I-HMO, i-PPO, okanye i-POS? Indlela yokuchonga iSicwangciso esilungileyo kuwe.
Ngaba ujongene nokwenza isigqibo malunga naluphi icebo lempilo yeqela lokukhetha kumqeshi wakho? Unakho ukhetho lokukhetha naziphi na izicwangciso ezintathu zokunyamekela eziphathisiwe-i-HMO, i-PPO, okanye i-POS. Ngelixa zonke ezi zicwangciso zibonelela ngononophelo olunzulu lweenkonzo zonyango, nganye zikhona iinkalo ezahlukeneyo kwezi zicwangciso. Ngaphambi kokuba wenze isigqibo kwisicwangciso sakho sokunakekelwa kwezempilo, uya kufuna ukwazisa ngeminikelo nganye.
Isicwangciso okhethiweyo kufuneka sisekelwe kwiimfuno zakho, iinkcukacha zezempilo kunye nokuqwalaselwa kwezemali.
Imibutho yezoMpilo (ii-HMO)
I-Organisation Management Management (i-HMO) yinkqubo enika ukunakekelwa ngononophelo olunzulu kwisibonelelo esikhokhelwa ngokuzithandela kubhaliso lwabavolontiya kwindawo ethile. Ii-HMO zigxininisa ukunakekelwa kokuthintela kunye nendlela yokuphila enempilo.
Ukunyulwa kwababoneleli ngezeNgcali
I-HMO inikezela ngogqirha ngamagqirha kunye nabasebenzi kunye / okanye abasebenzi abanezonyango, izibhedlele kunye nabanye oogqirha. Amalungu (izigulane) ayadingeka ukuba afumane unyameko kubanikezeli-nkonzo abambene ne-HMO. Ama-HMO amaninzi asebenza kwindawo engalinganiswanga yendawo, njengendawo yedolophu. Ukuba kufuneka unyango lwangaphandle kwendawo ye-HMO ekhankanywe kuyo, iya kunikwa ngethuba loxakeka kuphela.
Iindleko zePocket Out-of-Pocket
Ii-HMO zinikela ngononophelo lweenyanga eziqhelekileyo ngokuqhelekileyo ngaphandle kokunciphisa okanye ukuthengiswa kwemali.
Kwezinye iintlobo zezicwangciso, i-premium yenyanga ihlawulwa, kodwa bonke ababoneleli bahlawulwa njengoko iinkonzo zinikezelwa. I-HMO ihlawula ababoneleli ngokuthe ngqo kwaye, kwezinye iimeko, ababoneleli bangaqokelela i-copayment encinci ukutyelela iofisi.
Ulawulo lweNdleko
I-HMO igxininisa ukunakekelwa kokuthintela kwaye oogqirha abanakho ukukhuthaza ukuba bafumane "iimvavanyo" okanye unyango.
Kwezinye iimeko, oogqirha kunye nabanye abaqeqeshi bezonyango banokufumana iibhonasi ukuba isakhiwo se-HMO sisebenza ngendlela echanekileyo. Kuye kwagxininiswa ekunciphiseni iindleko ngokwenza iinkqubo ezithile kwisithuba sengqondo esisodwa kunye nokuvuma isigulane esibhedlele.
Abamasango
Ngokomlando, ii-HMO zinike ilungu ngalinye "umgcini-masango," oqhelekileyo ugqirha wezonyango okanye mhlawumbi umqeshwa. Kutshanje, ezinye ii-HMO zivumela amalungu ukuba axhumane neengcali zentengiso ngqo. Lo mgcini-mgcini uqondisa ukunakekelwa kwabasemagunyeni kwaye unquma ukuba nini kwaye ukuba umntu okhuselekile uza kutyelela ingcali, angeniswe esibhedlele, njl njl.
I-PPACA idinga ukuba umthengi avunyelwe ukukhetha umgcini wesango.
Ukunyamekela
Ii-HMO zigxininisa ukunakekelwa kokuthintela okuqhelekileyo kubandakanya ukukhutshwa okupheleleyo kwezigonyo kunye namayeza eqhelekileyo.
Inkqubo Yeebango
Bonke ababonelela ngesicwangciso bajongana ngqo ne-HMO yokuhlawula xa benza iikontraka zenkonzo. Kwiimeko ezininzi, i-HMO isebenzisa umniki-mboleko ukwenzela ukuba akukho mfuneko yemimiselo eyimfuneko. Ii-HMO zihlawula abathengi abaxhasiweyo kwiindlela ezahlukeneyo zokuthetha.
Imibutho yabanikezeli abathandayo (ii-PPOs)
Imibutho enikezelwayo yinkampani ifana nesicwangciso sonyango esibalulekileyo ngaphandle kokuba iipontrakthi ze-PPO ezineentlobo ezininzi zononophelo lwempilo "abanikezeli abakhethiweyo" ukufumana iindleko eziphantsi.
Ababoneleli bahlawula ngokuhlawula imali-ngenkonzo. Urhulumente ngamnye ulawula i-PPOs kunye neenkampani ze-inshorensi ezineziPPO ezininzi.
Ukunyulwa kwababoneleli ngezeNgcali
Isakhiwo senzuzo yePPO sifana nesicwangciso sonyango esibalulekileyo. Kukho inethwekhi yabanikezeli abathandwayo bamayeza, izibhedlele, njl., Kodwa i-insureds inokukhetha ukuphuma ngaphandle kwenethiwekhi ukufumana unonophelo. Nangona kunjalo, ukuba i-inshurensi ingaphandle kwintanethi, i-insured kufuneka ilindele iindleko ezingaphezulu kwe-pocket.
Izidingo zokuQala
I-PPO iya kufuna ukuvunyelwa kwi-PPO ngaphambi kokunyangwa kwezibhedlele, izicwangciso zonyango, njl njl.
Iindleko zePocket Out-of-Pocket
Umshurensi uya kuphinda ahlawule i-premium yenyanga ehleliweyo njengelungu le-PPO. Ukongezelela, iikopi, i-coinsurance, kunye ne-deductibles ziqhelekileyo.
Ukuba isiqinisekiso siya kumboneleli ongaphandle kwintanethi, i-coinsurance kwaye mhlawumbi iyahlawula kwaye iyancitshiswa iya kuphakama ngaphezu kwonyango ngaphakathi kwoluhlu oluvunyiweyo lwababoneleli bezempilo.
Ukunyamekela
Kwiminyaka yakutshanje, ii-PPOs zandise iinkonzo zokunakekelwa kwezithintelo, kodwa aziqhelekanga ngokubanzi njengoko i-HMO icebo.
Inkqubo Yeebango
Ukuba ngababoneleli benethiwekhi banikezela iinkonzo, ababoneleli baya kufaka amabango ngePPO. Ukuba ngababoneleli
bengaphandle kwenethiwekhi, i-insured ingaba nexanduva lokufakela ibango, nangona umniki-mboleko angafumana isigunyaziso kwi-insured ukuba ifake ibango ngqo.
Izicwangciso zeNkonzo (iPOS)
IsiCwangciso seNkonzo-nkonzo (POS) yi-hybrid ye-HMO kunye ne-PPO. Uhlobo oluqhelekileyo lwe-POS "yi-HMO evulekile," evumela amalungu e-HMO ukuba ahambe ngaphandle kwenethiwekhi ye-HMO kwaye alawulwe ipesenti ye-coinsurance ephezulu. I-POS engaqhelekanga "i-PPO yesango," esebenza njengePPO, kuquka nokusetyenziswa kwabanikezeli benethiwekhi ngamalungu, kodwa ugqirha wezonyango ulona lisebenza njengomgcini-masango.
Ukunyulwa kwababoneleli ngezeNgcali
Naluphi na uhlobo lwesicwangciso se-POS, i-insureds inokukhetha ukungena ngaphandle kwenethiwekhi ukufumana unonophelo. Nangona kunjalo, ukuba i-inshurensi ingaphandle kwintanethi, i-insured kufuneka ilindele iindleko ezingaphezulu kwe-pocket. Umgcini-wesango anganciphisa ukufikelela kwiingcali ngaphandle kwesicwangciso.
Izidingo zokuQala
Isicwangciso se-POS siya kufuna ukuvunyelwa kwi-PPO ngaphambi kokunyangwa kwezibhedlele, iinkqubo zonyango, njl njl.
Iindleko kwiNkxaso-mali
Njengentlangano ye-HMO kunye ne-PPOs, ababoneleli be-POS bahlawula i-premium yenyanga kumalungu abo, kwakunye neepayipi xa kuthe tye oogqirha benethiwekhi. Iideductibles zingasebenza, kuxhomekeka kwisicwangciso esithile. I-Coinsurance inokufaka izicelo kubanikezeli bee-out-of-network.
Ukunyamekela
Kungenzeka ukuba i-POS iya kubandakanya ezinye iinkonzo zokunakekela ukhuseleko, kodwa ziyahluka ngohlobo lwePOS plan.
Inkqubo Yeebango
Ukuba ngababoneleli benethiwekhi banikezela iinkonzo, ababoneleli baya kufaka amabango ngePPO. Ukuba ngababoneleli bangaphandle kwe-intanethi, i-insured ingaba nexanduva lokufakela ibango, nangona umniki-mboleko angafumana isigunyaziso kwi-insured ukuba ifake ibango ngqo.
COBRA
Ngelixa i-COBRA ingahambelani nezicwangciso zeenkonzo zokunakekelwa kwempilo, kulabo bantu abafumana "isiganeko esifanelekileyo," i-COBRA, uMthetho wokuQiniswa koHlahlo lwabiwo-mali we-Omnibus ku-1985 , iya kubangela ukuba abasebenzi nabathengi abathile bafumane inkcitho yeqela elifanayo lonyango i-inshorensi, ngaphandle kobungqina bokungaqiniseki, kwiinyanga ezingama-36.
Ngokuxhomekeke kwisiganeko esifanelekileyo, ukuhanjiswa kungaqhubeka kwiinyanga ezili-18-36. Iziganeko ezinjalo ezifanelekileyo zi:
- Ukupheliswa komsebenzi, ngaphandle kokungaziphathi kakuhle (iinyanga ezili-18).
- Ukunciphisa kwimizuzu yomsebenzi womqeshwa ukuya kumlinganiselo wokuba engasenelungelo lokufumana ingxelo.
- Ukulahlekelwa kwenkxaso-mboleko ngumxhomekeke ngenxa yempilo yomqeshwa, umtshato, ukwahlukana ngokomthetho, okanye ukufaneleka kwe-Medicare.
- Ukulahlekelwa kwimeko yokuxhomekeka kubantwana bemivuzo (umzekelo, ukufikelela kumda osemgangathweni weminyaka)
Ukuba ngaba kwenzeka isiganeko esifanelekayo, aba bantu balandelayo bafumana abaxhamli abaneemfanelo ezifanelekileyo ukuqhubela phambili kwenkcazo yeqela:
- Umqeshwa okhuselekileyo
- Umlingane womqeshwa okhuselekileyo
- Abantwana abaxhomekeke kubasebenzi
- Ukulandela abaqeshi akudingeki ukuba banikezele ukuhanjiswa kokusebenza kwabasebenzi babo:
- Abaqeshi abanabasebenzi abangaphantsi kwe-20
- Iicawa
- Abaqeshi bakaRhulumente
Umqeshwa ofanelekileyo unokukhetha ukwenziwa komsebenzi phantsi kwe-COBRA ngexesha leentsuku ezingama-60 emva kwangoko emva kwemihla emibini:
- Umhla wokubhengezwa komntu unqumla, okanye
- Umhla umcwangcisi wezaziso wazisa umxhamli ofanelekileyo welungelo lomzuzi ukuba aqhube phambili
Isicwangciso somlawuli siyafuneka ukuba sazise bonke abaxhamliweyo abafanelekileyo kwiintsuku ezili-14 zolwazi lwesiganeko esifanelekileyo. Umqeshi unemihla engama-30 ukuze azise umlawuli xa kwenzeka isiganeko esifanelekayo. Ixesha lokhetho le-COBRA liqala ngemihla yesiganeko esifanelekileyo kwaye kufuneka lugcine ubuncinane iintsuku ezingama-60 ukususela ngexesha umzuzi afumana isaziso kumlawuli.
Ngaba ucinga ukuba uluhlobo luni lweqela lonyango lokunyulwa? Qiniseka ukwenza umsebenzi wesikolo sakho kwaye uqonde oko kufakwe kwisicwangciso ngasinye.
Ukubhengezwa: Le ngcaciso inikezelwa kuwe njengomthombo wolwazi kuphela. Kuhanjiswa ngaphandle kokuqwalaselwa kweenjongo zotyalo-mali, ukunyamezela ngengozi okanye imeko zezimali kwanoma yimuphi umtyalo-mali othile kwaye angenakufaneleka kubo bonke abatyalo-mali. Ukusebenza kwangaphambili akubonakali kweziphumo ezizayo. Utyalo-mali luquka ubungozi kubandakanya ukulahlekelwa kwinqununu. Le ngcaciso ayijoliswanga, kwaye ayifanele, yenze isiseko esisisiseko saso nasiphi isigqibo sotyalo-mali ongayenza. Njalo qhagamshelana nomcebisi wakho wezomthetho, wezorhafu okanye utyalo-mali ngaphambi kokuba wenze nayiphi na ingxowa-mali / ityala / indawo / izicwangciso zezimali okanye izigqibo.