Yilwayo Yelungelo Lwamalungelo Ngokubhekiselele kuMthetho Wokunakekelwa Ojongene Nempilo

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Ukunqabela ukuchasana nezigulane ezineemeko eziPhambi kwexesha

Izicwangciso zokunakekelwa kwezempilo kunye nabahlawuli abasayi kuvunyelwa ukuba bachaze izigulane ezisekelwe kwiimeko ezikhoyo ngaphambili. Isimo esele sisekho ngaphambili naluphi na uhlobo lwezokwelapha olufunyenwe phambi kwesigulana esifumana i-inshorensi yempilo yakhe yangoku.

Umthetho ononophelo loNonophelo uyaqinisekisa ukuba bonke abantu abafaka isicelo sokubambisana nezempilo baya kuthengiswa umgaqo-nkqubo ngaphandle kweyonyango yabo kwaye iinkampani ze-inshorensi yezempilo ayinakho imeko ekhoyo ngaphambili kwi-plan yezempilo.

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Ukuvalwa kwiinkampani ze-inshurensi ukuchitha

Izicwangciso zokunakekelwa kwezempilo kunye nabahlawuli abasayi kuvunyelwa ukuba bayeke ukukhawulelwa kwisigulane esekelwe kwiphutha elingenamsebenzi kwisicelo se-inshorensi yezempilo. Iiprogram ze-inshorensi yezempilo inokuthi ikhuphe umgaqo-nkqubo wokunakekelwa kwempilo kuphela ngenxa yesenzo sobuqhetseba njengokwenza ngenjongo nangenqununu ukushiya okanye ukuchasisa ulwazi malunga nesicelo sokubhengezwa.

Umthetho wokuNakekelwa ongenakunqwenelekayo uqinisekisa ukuba umgcini-mali unokukhansela kuphela umgaqo-nkqubo wokunakekelwa kwempilo xa umntu eyeka ukuhlawula iipriyamu, eyeke ukunikela ngomshuwalense okanye ushiye indawo yoshishino lomshuwalense, umntu uhamba ngaphandle kwendawo yemarike yomshuwalense, okanye i-inshorensi inikezelwa ngumbutho kwaye ubulungu kumbutho lukhanselwa.

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Ukuvalwa kwiinkampani ze-Intsholongwane

Izicwangciso zokunakekelwa kwezempilo kunye nabahlawuli abaya kuvunyelwa ukukhawulela ukukhutshwa ngenxa yokugula okungapheliyo okanye okunzulu njengomlinganiselo wonyaka okanye wokuphila kwemida yezigulana ezifuna ukunakekelwa okubalulekileyo.

UMthetho ononophelo loNonophelo uyaqinisekisa ukuba umgcini-mali awukwazi ukunciphisa unyango lwezigulana kwixabiso elithile leedola eliyishiya ngaphandle kweendlela ezifanelekileyo zokuhlawula unyango olubalulekileyo.

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Ukuvalwa kwiinkampani ze-inshurensi Ukunciphisa ukhetho lwezogqirha

Izicwangciso zonyango kunye nabakhokheli abasayi kuvunyelwa ukuba baxelele ukuba ugqirha unokufuna unyango. Ukuba isicwangciso sidinga ukukhethwa kwe-PCP (ugqirha wezonyango lokuqala), isigulane sinokukhetha ugqirha wayo kwinethiwekhi ye-inshurensi yempilo yabanikezeli. Oku kubandakanya inkululeko yokukhetha isidumbu sezingane kunye ne-OB / GYN yesigulane.

Umthetho wokuNakekelwa ongenakunqwenelekayo uqinisekisa ukuba i-insurer ayikwazi ukukhetha i-PCP egameni lesigulane okanye ifuna imvume yangaphambili, igunya okanye ukuthunyelwa ukutyelela i-OB / GYN.

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Ukuvalwa kwiinkampani ze-inshurensi ekukhawuleleni ukunakekelwa kwamagumbi okuphucula

Izicwangciso zokunakekelwa kwezempilo kunye nabahlawuli abasayi kuvunyelwa ukuba bafune imvume ngaphambi kokuba bafune unyango olungxamisekileyo . Izigulane ezibonisa iimpawu ezinzima kufuneka zifune ingqwalasela ngokukhawuleza kwigumbi eliphuthumayo elisondeleyo ngaphandle kokukhathalela okanye ukukhathalela ngemicimbi yezemali.

Umthetho wokuNakekelwa ongenakunceda uqinisekisa ukuba i-insurer ayinakufuna ukugunyazwa kwangaphambili kwiinkonzo eziphuthumayo, ukukhanyela iinkonzo eziphuthumayo ze-network, ukuhlawula iipayili okanye i-coinsurance ephezulu kwiinkonzo eziphuthumayo ze-network, okanye umda wokukhawulelwa kweenkonzo eziphuthumayo zangaphandle. .

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Ilungelo lokuBhenela

Izicwangciso zokunakekelwa kwezempilo kunye nabahlawuli-mali abavumelekanga ukukhusela abantu ukuba bangafaki isikhalazo xa umntu engavumelani nesigqibo socwangciso lwempilo sokwenqaba ukuhlawula okanye ukunciphisa intlawulo nayiphi na isizathu.

UMthetho ojongene noNonophelo ojongene noNgcono uyaqinisekisa ukuba umshwalense kufuneka alandele inkqubo yesibheno njengoko kusekwe nguRhulumente wephondo.

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Ukugubungela abantu abadala abakwiSicwangciso soMzali

Izicwangciso zezononophelo zezempilo kunye nabakhokheli abasayi kuvunyelwa ukuba bayeke ukuxhomekeka kwabantwana abaxhomekeke phantsi kweminyaka engama-26 kwabo bafanelekayo. Abantu abadala abasele bavunyelwe ukuba bahlale kwi-inshurensi yabazali babo ixesha elide.

UMthetho ononophelo loNonophelo uqinisekisa ukuba umshwalense kufuneka aqhubeke nokubonelela ngeenkcukacha kubantwana abaxhomekeke kwi-26 ubudala.

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UkuKhusela ukunakekelwa koKhuseleko ngaphandle kweNdleko

Izicwangciso zokunakekelwa kwezempilo kunye nabahlawuli abasayi kuvunyelwa ukuhlawula iikopi, i-coinsurance okanye i-deductibles kwizinto ezithile zokuthintela iinkonzo. Bona uluhlu olupheleleyo lweenkonzo ezinconywayo. A

Umthetho wokuNakekelwa ongenakunqwenelekayo uqinisekisa ukuba i-insurer ayinakufuna ukwabelana ngeendleko zokunyamekela okunokuthintela ukunqanda ukukhusela i-blood screening, ukukhangela itekisi, ukuhlolwa kwesifo somhlaza, ukuvavanya umdlavuza, ukuvavanya umlomo kunye nokuhlolwa.