Oko Kufuneka Ukwazi
Ifom yefom yefayili yoluhlu lwezilwanyana zonyango, zombini igama lomenzi kunye negama lesigqirha, ezikhethwa yicebo lakho lempilo. Isicwangciso sakho sempilo sinokuhlawula kuphela amayeza anoluluhlu "olukhethiweyo". Ukongezelela, izicwangciso zempilo ziya kuhlawula kuphela amayeza avunyelwe ukuthengiswa yi-US Food and Drug Administration (FDA).
Injongo yesiqulatho sakho socwangciso lwezempilo kukukukhokelela kumachiza angancinci ayenzileyo ekunyangeni imeko yakho yempilo.
Uya kuhlawula ngakumbi ukuba wena kunye nogqirha wakho ukhetha iyeza elingafihliweyo kwifom ye-formulary yakho yezempilo.
Izicwangciso zezempilo zihlala zicela oogqirha ukuba banike imithi ekhoyo kwifomula xa kunokwenzeka. Izicwangciso ezininzi zezempilo ziphonononga ukuba ingaba ugqirha usebenzisa isicwangciso sezempilo. Ukuba akunjalo, isicwangciso sezempilo sinokuqhagamshelana nogqirha kwaye simkhuthaze ukuba asebenzise amayeza kwi-formulary.
Uthi uDkt Mike tip: Ukuba awuyiqondi izicwangciso zonyango lakho, unokumangaliswa xa kufuneka uhlawule iindleko ezipheleleyo zokuthengisa iimfuno zakho.
Ngubani okhetha iziyobisi kwiFormulary?
Kwiinkqubo ezininzi zezempilo, i-formulary iphuhliswa yikomiti yezokhempi kunye nezobugcisa eziqulunqwe ngamagqirha kunye noogqirha bezobugcisa ezahlukeneyo.
Ikomiti iphinda ihlaziywe imishanguzo emitsha kunye nekhoyo kwaye ikhetha iziyobisi ukuba ifakwe kwifom ye-formulary yezempilo ngokusekelwe kukhuseleko kunye nendlela esebenza ngayo.
Ikomidi ke ikhetha izidakamizwa ezininzi ezichanekileyo kwiklasi nganye yokwelapha. Iklasi yokwelapha liqela lamayeza aphethe imeko ethile yempilo okanye esebenza ngendlela ethile. Ngokomzekelo, i-antibiotics isetyenziselwa unyango lwezifo.
Ngaphantsi kohlengahlengiso olwenziwe nguMthetho woNonophelo ongenakunqwenelekayo, izicwangciso zeqela kunye namancinci kufuneka zibandakanye ubuncinane isilwanyana esinye kwi-US Pharmacopeia (i-USP) kunye neklasi, OKANYE inani lezonyango kwiqela ngalinye le-USP kunye neklasi njengecebo lokutyala, nawuphi na omkhulu.
Ngokuqhelekileyo, i-formulary ihlaziywa ngonyaka, nangona itshintshe kunyaka wonke. Olunye utshintsho luxhomekeke ekufumanekeni kwamachiza amatsha, kwaye amanye ayenzeka ukuba i-FDA ibona ukuba isichengisi singakhuselekanga.
Iyintoni Intlawulo-ntlawulo?
Intlawulo yentsebenziswano isabelo sakho seendleko zemvume, xa ikhethwe njengexabiso elingu-dollar. Ngokomzekelo, ukuba isicwangciso sakho siquka izidakamizwa ze-Tier 1 kunye ne-20 yenkokhelo ye-copayment kunye ne-Tier 2 iziyobisi kunye ne-$ 40 ye-ikopiyure, ezo zixabiso oza kuzihlawulela xa ugcwalisa umyalelo, kunye neendleko ezisele zihlawulwa ngesicwangciso sakho sempilo.
Yintoni yoQoqosho?
Ukuba isicwangciso sakho sempilo sisebenzisa i- coinsurance kwenkcazo yemvume (eqhelekileyo kwiziyobisi kwiNqanaba 4 nangaphezulu), kuthetha ukuba uza kuhlawula ipesenti yeendleko zesilwayo, kunokuba i-copay amount. Ngoko ukuba izidakamizwa ezineNqanaba 4 libiza i-$ 1,000 kunye nesicwangciso sakho sinamaxabiso angama-30 e-Coinsurance kwi-Level 4, oko kuthetha ukuba uya kuba noxanduva lwe-$ 300 yeendleko xa ugcwalisa umyalelo.
Kweminye imimiselo - njenge-MS, umzekelo - zonke iziyobisi ezikhoyo zibhekwa njengezizodwa zamachiza, oko kuthetha ukuba bahlala kwiNqanaba 4 okanye ngasentla, kwaye i-coinsurance isebenza rhoqo. Isiphumo singabelana kakhulu ngeendleko, kodwa umyinge we-Out-of-pocket owenziwe ngumphumo we-ACA kwisicwangciso sezempilo ekugqibeleni uqokelele i-100 ekhulwini leendleko, xa ilungu lidibene nomda wokulinganisa indleko kunyaka.
Yintoni Umyinge weFormulary?
Izidakamizwa kwi-formulary zihlala ziqokelelwe kwii-third party, kwaye intlawulo yakho yokubambisana okanye i-coinsurance igqitywe ngumyinge onokuthi unyango lwakho lusetyenziswa. Ifom yefom yefayile efana neyesine okanye ezintlanu. I-tier ephantsi kakhulu iya kuba ne -share-down share-cost sharing , ngelixa iziyobisi kwi-upper tier ziza kuba negalelo elibi kakhulu.
Inqanaba 1 linokuhlawula i-co-intlawulo esezantsi kwaye ngokuqhelekileyo kubandakanya imishanguzo yonyango .
Umgangatho wesi-2 unomvuzo ophezulu wokubambisana kunye nomyinge woku-1 kwaye ungabandakanya ii-generic ezingenanto ezikhethiweyo kunye / okanye ezikhethiweyo zegama lomhlaza.
Umgangatho wesi-3 unomvuzo ophezulu ophezulu kunye kwaye unokuquka ukukhethwa kwegama lomenzi wegama lomenzi.
Umgangatho wesi-4 no-5 Ngokuxhomekeka kwisicwangciso, izidakamizwa zakho zindleko eziphezulu ziza kuba ziNqanaba 4 okanye 5. Isicwangciso sakho sezempilo singasifaka amayeza kwi-top tier kuba isitsha kwaye singabonakali ukuba sikhuselekile okanye sisebenza. Okanye, amayeza angase abe ngowona mgca ophezulu kuba kukho izidakamizwa ezifanayo kwinqanaba elincinane le-formulary elingakunika inzuzo efanayo kwindleko ephantsi. Izidakamizwa ezizodwa zifakwe kwizinga eliphezulu kakhulu. Izidakamizwa kwi-top tier zivame ukugqitywa nge-coinsurance kunokuba i-copay, ngoko i-out-of-pocket yakho iindleko kule nqanaba ingaba phezulu.
Kweminye yalezi yobisi, isicwangciso sakho sempilo sinokuthathethana nenkampani yezobisi ukufumana ixabiso eliphantsi. Ngako oko, isicwangciso sakho sezempilo sichaza imithi "njengesicatshulwa esikhethiweyo" kwaye ke senza ukuba sibe khona kumgca ophantsi, kubangele ukwabelana ngeendleko eziphantsi.
Isicwangciso sakho sezempilo sinokukunika uluhlu lweemithi ezingafihliweyo kwaye kufuneka uhlawule intlawulo epheleleyo yokuthengisa. Olu luhlu lungabandakanya imilingo yokulinga, amayeza amaninzi, kunye nezobizwa ngokuthi izidakamizwa zendlela yokuphila, njengalezo ezisetyenziselwa ukuphathwa kakubi kwe-erectile okanye ukulahleka kwesisindo.
Ngaba i-Formularies Ingaba nayiphi na imiqobo?
Uninzi lweplani yefom ye-formularies ineenkqubo zokunciphisa okanye ukunciphisa imithi ethile. Oku kwenziwa ukukhuthaza ugqirha wakho ukuba asebenzise amayeza athile ngokufanelekileyo, kunye nokugcina imali ngokuthintela ukusetyenziswa kakubi kweyeza. Ezinye izithintelo eziqhelekileyo ziquka:
Ukugunyazwa kwangaphambili : inkqubo apho ugqirha wakho kufuneka afumane imvume kwisicwangciso sakho sempilo ukuba ufumane ukufumana ingxelo malunga neyeza kwi-formulary. Ngokuqhelekileyo, le miyeza enokuthi ibe neyokhuseleko, ikwazi ukusetyenziswa ngokungafanelekanga, okanye ibe neendlela ezincinci kwi-formulary.
Ukunakekelwa kweMpilo yoBuncwane: inkqubo apho isicwangciso sakho sezempilo siphonononga imishanguzo yonyango ngaphambi kokuzaliswa ukuqinisekisa ukuba ubungakanani kunye nokulingana kuyahambelana neengcebiso ze-FDA
Inyathelo lokunyango : inqubo apho isicwangciso sakho sempilo sifuna ukuba uqale uzame amayeza athile ukuze uphathe impilo yakho ngaphambi kokusebenzisa elinye iyeza zeso simo. Ngokuqhelekileyo, imithi yokuqala ingabizi.
Ngaba kukho ngaphandle kwale Mithetho?
Isicwangciso sakho sempilo sinokuvulela ukwenza iimeko ezihlukeneyo kwiimeko ezininzi:
- Ucela icebo lokugubungela imithi engekho kwifomula.
- Ucela icebo lokukhupha izithintelo zokukhawulela okanye umda kwiyeza lakho.
- Ucela isicwangciso sokubonelela ngamachiza ngenkokhelo yokubambisana enokuhlawuleka.
Ngokuqhelekileyo, isicwangciso sakho sezempilo siya kuqwalasela oku ngaphandle kokuba ukungabikho kokuxhaswa kwamachiza akho kukubangela ukuba usebenzise isicatshulwa esingaphantsi okanye senze ukuba unobungozi obunobungozi.
Ukuba isicelo sakho sithuba siphelile, unelungelo lokubhena eso sinqumo. Zonke izicwangciso zezempilo zinomsebenzi wesikhalazo, ezinokubandakanya abantu abangakhethiyo abangaqeshwanga kwisicwangciso. Ngaphezu koko, ukuba isibheno sakho siphihliwe unako ukukhetha ukuba ugqirha wakho amnike amachiza, kodwa uya kuba noxanduva lokuzaliswa ngokupheleleyo kweziyobisi.
Ezinye iingcebiso ezivela kuDkt Mike
Yazi i- Formula Plan yakho yezeMpilo
Zonke izicwangciso zezempilo zineenkomfa ezahlukeneyo, kwaye kubalulekile ukuba uqonde ifom yakho yesicwangciso. Xa ubhalisile, kufuneka ufumene incwadana echaza i-formulary kwaye uluhlu zonke iimichiza ezivunyiweyo, kunye neenkcazo zeentlawulo zentsebenziswano kunye / okanye i-coinsurance. Unokufikelela kwi-formulary yakho kwikhompyutha. Ukuba awufumananga ifomula, shayela inombolo yenkonzo yamakhasimende kwikhadi lakho leziyobisi ukuze ucele enye.
Thetha noDokotela wakho
Ukuba udinga umyalelo wesikhalazo, thetha nomboneleli wakho wezempilo malunga nokuchaza isixhobo esichaphazelekayo okanye igama lonyango elikhethiweyo ukuba lilungele imeko yakho.
Khetha iSicwangciso Sakho Sempilweni Ngokuhlakanipha
Ukuba unokuzikhethela izicwangciso zempilo kwaye ufuna imithi yokugula okungapheliyo, kufuneka ujonge kwiifomries ezahlukeneyo uze ukhethe icebo elijongene namachiza akho.
Ukuhlaziywa nguLouise Norris.
> Imithombo:
> Iziko loLwazi loThengi kunye noLawulo lweNtshuwalense, uLwazi malunga neNzuzo yezeMpilo ebalulekileyo (i-EHB).
> Iziko lezeMpilo kunye neenkonzo zeMedicaid, iSaziso sokugqibela seNzuzo kunye neParameters Payment for 2016