumelwano sakho. Qaphela, inkampani ye-inshorensi ingakhetha ukuba inamathele iintlawulo zebango zamabango ngaphakathi kwithuba lobabalo kuze kuhlawulwe i-premium.
ObamaCare Grace Ixesha
Ngokutsho kwe-AMA, phantsi kwe-Obamacare okanye abantu abane-Affordable Healthcare Act (ACA) abafumana iikhredithi zempilo ze-premium zangaphambili kwaye abayihlawula iiprojeyam zabo ze-inshorensi zempilo ngokugcwele baya kungena kwixesha eli-90 lobabalo, ukuba bahlawule ubuncinane inyanga enye yabo nkqubo. Ukuba abanakho ukuhlawula iiprayimari zabo ngokupheleleyo ngeli xesha le-90 lomusa, ngoko ke ukuxhaswa kwabo kungacinywa kwakhona ukuya kutsho lokugqibela lwenyanga yokuqala yobabalo. Ukuba banayo ibango kwinyanga yesibini okanye yesithathu, ngaphambi kokuba ixesha lobabalo liphelile ngaphambi kokuba lihlawule, i-inshorensi yabo yezempilo inokubamba ukuhlawulwa kwebango kuze kuhlawulwe intlawulo ngokuzeleyo, kwaye uhlawule kuphela ibango xa kukho imali epheleleyo. ngexesha lobabalo. Nangona kunjalo, intlawulo kufuneka yenziwe ngaphambi kokuphela kwexesha lobabalo okanye ibango linganqatshwa.
Inkcazo yoBomi beMaximum
Le yona maninzi imali yemigaqo-nkqubo ye-inshorensi yempilo iya kuhlawula ubomi bonke. Nika ingqalelo kwiimilinganiselo zomntu ngamnye kunye namaxesha okuphila kwintsapho njengokuba ahluke.
Inkcazo ye-Out-of-Pocket
Ukuphuma kwipokethi ibhekisela kwiindleko zomntu ngamnye. Iindleko zepokothwa zingabhekisela ekungeneni kwe-intlawulo-ntlawulo, imali ye-coinsurance okanye i-deductible. Kwakhona, xa i-term ex -pocket of maximum pocket isetyenziswe, eli libhekiselele kwinqanaba eliza kuhlawulwa ngalo umnyaka wonke ephakamileyo, ngaphandle kwama-premium.
Inkcazo yeemeko zangaphambili
Isimo esele sisekhona yimeko yonyango yokuba umshwalense wayenayo ngaphambi kokuba ipolisi yomshuwalense iqale. Ezinye izicwangciso ziza kubhalela iimeko ezikhoyo ngaphambili kanti ezinye zingabandakanyi ngokupheleleyo. Imiqathango ekhoyo ngaphambili ihlawulwa ngexesha lokulinda ngaphambi kokuba ihlanganiswe, ngamanye amaxesha ayifakiwe ngokupheleleyo.
Inkcazo yexesha lokulinda
Eli lixesha eliza kufuneka lilinde kude kubekho i-inshorensi yezempilo.