Inani elinyukayo leenkampani ze-inshorensi kunye nemibutho yokunyamekela iminyango ihlanganisa iyeza elongezelelweyo nelinye, elikhutshwa ngumfuno lwabathengi kunye nomzimba okhulayo wobungqina benzululwazi obonisa inzuzo kunye neendleko-mpu melelo.
Uphando olutsha lwe-HMO ezili-18 kunye nabanikezeli bomshuwalense, kuquka i-Aetna, i-Medicare, i-Prudential, kunye noKaiser Permanente, bafumanisa ukuba aba-14 kubo babhekise ubuncinane kwi-11 ye-34 yezinye iindlela zokwelapha.
I-chiropractic, i-massage therapy, kunye ne-acupuncture yilezi zonyango ezithanjwe kakhulu zilandelwa yimithi ye-naturopathic. Ezinye iindlela zokwelapha eziya kubandakanywa ziyimichiza yemithi, i-homeopathy, ukuphathwa kwengqondo yomzimba kunye nokucamngca.
Kodwa ubungakanani bendlela yokukhawulwa kwemali kusekuncinci; abantu bahlawula iinkonzo ngexabiso elihlawulelwayo-ngenkonzo okanye bavunyelwe inani elincinci leeseshoni.
Isiphumo sokuphela kukuba unyango lugwetywa ngokungafanelekanga njengento engasebenziyo xa ingxaki eyona nto ingavumelekanga ukuba umntu agqibe icebo locetywayo loncedo.
Nazi izimpendulo kwimibuzo engama-12 eqhelekileyo ngemibuzo malunga ne-insurance coverage yonyango elongezelelweyo kunye nelinye.
1. Abantu bahlawula njani ukuhlaziywa kunye nezinye iindlela zokwelapha?
Uninzi lwabantu luhlawula iinkonzo zonyango kunye nezinye iimveliso zonyango ngokwabo.
Inani elikhulayo lezicwangciso zezempilo linikezela ngegalelo lonyango elongezelelweyo nelinye, nangona kunjalo, lusetyenziswa ukukhawulelana kwaye lusehluka ukusuka kurhulumente ukuya kwilizwe.
2. Ndingayifumana njani ukuba kukho nayiphi na imithetho kum imeko yam inshorensi yonyango endiyithandayo?
Unokuzama ukudibanisa nombutho wezobugcisa welizwe olo hlobo lonyango, umzekelo, imibutho ye-acupuncturists.
Uninzi lwale mibutho iqaphele i-inshorensi kunye nokubuyiselwa imali ekhethekileyo.
3. Ndinomshuwalense wezempilo. Ukuba ndinomdla ekufumaneni unyango ukusuka kwicandelo, ngaba yiyiphi imibuzo yemali endiyifunayo?
Okokuqala, kufuneka ube nolwazi malunga nesicwangciso se-inshurensi yezempilo. Ingaba inikezela nayiphi na inkcazo yonyango olongezelelweyo kunye nolunye unyango? Ukuba kunjalo, zeziphi iimfuno kunye nemida? Umzekelo, ngaba isicwangciso sinciphisa iimeko eziza kufikelela kuzo, zifuna iinkonzo zonyango ezongezelelweyo kunye nezongezelelweyo zihanjiswe ngabasebenzi abathile (njengogqirha ogqithisiweyo onelayisenisi okanye oogqirha kwintanethi yenkampani), okanye bajonga kuphela iinkonzo ukuba eso sicwangciso sinquma ukuba mfuneko? Funda isicwangciso sakho ngokucophelela, kubandakanywa nemida kunye nezibonelelo. Ingcinga efanelekileyo ukujonga inkampani yomshuwalense ngaphambi kokuba ufune unyango.
Nazi ezinye iimbuzo ekufuneka zibuze umshwalense:
- Ingaba le nkathalo kufuneka iguqulwe ngaphambili okanye ivunyiwe ngaphambili?
- Ngaba ndifuna ukudluliselwa kumboneleli wam osisiseko?
- Ziziphi iinkonzo, iimvavanyo, okanye ezinye iindleko eziza kugutywa?
- Zingaphi iindwendwe ezigqityiweyo kwaye lixesha lini lexesha (umzekelo, u-6-10 ukutyelela unyaka wokuguqulwa komzimba)?
- Ngaba kukho intlawulo yentsebenziswano?
- Ingaba unyango luya kubanjelwa nayiphi na imeko okanye iimeko ezithile?
- Ngaba ziza kuhlawulwa iindleko ezongeziweyo, ezifana neemvavanyo zebhabhi, izongezo zokutya, izixhobo, okanye iimpahla?
- Ngaba ndiza kufuneka ndibone udokotela kwinethiwekhi yakho? Ukuba kunjalo, unako ukundinika uluhlu lwabaphandi kwindawo yam?
- Ukuba ndisebenzisa udokotela ongeyena inethiwekhi yakho, ngaba unika nayiphi na ingxelo? Ingaba kukho naziphi iindleko ezingaphezulu kwee-pocket?
- Ngaba ikhona na idoli okanye ikhalenda yokukhawulela kwam?
Kuya kukunceda ugcine iirekodi ezihlelekile malunga nazo zonke iintsebenziswano nenkampani yakho yinshuwalense. Gcina iikopi zeencwadi, iibhilikhwe kunye namabango.
Yenza amanqaku malunga neefowuni, kuquka usuku, ixesha, igama lommeleli wenkonzo yamakhasimende, kunye nento oyitshelwe yona. Ukuba awunelisekanga ngcaciso yommeli, cela ukuthetha nomnye umntu.
Ukuba inkampani yomshuwalense idinga ukuba uhanjiswe, qiniseka ukuba uyifumane kwaye uyithathe kunye nodokotela. Ingcamango enhle yokugcina ikopi yeengxelo zakho.
4. Yimiphi imibuzo emali endimele ndiyibuze yona?
Nayi eminye imibuzo ekufuneka uyibuze yona okanye abasebenzi bakhe baseofisi:
- Ngaba uyamkela i-inshurensi yempilo?
- Ngaba ndifake iifom zamabango, okanye ngaba wena (umboneleli) uyayinyamekela loo nto?
- Ziyintoni iindleko zokuqokwa kokuqala?
- Zingaphi unyango ndiza kulufuna?
- Ngaba ndiyakwamkela unyango ngexesha lokuvavanya ukuze ndibone ukuba unyango lisebenza kum phambi kokuba ndizinike kwikhosi epheleleyo?
- Ngaba kukho iindleko ezongeziweyo?
Kungaba luncedo ukubuza ukuba yiyiphi iplani ye-inshorensi eyamkelayo, ukuba ngaba unomdla ekutshintsheni izicwangciso ngexesha elithile (umzekelo, ngokutshintshwa kwengqesho).
Ukuba awunayo i-inshorensi yokufumana unyango kunye nokuhlawula umrhumo opheleleyo ngexesha eliya kuba nzima kuwe, unokubuza:
- Ingaba i-ofisi yakho ingahlela isicwangciso sokuhlawula ukuze iindleko zam zifakwe kwixesha elide?
- Ngaba unika imali yokulinganisa? Umrhumo wezinga lokulinganisa ulungisa iindleko ezisekelwe kwingeniso yesigulane kunye nokukwazi ukuhlawula.
5. Kuthekani ngokubhekiselele kwintengiso yomshuwalense wee-inshorensi ezongezelelweyo ezingenakwenziwa ngabaqeshi?
Ukuba kunikwa igalelo elongezelelweyo kunye neyeza elithile, ngokuqhelekileyo linye yeentlobo ezilandelayo:
Ukuhlawula okuphezulu. I-deductible yiyonke inani leedola elimele umboleki ahlawule phambi kokuba umkhupha umshwalense uqala ukwenza iintlawulo zonyango. Ngaphantsi kwolu hlobo lomgaqo-nkqubo, ukuxhaswa kwonyango olongezelelweyo kunye nolunye luya kunikwa, kodwa umboleki uhlawula i-deductible ephezulu.
Abagibeli bePolisi. Umgibeli uyisichibiyelo somgaqo-nkqubo we-inshorensi onokutshintshwa kwendlela ethile (njengokwenyuka okanye ukunciphisa inzuzo). Unokwazi ukuthenga umgibeli ongeze okanye owandisa ukukhawulelana kwimeko yonyango elongezelelweyo kunye nelinye.
Inethwekhi yenkonzo yabasebenzi. Abanye abaqinisekisi basebenzisana neqela labanikezeli beyeza abancedisayo kunye nabanye abavuma ukuba banikele iinkonzo kumaqela eqela ngesantya esingaphantsi kunezo ezingengamalungu. Uhlawula i-pocket ukuze unyango, kodwa ngezinga eliphantsi.
Abaqeshi baxoxisana neenkampani zomshuwalense ukwenzela ukulungiswa kwemilinganiselo kunye neenkonzo. Oku kwenziwa ngexesha (ngokuqhelekileyo ngonyaka). Unokuba unqwenela ukuvumela i-benefit manager yakho yenkampani ukwazi malunga naluphi na ukhetho olukhethwa kukho. Ukuba inkampani yakho inikeza isicwangciso esingaphezulu kweyodwa, hlalutye ngokucophelela oko ngamnye unikezelayo, ngoko unokukhetha icebo elijongene nezidingo zakho.
I-Arhente yoPhando lwezeMpilo kunye neMigangatho (AHRQ), i-agency ye-Federal, ineempapasho ezincedo malunga nokukhetha nokusebenzisa isicwangciso se-inshorensi yezempilo.
6. Umshuwalense wam undenzele ubungqina, kwiincwadi zenzululwazi nezonyango, malunga nokusetyenziswa kwonyango olongezelelweyo. Ndiyifumana phi?
Iziko leSizwe leNgcaciso kunye noNyango (Alternative Medicine) I-Clearinghouse inokukunceda ukuba ufumane ulwazi kwiincwadi zenzululwazi nezonyango malunga nolunye unyango. Basebenzisa iinkcukacha zeengxelo zezobugcisa zonyango kunye nezokwelapha, ezifana neCAM kwi-PubMed.
7. Ikhampani yam yomshuwalense inqabele ibango lam ngenxa yonyango olongezelelweyo / olunye. Ngaba kukho nto endinokuyenza?
Akukho nto ikhungathekileyo kunokuba kufunyanwe ibango. Kuye kwenzeka nakubantu emva kokuba baqinisekisile phezu kwefowuni nenkampani yomshuwalense malunga nenkathalo ethile.
Njengoko kuxoxwe ngaphambili, qiniseka ukuba uyazi umgaqo-nkqubo wakho kuquka oko kukuthi, kwaye akunjalo, okufuneka ugube. Khangela ukuba kukho impazamo ekukhoneni okanye ekukhokhweni kwenkonzo yakho (ebizwa ngokuba yimpazamo yekhowudi), nokuba yiofisi yecandelo okanye kwinkampani yomshuwalense; thelekisa iikhowudi kwiphatywala yonyango kunye neenkcukacha zedokethi oyifumene kwinkampani yomshuwalense.
Ukuba ucinga ukuba i-insurer yakho yenza iphutha ekuqhubekeni ibango lakho, unokucela ukuhlaziywa kwinkampani.
Kwakhona, inkampani yomshuwalense kufuneka ibe nenkqubo yesibheno kwaye inikeze ikopi yayo ngenqubomgomo yakho. Kungaba luncedo ukuxoxa nodokotela wakho nokuba unokuyenza nantoni egameni lakho, njengokubhala incwadi. Ukuba uthe wathatha amanyathelo kwaye ingxaki ayisombululwanga, qhagamshelana neofisi yakho yomshuwalense we-state, eneenkqubo zesikhalazo somthengi.
8. Ngaba kukho imithetho yokunceda ndigcine i-inshurensi yam impilo xa ndilahlekelwa okanye nditshintshe imisebenzi? Ngaba le mithetho iyasebenza kwiindlela zokwelapha ezongezelelweyo kunye nezinye?
Ukuba njengamanje unesicwangciso se-inshurensi equka nayiphi na inkcazo yokuxhaswa kweyeza kunye nokunye, le mithetho ingayinomdla kuwe.
Umthetho we-Health Insurance and Accountability Act (i-HIPAA) ka-1996 unikezela ukhuseleko oluninzi kubantu baseMerika abasebenzayo. I-HIPAA ikhusela i-inshorensi yempilo yabasebenzi kunye neentsapho zabo ukuba umsebenzi uyatshintsha okanye alahlekelwe ngumsebenzi wakhe. Umthetho:
- Ukunciphisa ikhono leenkampani ze-inshorensi ukuba zithintele ukuxhaswa ngokusekelwe kwiimeko ezixhasayo.
- Ithintela izicwangciso zezempilo zeqela ukukhanyela okanye ukuhlawulisa ngaphezulu ukukhutshwa ngenxa yempilo ekhoyo okanye ekhoyo.
- Ukuqinisekiswa kokuhlaziywa kwenkxaso, kungakhathaliseki nayiphi na imeko yezempilo yabantu abaphantsi komgaqo-nkqubo.
- Amagunya athile abaqeshi abancinci bamashishini, kunye nabantu abathile abaye balahlekelwa umsebenzi ochaphazelekayo, ilungelo lokuthenga inshuwalense yezempilo.
Amaziko e-Medicare kunye neeNkonzo zeMedicaid angakunika ulwazi oluqhelekileyo kwi-Federal HIPAA program. Qaphela ukuba ilizwe ngalinye lingaba nemithetho ethile ehambelana neemfuno ze-HIPAA; Ukuba ufuna ulwazi oluninzi nge-HIPAA kwimeko yakho, qhagamshelana neofisi yomkhoshurensi wakho welizwe.
Omnye umthetho we-Federal onokukunceda nguMthetho wokuQiniswa koHlahlo lwabiwo-mali lwe-Omnibus (COBRA) ka-1985.
I-COBRA yokuqhubela phambili i-postage ikunika ithuba lokuthenga nokugcina igalelo lakho lempilo yexesha elikhoyo malunga nexesha elichaziweyo ukuba unikwe okanye usebenze iiyure zomsebenzi phantsi kwezinga lokufumana inzuzo.
Ubungakanani bokuqhubeka kwekharityhulam kuxhomekeke kwisizathu sokulahleka kwakho kwenkcazo yeqela.
I-COBRA ngokubanzi iquka izicwangciso zempilo zamashishini kunye nabasebenzi abangama-20 okanye ngaphezulu, imibutho yabasebenzi kunye noorhulumente karhulumente okanye basekhaya.
Kufuneka uhlangabezane nexesha elithile lexesha elichanekileyo kunye nezinye iimeko, njengeefomethi zentlawulo, ukugcina ingxelo phantsi kweCOBRA. I-COBRA inokukunceda ukuba ugweme ikhefu ekukhuselweni xa utshintshe imisebenzi kwaye awukhawulezi ngokukhawuleza ukufumana ingxelo kwinkampani yakho entsha.
Ukufumana ulwazi oluthe xaxa malunga neCOBRA, qhagamshelana neofisi yakho esondeleyo ye-Pensions kunye neNtlalo yeNhlalakahle yoLawulo lweSebe lezeMisebenzi.
Urhulumente wakho unokuba nomthetho ofuna abaqinisekisi ukuba baqhubeke nokukhawulela iiplani kwiqela labantu abalahlekelwa inkxaso yabo yezonyango ngezizathu ezahlukahlukeneyo. Hlola ngeofisi yomkhoshurensi wakho welizwe.
9. Ziziphi iingxelo ezihlawulwe irhafu kwiindleko zonyango? Bangandinceda njani?
Ilungiselelo lokuchitha imali (FSA; ngamanye amaxesha libizwa ngokuba yi-akhawunti ye-Flexible Spending Account) inzuzo eyenziwa ngabanye abaqeshi ababonelela indlela yokuncedisa ukuhlawula iindleko zonyango ngaphandle kwexesha, ngelixa kunciphisa imali engenayo yerhafu.
Ngee-FSA zeendleko ezinxulumene nempilo, ukhetha inani lemali e-pre-tax ukuze ibekwe eceleni kwikhokheji yakho nganye. Le mali iyafumaneka kwakhona ukubuyisela iindleko ezithile ezihlobene nezempilo ezingahlawulwa nayiphi na enye indlela, njenge-inshurensi.
Unokudinga ukunikezela ngamaxwebhu avela kumgqirha okanye omnye umboneleli wezempilo ukuba unyango luyimfuneko yonyango.
Qaphela ukuba ii-IRS azivumeli ukuba iindleko ezifanayo zihlawulwe zombini nge-FSA kwaye zifunwe njengedithwa yerhafu.
Olunye uhlobo lwentlawulo ehlawulwa irhafu yeendleko ezihambelana nempilo yi-akhawunti yokulondoloza impilo (HAS). Ukumiselwa yiCongress ngoDisemba 2003, ii-HSA zivumela abantu abathile abathatha inxaxheba kwisicwangciso sezempilo esinokudityaniswa kakhulu ukugcina imali kwi-akhawunti engenakho irhafu. Ukuba uvumelekile, ungasebenzisa lo ndolozo ukuhlawula iindleko zakho zonyango okanye kwiqabane lakho okanye abaxhomekeke kuyo. I-IRS ineempapasho ngolwazi olungakumbi malunga ne-FSA kunye nee-HSA. ISebe le-Nondyebo linxulumene ngqo ngolwazi malunga nee-HSA kwiwebhusayithi yayo.
10. Ngaba uRhulumente waseburhulumenteni unokufumana izixhobo ezinokuncedisa ngemali kunye neendleko zangezempilo?
Okwangoku, iiprogram zoNcedo lwezeMpilo zaseburhulumenteni azisetyenziswanga ukuncedisa ezinye iindleko zeyeza.
Zijoliswe ukubonelela ngenkxaso ngokuthe ngqo (iintlawulo ezithe ngqo) okanye inkxaso engekho ngqo (njengezindlu okanye iinkonzo zokunakekela abantwana, unyango lwezonyango kwiiklinikhi zorhulumente, okanye ezinye iinkonzo zentlalo) kubantu abaqulunqwe nguRhulumente ukuba banesidingo. Imizekelo ibandakanya abantu aba:
- Unomvuzo ophantsi kunye nezibonelelo ezincinci
- Awunayo enye inshorensi yonyango
- Ukukhubazeka
- Ngaba yinxalenye yabemi abanenkinga yokufikelela kwonyango
- Ubuncinane ubuneminyaka engama-65 ubudala
- Ndiye ndikhonza emkhosini
Kukho i-Federal yolwazi kwi-Intanethi engakuzisa kule nkqubo. I-GovBenefits (www.govbenefits.gov) inikeza uluhlu olusisiseko kunye nokuvavanya ukuza kukunceda ukuba uqaphele ukuba naziphi na izibonelelo ezifanelekileyo iimfuno zakho. I-FirstGov (www.firstgov.gov) ineenkcukacha kwiinkqubo ezahlukeneyo zempilo ezifana ne-Medicare neMedicaid.
Njengengxenye yophando lwayo, iZiko leSizwe leNgcaciso kunye noNyango (Alternative Medicine) (NCCAM) liqhuba izilingo zonyango kwezinye iindlela zonyango.
11. Ngaba iinkonzo zonyango ezongezelelweyo kunye neyezinye ezichithwe kwiirekhodi zam zerhafu?
Ukususela ngo-2002, i-IRS ivumela inani elincinci lokuncincika kwiinkonzo ezongezelelweyo kunye nezinye iimveliso.
12. Ngaba unganceda naziphi na ezinye izixhobo?
Ukuba unyango (nokuba ngaba uncedo olongezelelweyo okanye olunye oluqhelekileyo) ngesifo okanye imeko idala inkathazo yezemali kuwe nakwintsapho yakho, unokufisa ukuzama oku kulandelayo ngolwazi olungakumbi:
- Ukuba ufumana unyameko esibhedlele okanye kwikliniki, eso sakhiwo sinokuthi unontlalontle okanye ummeli wesigulane onokukucebisa.
- Unokufumana uncedo ukuqhagamshelana nemibutho engenzi-nzuzo esebenza kwisifo sakho okanye imeko yonyango (zama ukukhangela i-intanethi okanye ukhangele iirejista kwilayibrari yakho yasekuhlaleni).
Umthombo: iiNkcazo zezeMali zabaThengi kwiMidiya eQinisekisiweyo kunye noNyango, iNational Centre yeNcediso yeMicrosoft (Alternative Medicine (NCCAM). http://nccam.nih.gov/health/financial/
Ukuziphendulela: Ulwazi oluqulethwe kule ndawo lujoliswe kwiinjongo zemfundo kuphela kwaye alithathi indawo yeengcebiso, ukuxilongwa okanye unyango.