Iingcamango ezi-7 zibalulekileyo ekusebenziseni iziCwangciso zakho zeMpilo ngokuBulumko
Ukuba untsha kwi-inshurensi yezempilo kukho iziqulatho eziyisixhenxe ezisisiseko omele uziqonde ukukhusela izinto ezinzima zemali. Ukuba awuyiqondi le ngcaciso ebalulekileyo, awuyi kukwazi ukukhetha isicwangciso sezempilo ngokufanelekileyo okanye usebenzisa i-inshorensi yakho yempilo ngokufanelekileyo.
Ukwabelana ngeendleko
Inkampani yakho yinshorensi yempilo ayiyi kuhlawula zonke iindleko zonyango zakho. Unembopheleleko yokuhlawula inxalenye yezinyathelo zakho zokunyamekela ngempilo nangona unayo inshorensi yempilo.
Oku kwaziwa ngokuba ukwabelana ngeendleko kuba wabelana ngeendleko zempilo yakho kunye nenkampani yakho yinshorensi yezempilo.
Ezi zintathu iindlela eziqhelekileyo zokwabelana ngeendleko zidityaniswa, iipayili , kunye ne- coinsurance . Ezinye izicwangciso zezempilo zisebenzisa zonke iindlela zobugcisa, ngelixa abanye bangasebenzisa enye okanye ezimbini kuphela. Ukuba awuyikuqonda iimfuno zokwabelana ngeendleko zezempilo, awukwazi ukuba uyazi ukuba uza kuhlawula phi na uncedo lwenkonzo yonakekelo lwempilo.
I- deductible yinto ekufuneka uyihlawule ngonyaka ngaphambi kokuba u-inshorensi yempilo yakho ikhawule ngokupheleleyo kwaye uqale ukuhlawula isabelo sayo. Ngokomzekelo, ukuba unayo imali engama-$ 1,000, ufanele uhlawule i-$ 1000 yokuqala yee-billing yakho zempilo ngaphambi kokuba inkampani yakho yinshorensi iqale ukuhlawula. Emva kokuba uhlawule i-$ 1,000 kwiindleko zonyango lwempilo yakho, "udibene ne-deductible" ngaloo nyaka kwaye awuyi kuhlawulwa nayiphi na into echithwayo kunyaka ozayo.
Ngombulelo kuMthetho woNonophelo olungabonakaliyo, inkampani yakho yinshorensi yempilo ngoku kufuneka ihlawule ukhuseleko lwakho lwezempilo olukhuselekileyo ngaphandle kokufuna ukuba uyihlawule okokuqala.
Oku kuthetha ukuba kuya kuhlawula izinto ezifana nokuhlolwa kwakho kwenyama yonke kunye nokuhlola i-mammogram nokuba ngaba awuzange udibane ne-deductible yakho okwamanje. Nangona kunjalo, gxotha i-ankle yakho okanye ufumane umkhuhlane kwaye uya kufuneka udibane ne-deductible phambi kokuba umgcini-mali wakho ahlawule.
Funda kabanzi malunga nokudityaniswa kwi-" Deductible-Into eyiyo kunye nendlela eSebenza ngayo ."
Iikopi zincinci elincinci, elihlawulelwayo elihlawula rhoqo xa ufumana uhlobo oluthile lwenkonzo yokunakekelwa kwezempilo. Ngokomzekelo, unakho u-$ 40 ikhoyayure ukufumana ugqirha. Oku kuthetha ukuba naliphi na ixesha xa ubona ugqirha, uhlawula i-$ 40 ukuba ibhajethi yegqirha i-$ 60 okanye i-$ 600. Inkampani yakho ye-inshorensi ihlawula lonke ixesha.
Inkxaso-mali yipesenti yebhili-mali ohlawula rhoqo xa ufumana uhlobo oluthile lwenkonzo yonakekelo lwempilo. Ngokomzekelo, ukuba une-30% ye-coinsurance ye-hospital hospital kunye ne-bill yakho yesibhedlele i-$ 10,000, uya kuhlawula i-$ 3,000; inkampani yakho yomshuwalense iya kuhlawula i-$ 7,000.
Funda kabanzi malunga neepayayenti kunye ne-coinsurance, inzuzo kunye neengxaki zecandelo ngalinye, kunye neenkxalabo ezimbi ukuzijonga ngokubhekiselele kwi " Uphi umehluko phakathi kweCopay kunye neNkxaso-mali? "U
Kukho-kwe-Pocket Ubukhulu
I-out-of-pocket maximum yiyona nto apho unokuyeka ukukhipha imali ephaketheni lakho ukuhlawula iidroxable, i-copayments kunye ne-coinsurance. Emva kokuba uhlawule ngokwaneleyo ukuya kwii-deductibles, i-copays kunye ne-coinsurance ukulingana nesicwangciso sakho sempilo esiphezulu se-pocket, yakho inshurensi yempilo iya kuqala ukuhlawula i-100% yeendleko zonyango zempilo yakho yonke loo nyaka. Njengemali edityanisiweyo, imali oye uyihlawula kwi-out-of-pocket ephezulu yokuthengisa ekuqaleni kwonyaka ngamnye.
Funda kabanzi malunga ne-out-of-pocket ephezulu kwi " Out-of-Pocket Maximum-Indlela Esebenzayo Nesizathu Sokuba Uqaphele ."
Network Networks
Uninzi lwezicwangciso zezempilo zineenkonzo zononophelo zonyango eziye zenza isivumelwano kunye nesicwangciso sezempilo ukubonelela ngeenkonzo ngexabiso lokuncishiswa. Ngokubambisana, aba banikezeli ngeenkonzo zonyango bayaziwa njengenethiwekhi yomboneleli wezempilo . Inethiwekhi yomboneleli ayibandakanyi nje oogqirha kuphela, kodwa nezibhedlele, ii-laboratories, amaziko okunyanga, ii-X-ray kunye namaziko okucinga, iinkampani zempilo yasemakhaya, amaziko okhuseleko, iinkampani zonyango, izigulane zokuhlinzwa eziphuthumayo, amaziko okunakekelwa ngokukhawuleza, ii-pharmacy kunye nezinye ezininzi iintlobo zabanikezeli beenkonzo zonyango.
Abanikezeli benonophelo lwempilo babizwa ngokuthi "in-network" ukuba ngaba yinxalenye yesicwangciso sakho senethiwekhi yomboneleli wezempilo, kwaye "ngaphandle kwe-network" ukuba ayingeyona inxalenye yomncedisi wenethiwekhi yakho.
Isicwangciso sakho sezempilo sifuna ukuba usebenzise ababoneleli ngee-intanethi kwaye unikeza izikhuthazo ukuba wenze njalo. Ezinye izicwangciso zempilo, ngokuqhelekileyo i- HMOs kunye nee- EPO , aziyi kuhlawula nayiphi na into enokuyinyamekela oyifumana kwiinkonzo zononophelo zezempilo ngaphandle kwe-network. Uhlawula lonke i-bill yakho ngokwakho xa uphuma ngaphandle.
Ezinye izicwangciso zezempilo, ngokuqhelekileyo i- PPOs kunye nezicwangciso ze-POS, hlawula inxalenye yeendleko zokunyamekela ozifumanayo kubanikezeli bee-out-of-network, kodwa ngaphantsi kokuhlawula xa usebenzisa umnikezeli wenethiwekhi. Umzekelo, i-PPO yam idinga i-copay ye-$ 45 ukuze ibone udokotela okhethekileyo kwi-network, kodwa i-50% ye-coinsurance xa ndibona ingcali engaphandle kwesevisi. Esikhundleni sokuhlawula i-$ 45 ukuze ubone i-cardiologist ye-in-network, ndinokuphelisa ukuhlawula i-$ 200- $ 300 ukuze ndibone i-cardiologist yangaphandle kwintsebenzo, kuxhomekeke kwisixa-mali.
Ukugunyazwa kwangaphambili
Uninzi lwezicwangciso zempilo aluyi kukuvumela ukuba uncede naluphi na iinkonzo zempilo enqwenelayo, nanini na naphi na ukuthanda kwakho. Ekubeni isicwangciso sakho sezempilo sinyathela ubuncinci inxalenye yebhili-mali, kuya kufuna ukuqiniseka ukuba unyanzelekile uncedo lwempilo ofumanayo, kwaye ukuba uyifumana ngendlela efanelekileyo ngokwezoqoqosho.
Enye yeendlela eziqinisekisiweyo ze-health insurance insurers ukufeza oku kuyimfuno yokugunyazwa kwangaphambili . Ukuba isicwangciso sakho sempilo sinye, kuthetha ukuba kufuneka ufumane imvume yezempilo ngaphambi kokuba ufumane uhlobo oluthile lwenkonzo yonakekelo lwezempilo. Ukuba awufumani imvume kuqala, icebo lempilo liya kulahla ukuhlawula kwaye uya kubambelela kwi-bill.
Nangona ababoneleli bezempilo behlala befumana iinkonzo zangaphambili ezigunyazisiweyo ngokuzenzekelayo, ekugqibeleni umthwalo wakho wokuqinisekisa ukuba nayiphi na into efunekayo ukuba igunyazisiwe kwangaphambili igunyazisiwe ngaphambili. Emva kwakho konke, nguwe ophelisa ukuhlawula xa le nyathelo liyehliswa, ngoko ke inkohliso imele ihambe kunye nawe.
Isiqinisekiso sokuQala ukuVunywa-Kutheni kufuneka uqaphele .
Amabango
Inkampani yakho yinshorensi yempilo ayikwazi ukuhlawula iindleko ezingazi ngayo. Ibango le-inshorensi yezempilo yindlela iindlela ezininzi zezempilo ezikwaziswa ngayo malunga ne-bill bill. Kwiinkqubo ezininzi zempilo, ukuba usebenzisa umboneleli we-in-network, lowo mboneleli uya kuthumela ngokuzenzekelayo ibango lakho kwi-insurer yakho yempilo. Nangona kunjalo, ukuba usebenzisa umnikezeli wangaphandle, unokuba nguye ojongene nokufakela ibango.
Nangona ungacingi ukuba isicwangciso sakho sezempilo siya kuhlawula nantoni na kwibango, kufuneka uyifake. Umzekelo, ukuba ungacingi ukuba isicwangciso sakho sezempilo siya kuhlawula ngenxa yokuba awuzange udibane ne-deductible yakho okwangoku, kufuneka ufake ifowuni ukuze imali oyihlawulayo ihlawulwe kwi-deductible yakho. Ukuba isicwangciso sakho sezempilo asazi ukuba uchithe i-$ 300 kwonyango ye-ankle ehlanjwe, ayikwazi ukuthenga ukuba i-300 engama-deductible.
Ukongezelela, ukuba unayo i- akhawunti yokuchithwa kwemali ehlawulwayo ehlawulela iindleko zenkathalo zempilo ezingakhokhelwa yinshurensi yakho yezempilo, i-FSA ayiyi kubuyiselwa uze ubonise ukuba i-insurer yakho yezempilo ayizange ihlawule. Indlela yodwa onokubonisa ngayo oku kufaka ibango kunye ne-insurer yakho.
Iintlawulo zeeNyanga
Imali oyihlawulayo ukuthenga i-inshorensi yempilo ibizwa ngokuba yi- premium yomshuwalense wezempilo. Ngokuqhelekileyo, kufuneka uhlawule iimali-mali ze-insum yenyanga. Ukuba awuyi kuhlawula loo nyanga, mhlawumbi uya kukhishwa i-inshorensi yempilo yakho.
Ngamanye amaxesha awuyikuhlawula i-premium yenyanga. Oku kuqhelekileyo xa ufumana i-inshorensi yakho yempilo ngomsebenzi wakho. Isabelo se-premium yenyanga siyakhutshwa kwikhokheji yakho nganye, kodwa umqeshi wakho uhlawula inxalenye ye-premium yenyanga. Oku kuncedo kuba ungeyinyameko yonke imithwalo, kodwa yenza kube nzima ukuqonda iindleko zinyani kunye nenani le-inshorensi yakho yempilo.
Ukuba uthengula i-inshorensi yakho yempilo kwi-Career Affordable Care Act yakho, utshintshe imali yenkxaso-mali ye-arhente, ukuba uncede ukuhlawula iikhoyamu zakho zenyanga. Ukuxhaswa kusekelwe kwingeniso yakho kwaye ihlawulwa ngqo kwinkampani yakho yomshuwalense wezempilo ukuze wenze isabelo sakho se-premium yenyanga. Funda kabanzi malunga ne-Care Affordable Act yoNcedo lwe-inshorensi yezempilo " Ngaba Ndinokufumana Uncedo Lokuhlawula Intshuwalense yezeMpilo? "U
Ubhaliso oluvulekileyo noBhaliso oluKhethekileyo
Awukwazi ukubhalisela i-inshorensi yempilo xa ufuna; uvumelekile ukuba ubhalisele i-inshurensi yezempilo ngamaxesha athile. Oku kukuthintela abantu ukuba bazame ukugcina imali ngokulinda de bagula ukuba bathenge inshuwalense yezempilo .
Ungabhalisela i-inshurensi yezempilo ngexesha lokubhalisa okuvulekileyo . Uninzi lwabaqeshi banexesha lokubhalisa elivuliwe rhoqo ngonyaka, ngokuqhelekileyo ekwindla. I-Medicare inexesha lokubhalisa elivulekile nganye ekwindla. Unonophelo olungabonakaliyo Umthetho we-inshurensi yempilo yonyango unobhaliso oluvulekileyo rhoqo ngonyaka. Ukuba awuyi kubhalisela i-inshurensi yezempilo ngexesha lokubhalisa elivulekile, uya kufuneka ulinde kuze kube yithuba elizayo lokubhalisa, ngokuqhelekileyo ngonyaka kamva, ithuba lakho elilandelayo.
Okungavumelekanga kulo mgaqo, obangelwa ziziganeko ezithile, lixesha lokubhalisa okhethekileyo. Ithuba lokubhalisa elikhethekileyo lixesha elifutshane xa uvumelekile ukuba ubhalisele i-inshorensi yezempilo nangona kungabhaliso oluvulekile. Izihlandlo zobhaliso ezizodwa zivakala xa ulahlekelwa yinshurensi yakho yezempilo okanye utshintsho lobukhulu bentsapho. Umzekelo, ukuba ulahlekelwa ngumsebenzi wakho kwaye ngaloo ndlela unomshuwalense wezempilo osuselwe kumsebenzi, oko kuya kubangela ixesha lokubhalisa okhethekileyo kwi-yashishini yakho yoshishino yomshuwalense ekunikezela iintsuku ezingama-30 ukuya kuma-60 ukuze ubhalisele isicwangciso sempilo esekelwe kwishintshana nangona bhaliso oluvulekile.
Funda kabanzi malunga nezihlandlo ezizodwa zobhaliso, indlela asebenza ngayo, kwaye yintoni ebangela ukuba babekho " Kwimizuzu yokuBhalisa okhethekileyo? "U