Uthini umahluko phakathi kwe-copayment kunye ne-coinsurance? Zombili i-copay kunye ne- coinsurance zinceda iinkampani ze- inshorensi zempilo zigcina imali (kwaye ke gcina iiprayimari zakho ezantsi) ngokwenza unembopheleleko enxalenye yezinto zakho zonyango zempilo. Zomibini ziintlobo zokwabelana ngeendleko , oku kuthetha ukuba uhlawula inxalenye yeendleko zokunyamekela kunye nenkampani yomshuwalense yezempilo inika inxalenye yeendleko zokunyamekela kwakho.
Umehluko phakathi kwe-copay kunye ne-coinsurance
- indlela isabelo seendleko esahlukileyo phakathi kwakho kunye nenkampani yakho yinshorensi yempilo.
- isixa somngcipheko wezemali ngamnye sikubonisa.
Indlela iCopay isebenza ngayo
I-copayment iyimali ebekiweyo oyihlawulayo xa usebenzisa uhlobo oluthile lwenkonzo yokunakekelwa kwezempilo. Umzekelo, unokufumana i-copay ye-$ 40 ukuze ubone ugqirha oyintloko wokunyamekela kunye ne-copay ye-20 yengu-20 ukuze uzalise imithi. Uhlawula imali ye-copay; inkampani yomshuwalense wezempilo yikhokhela yonke ibhasoli. I-copay yakho yaloo nkonzo ayitshintshe kungakhathaliseki ukuba ugqirha lugqithise kangakanani, okanye ingaba iindleko zonyango ziyindleko.
Ngokungafani ne- deductible ehlawulwa kanye ngonyaka, uhlawula i-copay rhoqo xa usebenzisa olo hlobo lweenkonzo zonyango. Ngoko ke, ukuba unayo i-copay ye-$ 40 ukuya kwiofisi yezobugqirha kwaye ubona ugqirha kathathu kwi-ankle yakho, ufanele uhlawule i-$ 40 nganye, u-$ 120.
Indlela yoQoqosho kusebenza ngayo
Ngokuqinisekisana, uhlawula ipesenteji yeendleko zenkonzo yonakekelo yezempilo (ngokuqhelekileyo emva kokuba udibene ne-deductible yakho, kwaye kufuneka uqhubeke uhlawula imali yexabiso kuze kube yilapho udibene nesiphakamiso sakho esiphezulu se-pocket ngonyaka). Inkampani yakho yinshorensi yempilo ihlawula lonke iindleko.
Ngokomzekelo, ukuba unayo i-20% ye-coinsurance yokubhedlelelwa esibhedlele, oku kuthetha ukuba uhlawula i-20% yeendleko zokubhedlelelwa esibhedlele, kwaye i-insurer yakho yezempilo ihlawula enye i-80%.
Ekubeni iinkampani ze-inshorensi zempilo zixubusha kwiirhafu eziphuculwayo kubanikezeli be-in-network yabo , uhlawula i-coinsurance kwinqanaba elithengisiweyo . Umzekelo, ukuba ufuna iMRI, indawo ye-MRI ingaba nezinga eliqhelekileyo lama-600. Kodwa, ekubeni inkampani yakho yinshorensi yempilo ixoxisene nexabiso elihlawulelwayo leedola ezingama-300, iindleko zakho zemali-mali ziya kuba ngu-20% wezinga lokunciphisa ama-300, okanye i-$ 60. Ukuhlawuliswa kweengxowa-mali kwizinga elipheleleyo kunokuba isaphulelo sokuhlawula sisiphoso sokuhlawula esiqhelekileyo esiza kukuhlawula imali engaphezulu kunokuba kufuneka uyihlawule. Ukuba isicwangciso sakho sisebenzisa i-coinsurance, uya kufuna ukuqinisekisa ukuba ibhajethi ithunyelwe kuqala kwi-inshurensi yakho yezempilo yiphina i-adjustment adjustments, kwaye ke inxalenye yakho ihlawulwe kuwe (ngokuchasene nokuhlawula ipesenti yakho phambili ngaphambili yenkonzo).
Iinkonzo kunye neNgxowa yeCopay ngokubhekiselele kwiConinsurance
Inzuzo ye-copay kukuba akukho nto inokumangalela ngayo malunga nenkonzo eninzi. Ukuba i-copay yakho ingama-$ 40 ukuze ubone ugqirha, uyazi kakuhle ukuba uza kuhlawulwa phi ngaphambi kokuba wenze i-aphoyintimenti.
Ngakolunye uhlangothi, ukuba ngenkonzo ihlawula ngaphantsi kwe-copay, kufuneka uhlawule i-copay epheleleyo (ngamanye amaxesha inokuthi ibe yimeko yeemfuno eziqhelekileyo, ezinokuthi zibe neendleko zokuthengisa ezantsi kangangokuthi i-copay yakho yesicwangciso sezempilo seNqanaba 1 iziyobisi zingaba ziphezulu kunexabiso lokuthengiswa kweziyobisi). Ukuba ubona ugqirha ngokuphindaphindiweyo okanye uzalise imimiselo emininzi, iifayili ziyakongeza ngokukhawuleza.
I-Coinsurance iyingozi kuwe ekubeni awukwazi ngokuchanekileyo ukuba uza kuhlawulisa kangakanani uncedo lwenkonzo. Umzekelo, unokufumana uqikelelo lwe-$ 6000 malunga nokuhlinzwa kwakho okuzayo. Ekubeni unesiqinisekiso se-20%, isabelo sakho seendleko kufuneka sibe ngu-1200.
Kodwa, kuthekani ukuba ugqirha adibana neengxaki ezingalindelekanga ngexesha lotyando kwaye kufuneka alungise loo nto? I-bill yakho yokuhlinzwa ingaphuma kuma-$ 10,000 kunokuba uqikelelo lwe-$ 6000 lwangaphambili. Ekubeni i-coinsurance yakho ingama-20% weendleko, ngoku uhlawula i-$ 2000 kunokuba uyi-$ 1200 oye wayilungiselela (isicwangciso sakho sempilo esingaphandle kwe-pocket siyakuthabatha imali oyenayo, ngoko akuyingozi engapheliyo).
Iinkampani zomshuwalense zifana namalungiselelo e-coinsurance kuba bayazi ukuba kuya kuba negalelo elikhulu kwiindleko zezinto ezibizayo ngaphantsi kwe-coinsurance arrangement kunokuba ungathanda ukuba uhlawula i-copay elula. Bathemba ukuba kukukhuthaza ukuba uqiniseke ngokwenene ukuba uvavanyo oluxabisekileyo okanye inkqubo kuba isabelo sakho seendleko sinokuba nemali eninzi, nokuba ngaba i-20% kuphela okanye i-30% yelwayo.
Xa i-Deductible ifaka isicelo?
Uninzi lwezicwangciso ze-inshorensi zempilo zinomdaka oza kudibana phambi kokuba u -coinsurance uqhekeke. Uku kuthetha ukuba uya kuhlawula iipesenti ezili-100 zeendleko zokuxoxwa kocwangciso lwakho unyango de uze ufikelele kwi-deductible, kwaye uhlalutyo lwemali luya kusebenza kude kube udibana ne- out-of-pocket yakho ephezulu ngonyaka.
Iikopi zivame ukusebenzisa ngokufanelekileyo ukususela ekuqaleni, nangona ungakhange udibane ne-deductible yakho okwamanje, ekubeni bavame ukufaka izicelo kwiinkonzo ezihlukileyo kwi-deductible. Ngoko isicwangciso sakho sinokudityaniswa kunye ne-coinsurance esetyenziswa kwiinkathalo zonyango, kodwa ii-copays ezisebenza ekutyelelwe i-ofisi kunye nemiqathango.
Indlela iCopay kunye ne-Coinsurance ezisetyenziswa ngayo kunye
Awunakufanela ukuhlawula zombini i-copay kunye ne-coinsurance kwinkonzo efanayo yokunakekelwa kwezempilo. Ngokomzekelo, kuya kuba yinto engavamile ukuhlawula i-copay ye-$ 40 kwireferensi yokutyelela iofisi, kwaye kwakhona kufuneka uhlawule i-coinsurance ye-20% yeendleko kweso sihlandlo esifanayo. Nangona kunjalo, akukho mthethweni kwi-inshorensi yezempilo ukufuna le nto. Funda isishwankathelo senkxaso ngokucophelela xa ukhetha isicwangciso sezempilo ukuze uqaphele ukuba isicwangciso sempilo sidinga le fom kabini yokwabelana ngeendleko.
Unokuphelisa ngokukhawuleza ukuhlawula i-copay kunye ne-coinsurance kwiindawo ezahlukeneyo zenkonzo yononophelo yezempilo. Nantsi indlela oku kusebenza ngayo. Masithi unayo i-copay ye-$ 50 ukutyelela ugqirha xa usesibhedlele kunye ne-30% ye-coinsurance yokubhedlelelwa esibhedlele. Ukuba ugqirha ukutyelela ngokuphindwe kane esibhedlele, uza kugqiba ukuhlawula i-copay ye-$ 50 nganye kwezo zihlandlo, i-$ 200 kwiindleko ze-copay. Uya kuhlawulwa nesibhedlele i-30% yentlawulo ye-coinsurance yesabelo sakho se-bill bill. Kungathi ngathi uyacelwa ukuba ukhokhe zombini i-copay kunye ne-coinsurance yesibhedlele esifanayo. Kodwa, uhlawula ngokwenene i-copay kwiinkonzo zogqirha, kunye ne-coinsurance kwiinkonzo zebhedlele, ezihlawulwayo ngokwahlukileyo.
Ezinye izicwangciso zezempilo zikhompyutheni ezisebenza kwezinye iimeko kodwa zikhutshwe kwabanye. Umzekelo oqhelekileyo ngowama-copays asebenza kwiindawo zokutyelela kwizithuba eziphuthumayo kodwa ziyakususwa xa ugqiba ukuvunyelwa esibhedlele. Ngaphantsi kwolu hlobo lwesicwangciso, ukutyelela kwi-ER engazange kubangele ukufakwa kwesibhedlele kungaba yi-copay eyi-100. Kodwa ukuba imeko imbi ngokwaneleyo ukuba uphele esibhedlele, awuyi kuhlawula i-copay ye-$ 100, kodwa kunoko kufuneka ukuba ukhokhe i-deductible yakho kunye ne-coinsurance (ukuhambela esibhedlele ngokupheleleyo, kuquka nexesha lakho kwi-ER kunye nexesha lakho njengesigulana esivumelekileyo), ukuya kwi-out-of-pocket ephezulu kwisicwangciso sakho.
IiCopays kunye noQinisekiso lweMithi yeeDakamizwa
Ukwahlukana phakathi kwe-copay kunye ne-coinsurance kunokudideka ngokugqithiseleyo kunye nokusetyenziswa kweziyobisi. Uninzi lwe-inshorensi yezempilo unomfomfom we- drug formula okwazisa ukuba zeziphi izilwanyana izicwangciso zezempilo , kwaye uluphi uhlobo lokwabelana ngeendleko olufunekayo. I-formulary ibeka izidakamizwa kwiindidi zamanani ahlukeneyo, okanye iinqununu, kwaye ifuna ilungiselelo lokwabelana ngeendleko kwiqela ngalinye.
Ngokomzekelo, i-tier ephantsi kakhulu inokuba yiziyobisi eziqhelekileyo kunye neziqhelekileyo, izidakamizwa ezincinci. Loo mbambano unokufuna i-copay ye-$ 15 ngokubonelelwa kweentsuku ezingama-90 zeziyobisi. Umgca wesibini unokuba luncedo kakhulu kwii-brand name name and require a copy of $ 35 ukuze unikezele iintsuku ezingama-90. Kodwa i-top tier (kwizicwangciso ezininzi zezempilo, oku kuphakathi kweNqanaba lesi-4 okanye le-5, kodwa ezinye izicwangciso zempilo ziphula iziyobisi ukuya kumanqanaba angama-6) zinokuba zizonyango ezikhethekileyo eziyindleko ezibiza amawaka eedola nganye kwiqondo.
Kulo mgca, isicwangciso sezempilo sinokushiya i-copay-share sharing-usetyenziso kwizithuba ezingaphantsi kwaye utshintshe kwi-coinsurance naphi na i-20% ukuya kuma-40 ekhulwini. I-coinsurance kwizilwanyana ezibiza kakhulu zivumela i-inshurensi ukunciphisa ingozi yemali ngokutshintsha isabelo esikhulu seendleko zesilwanyana esibuyela kuwe. Oku kunokudideka kuba ininzi imimiselo yakho iya kufuna i-copay echanekileyo, kodwa imimiselo ebiza kakhulu, izidakamizwa eziphezulu, ziza kufuna ipesenti ye-coinsurance kune-copay.
Ukuba ukhona kule meko kwaye ujongene nokuba unokuhlawula amawaka eedola ngenyanga ngeemfuno ezizodwa zemithi, uya kuvuya ukwazi ukuba xa udibene nesicwangciso sakho esiphezulu se-pocket ngonyaka, wakho Isicwangciso sempilo siya kuqala ukuhlawula iipesenti ezili-100 zeendleko zamachiza entsalela yonyaka. Ngaphandle kokuba icebo lakho likhulu okanye likhulu, i-out-of-pocket maximum ayinakuphakama ngaphezu kwe-$ 7,150 ngo-2017, kunye ne-$ 7,350 ngo-2018 (loo mida iyasebenza kumntu oyedwa; Umda uphindwe kabini phezulu).
I-Coinsurance kunye ne-copay inokudideka, kodwa ukuqonda umahluko phakathi kwe-copay kunye ne-coinsurance kuthetha ukuba ulungele ukukhetha isicwangciso sempilo esihlangabezana nezilindelo zakho, uhlahlo lwabiwo lweendleko zonyango kunye neempembelelo zokubamba kwiibhilidi zakho zonyango.
> Imithombo:
> Isebe lezeMpilo kunye neNkonzo zoLuntu, uMkhuseli weMonde kunye noMthetho woNonophelo ojongene noThutho, iSaziso seHSS soNcedo kunye neParameters yokuhlawulwa ngo-2017. Matshi 8, 2016.
> Isebe Lempilo Neenkonzo Zoluntu. Isiqinisekiso soMonde kunye noMthetho woNonophelo ojongene noThathaka, iSaziso seHHS soNcedo kunye neParameters yokuhlawula i-201 8. Disemba 22, 2016.