Indlela yokuchaza indlela oyichaza ngayo ngeenzuzo
Yiyiphi inkcazo yeeNzuzo?
Inkcazo ye-Benefits (i-EOB) ifom okanye umqulu onokuthunyelwa kuwe kwinkampani yakho yomshuwalense emva kweeveki okanye kwiinyanga emva kokufumana inkonzo yononophelo ehlawulwa yinkampani yomshuwalense (okanye emva kokuba ibango lifakwe, nokuba Iindleko ezipheleleyo zafakwa kwixabiso lakho elichithwayo kwaye uthathwa uxanduva lwakho).
Ufanele ufumane i-EOB ukuba unomshuwalense wonyango wabucala, isicwangciso sempilo esivela kumqeshi wakho, okanye kwi-Medicare.
Isipho esivela kuDkt Mike: Ukuba uyilungu lenhlangano yokugcinwa kwempilo (HMO) ehlawula ugqirha wakho ngokubetha (imali ehleliweyo nyanga nganye ukunyamekela), awukwazi ukufumana i-EOB kuba ugqirha wakho ingayikhokhisi inkampani yomshuwalense. Olu hlobo lwesilungiselelo aluqhelekanga.
I-EOB yakho ikunika ulwazi malunga nendlela ibango le-inshurensi evela kumniki-nkonzo (njengogqirha okanye esibhedlele) ihlawulwe ngenxa yakho.
Ngolwazi olunjani kwiNgcaciso yam eNcedo?
I-EOB yakho inolwazi oluninzi luncedo lunokukunceda ukulandelela iinkcitho zakho zezempilo kunye nokukhumbuza iinkonzo zonyango ozifumene kule minyaka edlulileyo.
U-EOB oqhelekileyo unolwazi olulandelayo:
- Umonde: Igama lomntu ofumene inkonzo. Oku kungenzeka ukuba wena okanye omnye wabaxhomekeke bakho.
- Inombolo yesazisi e- inshurensi : Inombolo yokuchongwa eyabelwe yona yinkampani yakho yinshuwalense. Oku kufanele kufane nombolo kwikhadi lakho le-inshurensi.
- Inombolo yeBango: Inombolo echaza, okanye ibhekisela kwibango lokuba wena okanye umboneleli wakho wezempilo ungeniswe kwinkampani yinshurensi. Ngokumalunga nenombolo ye-ID yomshuwalense, uya kufuneka le nombolo yebango ukuba unemibuzo malunga nesicwangciso sakho sempilo.
- Umboneleli: Igama lomnikezeli owenze iinkonzo kuwe okanye oxhomekeke kuyo. Oku kungaba ligama logqirha, ibhoratri, isibhedlele, okanye abanye ababoneleli ngezempilo.
- Uhlobo lwenkonzo: Ikhowudi kunye nenkcazo emfutshane kwinkonzo enxulumene nempilo oyifumene kumboneleli.
- Umhla weNkonzo: Imihla yokuqala neyokugqibela yenkonzo ehlobene nempilo oyifumene kumboneleli. Ukuba ibango liza kutyelela ugqirha, imihla yokuqala neyokuphela iya kufana.
- Intlawulo (eyaziwa nangokuthi iirhafu ezizaliswayo): Umrhumo wakho umniki-mboleko ukhokhele inkampani yakho yinshurensi kwinkonzo.
- Inani elingabhalwanga: Inani lemali enkampani yakho yomshuwalense ayizange ihlawule umniki wakho. Emva kwesi sixa ungabona ikhowudi ebonisa isizathu sokuba ugqirha ahlawulwanga inani elithile. Inkcazo yale khowudi idla ngokufumaneka phantsi kwe-EOB, emva kwe-EOB yakho okanye kwinqaku echanekileyo kwi-EOB yakho. Abagcini-mboleko ngokubanzi bathetha iintlawulo zokuhlawula kunye noogqirha, ngoko ke imali ephelile iyahlawulwa (kubandakanywa neengxenye ezihlawulwe ngumshwalense kunye nesigulane) ngokuqhelekileyo kuncinci kunomlinganiselo umniki-mboleko. Ukwahlukana kuboniswe ngenye indlela kwi-EOB, kunye nexabiso elingafihlakeleyo, okanye inani elipheleleyo elihlanganisiweyo elingaphantsi kwerhafu ehlawulweyo.
- Iindleko ezipheleleyo zeMonde: Isixa semali ofunekayo njengesabelo sakho sobhili. Le mali ixhomekeke kwiimfuno zakho ze- out-of-pocket zezicwangciso zezempilo, ezifana ne-deductible yonyaka, i-copayments kunye ne-coinsurance. Kwakhona, unokufumana inkonzo engagqityiweyo isicwangciso sakho sempilo apho unobangela wokuhlawula imali epheleleyo.
Ulwazi olongezelelweyo lungabandakanya inani lenkokhelo empeleni eyenziwa kumboneleli wakho kwaye ubuninzi bakho bonyaka obuthengiweyo kunye nongaphandle kwesikhwama .
Ngokuxhomekeke kwi-EOB yenkampani yomshuwalense, umyalelo wolwazi ungahluka.
Umzekelo we-EOB:
UFrank F.
ngumntu oneminyaka engama-67 ubudala onesifo seswekile nesigxina segazi. Uyabhalisa kwiCandelo leNzuzo ye- Medicare kwaye ubona ugqirha emva kweenyanga ezintathu ukulandelelana kwesifo sikashukela. Kwiiveki ezintandathu emva kokutyelela kwakhe kokugqibela, uFrank wathola i-EOB ngolwazi olulandelayo:
- Umonde: uFrank F.
- Inombolo yesazisi ye- inshurensi : 82921-804042125-00 - Inombolo yoLwazi lweNgcaciso ye-Medicine ye-Medicare Advantage Plan
- Inombolo yesibango : 64611989 - inani elibelwe kulo mabango nguPrans's Medicare Benevantage Plan
- Umboneleli: UDavid T. MD - igama likaGriths
- Uhlobo lweNkonzo: Ukutyelela i-Office Office
- Umhla woNkonzo : 11/21/09 - umhla uFrank asebenze ngawo kwi-ofisi kunye noDkt. David T.
- Ukuhlawulisa: $ 135.00 - isixa uDkt. David T. uhlawula i-Frank's Medicare Benevantage Plan
- Inani elingabhalwanga : $ 70.00 - isixa-mali sikaDkt. David T sokuba icebo likaFrank aliyi kuhlawula. Ikhowudi ecaleni kule nto yayingu-264, echazwe ngasemva kwe-EOB ye-EOB ngokuthi "Ngaphandle Kweliphi Ufolako Elivumelayo"
- Iindleko ezipheleleyo zeMonde: i-$ 15.00 - iofisi yeFrank ivakashele i-copayment
- Isixa esihlawulwe kumboneleli: $ 50.00 - inani lemali ukuba iPlani ye-Medicare Advantage Plan ithunyelwe kuDkt. David T.
Ezinye izibalo: UDkt. David T. uvunyelwe i-$ 65 (inkokhelo yakhe eyi-$ 135 ingaphantsi kwemali engakhange ifakwe i-$ 70.00 = $ 65.00). Ufumana i-$ 15.00 esuka kuFrank kunye no-50.00 kwi-Medicare.
Kutheni iNgcaciso yakho yeeNzuzo ebalulekileyo?
Iiofisi zeekliniki, izibhedlele kunye neenkampani zenkxaso-mali zonyango ngamanye amaxesha zenza iimpazamo zokuhlawula. Iimpazamo ezinjalo zinokubangela ukucaphukisa kunye nefuthe elibi, elide lemali elide.
I-EOB yakho ifestile kwimbali yakho yokuhlawula ngonyango. Hlaziya ngokucophelela ukuqinisekisa ukuba ngokwenene ufumene inkonzo enikezelwayo, imali oyenayo ugqirha wakho kwaye isabelo sakho sisilungile, kwaye ukuba ukuxilongwa kunye nenkqubo yakho ibhalwe ngokufanelekileyo kwaye ikhowudiweyo.
Ukuze ufunde kabanzi malunga nokuba kungani i-EOB yakho ibalulekile kwaye ungayifumana njani kwaye uyiphephe iimpazamo ze-EOB, funda:
Ukufunda malunga nendlela oogqirha, izibhedlele, kunye neenkampani zomshuwalense zisebenzisa iikhowudi kwi-EOB kunye nefom zefowuni, funda:
Isipho esivela kuDkt Mike: I-EOB yakho kufuneka ibe nenombolo yefowuni yenkonzo yabathengi. Unganqikazi ukubiza loo nombolo ukuba unemibuzo okanye uxhalaba malunga nolwazi kwi-EOB.