Ngubani omela iiprayimari, ezisekondari, okanye ezona ziphakamileyo kwiimangalo zonyango

Ukuqonda ukulungelelaniswa kweziNzuzo

Ulungelelaniso lweenzuzo (i-COB) ligama elisetyenziswe xa isiguli sinesibini okanye ngaphezulu kweeinshurensi zempilo. Imithetho ethile isebenza ukucacisa ukuba yintoni isicwangciso se-inshorensi yempilo ehlawula iiprayimari (yokuqala), yesibini (yesibini) okanye ephakamileyo (yesithathu). Kukho izikhokelo ezininzi ukufumana ukuba yintoni umyalelo weofisi yezobugqirha kufuneka ibhawule nganye isicwangciso se-inshurensi yezempilo:

Umthetho oxhomekeke kwiNkundla

Umthetho oxhomekeke kwi-Rondon / Nondwendwe usebenza kwi-inshorensi ye-inshorensi yempilo kunye neqabane lomthengi. Umhlawuli-mali oyintloko uyi-inshurensi yezempilo efaka isigulane njengomqeshwa, umbhalisi okanye ilungu. Umhlawuli-ntlawulo yesibini yinjongo ye-inshorensi yempilo efihla isigulane njengomxhomekeke.

Umthetho wokuzalwa

Umthetho wokuzalwa usebenza kubantwana abaxhomekeke kuyo ukuba ngaba abazali batshatile, bahlulelwanga, okanye banomyalelo wokugcinwa ngokubambisana ongenakucacisa uxanduva loxanduva lwezempilo. Umthetho wokuzalwa usho umhlawuli oyintloko oqeshwe ngumzali onokuzalwa kwakhe kuqala ekupheleni konyaka wekhalenda. Kwimeko apho bobabini abazali banomhla wokuzalwa, isicwangciso se-inshurensi yezempilo esinikezele ukukhutshwa kwexesha elide ngumvuzo omkhulu.

Ulawulo lweMpahla

Umthetho woKwazisa usebenza kubantwana abaxhomekeke kumtshato ohlukanisiweyo okanye abahlukeneyo ngaphandle komyalelo womtshato. Umyalelo wabahlawuli bhorensi ulandela lo myalelo:

1. Umzali okhuselekileyo
2. Umlingane womzali wokulinda
3. Umzali ongekho phantsi
4. Umlingane womzali ongeyena okhuselekileyo

Kwimeko apho kukho umyalelo wokuqhawula umtshato, isicwangciso se-inshorensi yempilo yomzali esabelwe inkundla ukuba ithwale i-inshorensi yempilo yomntwana ngumhlawuli oyintloko.

Umthetho wokuBhalisa

Umthetho wokuBhalisa unquma:

1. Xa umthengi enesicwangciso se-inshurensi yezempilo esebenzayo kunye nesicwangciso se-COBRA (i- Consolidated Budget Reconciliation Act ), i-inshurensi yempilo yonyango ngumvuzo oyintloko.
2. Xa umthengi okanye iqabane lomthengi inesicwangciso se-inshurensi yempilo kunye nesicwangciso seCOBRA, isicwangciso se-inshurensi yempilo ngumthengi oyintloko.
3. Xa umthengi enesicwangciso se-inshurensi yezempilo esebenzayo kunye nesicwangciso se-inshurensi yezempilo engasebenziyo, isicwangciso se-inshurensi yezempilo esisebenzayo ngumhlawuli oyintloko.
4. Xa umthengi unezicwangciso ezimbini ze-inshorensi zempilo, isicwangciso se-inshurensi yezempilo esiye sisebenze ixesha elide kakhulu ngumhlawuli oyintloko.

I-Medicare yesiKhokheli seSondari

I-Medicare Secondary Payer okanye i-MSP ibhekisela kwiintlawulo zeMedare xa i-Medicare engekho yinshuwalense eyona nto. I-Medicare idinga ukuba bonke abanikezeli bezempilo banikezele indlela yokuchonga xa i-Medicare yi-inshurensi yokuqala okanye eyesiqhelo kwiigulane zabo zeMedare. I-Medicare ibaluleke xa isigulane sithe:

1. 65 okanye ngaphezulu kwaye unesicwangciso esithile sezempilo esincinane ngokusebenzisa umqeshi wakho wangoku okanye ngomqeshi waloo mlingane
2. 65 okanye ngaphezulu nge-inshurensi ngokusebenzisa isicwangciso somhlalaphantsi
3. Abakhubazekileyo kunye neqela lempilo elincinci ngokusebenzisa umqeshi wabo wangoku okanye ngomqeshi waloo mlingane

Kwimeko apho i-inshurensi eyinkuba iphika ibango, i-Medicare inokuhlawula kuphela kwiimeko ezithile.

Intshuwalense yeNtlawulo yeThathu

Ngenxa yeenkonzo ezinxulumene neengozi, i-inshorensi yemfanelo yenkampani yesithathu kufuneka ihlale ifakwe njengeyona ndawo:

1. Inqwelo yeenqwelo okanye i-Auto Insurance ngaphandle kwephulo, umgaqo-nkqubo okanye iMed Pay
2. Inkonzo Yomshuwalense Wembuyekezo
3. Intshurensi yomninikhaya
4. I-inshurensi yokungasebenzi
5. I-Intshumo yoNyununu

Uxilongo - Umhlawuli werhafu yokugqibela

I-Medicaid ihlala ihlawula umvuzo wokugqibela. Oku kuthetha nje ukuba iMedicaid ihlawula ixesha lokugqibela apho ezinye iinjongo ze-inshorensi zempilo zikhoyo. Abafumanayo kufuneka bahlale bexhaswa yiMedicaid nayiphi na inkcazelo ye-inshurensi yezempilo. Ababoneleli banembopheleleko yokwazisa iMedicaid ye-inshurensi yenkampani yabanye bayifumana kunye nokukwazisa iMedicaid nayiphi na intlawulo yeentlawulo abafumanayo egameni lommkeli.