Ukungafani phakathi kwabathathi-nxaxheba abangenathatha inxaxheba
Funda malunga nokungafani phakathi kwabanikezeli abathatha inxaxheba (ngaba) kunye nabangabandakanyekanga (abangekho-par). Umnikezeli wezempilo unokukhetha ukungena kwiikontraka kunye nenkampani yomshuwalense kunye nabanye abahlawuli okanye akunjalo, kodwa kukho iingeniso kunye neengxaki kwi-shishini labo kunye nezigulane zabo.
Abanikezeli-nxaxheba (Par) Ababoneleli
"Abaphambili okanye abathatha inxaxheba ngabagqirha okanye abanye ababoneleli bezempilo abanesivumelwano nomthengisi othile we-inshorensi. Ezi zivumelwano zichaza imiqathango kunye neemeko zokuthatha inxaxheba kwabo bobabini umhlawuleli kunye nomboneleli.
Kukho imiphumo embalwa kubanikezeli abathatha inxaxheba abangena kwisivumelwano okanye kwisivumelwano kunye nabahlawuli bomshuwalense. Okubaluleke kakhulu, ababoneleli kufuneka bahambisane nemithetho ethile nemimiselo ebekwe ngumhlawuli:
Iinkonzo Zonyango Lonyango
Icandelo leenkonzo zononophelo zesigulane sesivumelwano phakathi komboneleli kunye nomhlawuli siquka ulwazi malunga neemfuno zonyango kunye nokuphathwa kokusetyenziswa. Umhlawuli ngamnye unokufumana intsingiselo yakhe yonyango oluxhomekeke kwinkcazo ecacileyo: "Ngokubhekiselele kwiinkonzo, unyango, izinto, okanye izinto ezinxulumene nazo eziyimfuneko kwaye ezifanelekileyo ngokusekelwe kubungcali bonyango kunye nemigangatho yononophelo lwezokwelapha ukuxilonga kunye / okanye ukuphatha ukugula okanye ukulimala okanye unyango, iinkonzo, okanye imisebenzi eya kuphucula impilo yesigulane okanye ukuba kungabikho okufanayo kuya kulimaza isigulane. "
Ukusetyenziswa kweemfuno zokusetyenziswa kubonisa izikhokelo zokufumana ukuqinisekiswa kwangaphambili, ukugunyazwa kwangaphambili, okanye enye imfuno ekhethiweyo ngenjongo yokuqinisekisa umgangatho wesigulane kunye nokulawula indleko.
Uxanduva loMonde
Bonke abahlawuli bafuna ukuba isigulane sibe nesigxina kwinxalenye ethile yeebhilidi zonyango. Lo xanduva lwesigulane luboniswe ngedola echithwayo, i-copayment kunye ne-coinsurance. Isivumelwano phakathi komhlawuli kunye nomboneleli ochaphazelekayo ubonisa ukuba umniki-mfuneko kufuneka enze yonke imizamo yokuqokelela uxanduva lomguli.
Iimfuneko zokuhlawula
Iimfuno zokuhlawula iimali zingahluka ngokuxhomekeka kumniki-nkonzo kunye nemimiselo echazwe kwisivumelwano somnikeli wenxaxheba. Ezi mfuno zichaze iinkcukacha malunga nolwazi lwekhowudi, ukuqhutyelwa kwamabango, ulwazi lwefowuni yolwazi, ukufakwa kwexesha ngexesha, iirekhodi zonyango kunye namaxwebhu, izikhokelo zezibheno, kunye nokubuyiselwa.
Ukugqiba ukuba ngaba okanye ungeyena umniki-nxaxheba uya kuxhomekeka kumhlawuli kunye nokuba kuya kuba luncedo njani ekufezeni iinjongo zombutho.
Ababoneleli Bangekho-Nxaxheba
Ababoneleli ngabangaphandle okanye abathathi-nxaxheba ngabagqirha okanye abanye ababoneleli bezempilo abangavumelwanga ukungena kwisivumelwano kunye nomhlawuli we-inshurensi othile, ngokungafani nababoneleli abathathe inxaxheba. Basenokubizwa ngokuba ngabanikezeli benethiwekhi ngaphandle .
Umehluko omkhulu phakathi kwabathathi-nxaxheba kunye nabangabandakanyeli bathengaqiniseki. Ababoneleli abakhetha ukungabandakanyekanga abanaso isiqinisekiso sokuthi baya kufumana inkokhelo evela kumhlawuli we-inshorensi.
Ukuba neSignali yeMonde isabelo seFomu yeZibonelelo
Isabelo sefom yefowuni ifomu eligunyazisa inkampani ye-inshurensi yempilo yegulane ukuba ihlawule ngokuthe ngqo kumgqirha, unyango okanye isibhedlele ukwenzela unyango olufunyenweyo.
Nangona isabelo sezibonelelo asikho isiqinisekiso sokuthi umhlawuli uya kubuyiselwa umntu ongekho ngumboneleli ngeenkonzo, umniki-mboleko unokufumana ilungelo lokufumana intlawulo yeentlawulo ezipheleleyo. Ababoneleli abathatha inxaxheba ababophekanga ukuba bahlengahlengise okanye bahlaziye nayiphi na isahlulo seendleko ezipheleleyo kuba bengenayo isivumelwano.
Kukho ezinye iimeko ezingabalulekanga ngokungekho ngabanikezeli ngeenkonzo ezikhetha ukwamkela isabelo kwiigulane ze-Medicare. I-Medicare idinga ukuba ababoneleli ngabanikezeli abamkeleyo isabelo samkele i-non-par evumelekileyo njengentlawulo epheleleyo.
Enye ingozi yokuba ngumntu ongekho ngumboneleli kukuba izigulane zikhuthazwa yinkampani yomshuwalense ukuba isebenzise ababoneleli abathatha inxaxheba kuphela. Oku kunokuba kunomda kumniki-nkonzo ngenxa yenani elinokuba nezigulane eziza kuba zilahlekelwe ngababoneleli abachaphazelekayo.