Yiyiphi Inqaku Elibhekiselele kwiNtshuwalense Yempilo Yakho?

I- inshorensi yakho yemali echithwayo kwaye iiprayimari zakho zenyanga zihlawumbi zakho zindleko zonyango ezinkulu. Nangona uhlawulelo lwakho lubalelwa kwingxenye yengonyama yebhajethi yakho yenkcitho-mali yokunakekelwa kwempilo, ukuqonda oko kubalulekile kwi-inshorensi yakho yempilo echithwayo kwaye oko akulula.

Uyilo lwesicwangciso ngasinye sezempilo lubona oko kubalulekayo kwi-inshurensi yempilo echithwayo, kwaye ukucwangciswa kwecwangciso lwezempilo kungabonakala kunzima.

Izicwangciso zonyango ezithengiswa ngunye-mphorensi yempilo ziyahlukahluka komnye nomnye kwizinto ezibalulekayo kwi-deductible. Kwanjalo isicwangciso esifanayo sinokutshintsha ukususela kunyaka ukuya kwesinye. Kufuneka ufunde ukushicilelwa okulungileyo kwaye ube nolwazi lokuqonda oko, ngokuqinisekileyo uza kulindela, kwaye xa, ngokuqinisekileyo uza kufuneka uyihlawule.

Yintoni ekhokelela kwi-inshurensi yakho yezempilo

Imali izuzwa ngokunyaniseka kwakho ngokuxhomekeka kwindlela ulwabiwo-mali lwenkqubo yakho yezempilo oluhlelwe ngayo. Kukho iindlela ezininzi zokwabelana ngeendleko ezinokwenziwa kweendleko, kodwa ezininzi ziwela kwiindidi ezibalulekileyo zokuyila.

1. "Uhlawula kuqala, i-inshurensi ihlawula kamva" uyilo: Intsholongwane yakho yempilo ayinakho ukuhlawula i-dime kuyo nayiphi na into ngaphandle kokunyamekela ukukhusela uze udibane ne-deductible yakho kunyaka. Emva kokuba udibeneyo udibene, uhlawula kuphela iipayili kunye ne- coinsurance ; yakho yinshuwalense yezempilo iyayiphakamisa yonke ithebhu.
   • Kulezi zicwangciso, ngokuqhelekileyo nayiphi na imali oyisebenzisayo ekunakekelwa ngononophelo oluyimfuneko kubalo kwi-inshorensi yakho yempilo echithwayo njengoko nje inzuzo efunyenweyo yecebo lakho lempilo kwaye ifunyenwe ngokulandela imithetho yezempilo.

1. I-"deductible" ikhutshwe kwezinye iinkonzo "uyilo: Intsholomali yakho yezempilo iyayifaka inxalenye yethebhu kwezinye iinkonzo ezingenakukhusela nangaphambi kokuba udibane ne-deductible yakho. Kulolu hlobo lwesicwangciso, ngokuqhelekileyo iinkonzo ezixolelwe kwii-deductible ziinkonzo ezifuna iimali-mali. Ingaba uhlawulelwe okanye awukho into edibeneyo, uhlawula kuphela i-copayment. Intshurensi yakho yempilo ihlawula intsalela yale nkonzo.
   
   Kwiinkonzo ezifuna i- coinsurance kunokuba ikhoyayment , uhlawula iindleko ezipheleleyo zenkonzo uze udibanekile. Emva kokuba i-deductible idibeneyo, uhlawula kuphela inani lemali-mali; isicwangciso sakho sezempilo sihlawula sonke.
   • Kulezi zicwangciso, imali oyisebenzisayo kwiinkonzo apho i-deductible ichithwe ngokuqhelekileyo ayinakucelwa ukuba uyayikhupha. Ngokomzekelo, ukuba unayo imali engama-$ 35 ukuze ufumane ingcali okanye ukuba awuzange uhlangabezane ne-deductible, loo mpahla ye-35 yecayili mhlawumbi ayiyi kubalwa ngokubhekiselele kwi-deductible yakho.
     
     Nangona kunjalo, oku kuhlukahluka kwisicwangciso sezempilo kwisicwangciso sezempilo; Ngoko, funda iSishwankathelo seNzuzo kunye nokuPhepha ngokucokisekileyo, uze ubize isicwangciso sakho sempilo ukuba awuqinisekanga. Funda kabanzi, " Ngaba i-Copays Bala kwi-Intshurensi yakho yezempilo? "

Khumbula, ngenxa yoNcedo loNonophelo olungabonakaliyo , kwizicwangciso ezininzi zezempilo, ukhuseleko lokukhusela lukhunjulwe i-100% yinshuwalense yezempilo. Awunakho ukuhlawula nayiphi na imali echithwayo, ikopi, okanye uhlalutyo lweenkonzo zokunakekelwa kwezempilo ezikhuselekileyo ozifumanayo kumboneleli we- in-network .

Kwaye xa udibana ne- out-of-pocket yakho engaphezulu ngonyaka (kubandakanywa ne-deductible yakho, i-coinsurance kunye ne-copayments), umgcini-mboleko wakho uhlawula iipesenti ezili-100 zeemfuno zakho zempilo eziyimfuneko, kwi-network.

Yintoni engabaliyo kwi-inshurensi yakho yezempilo

Imali oyihlawulayo ye-pocket kwiinkonzo zononophelo zezempilo ezingenayo inzuzo efunyenwe yinshurensi yakho yempilo ayiyi kukhankanywa kwi-inshorensi yakho yezempilo. Ngokomzekelo, ukuba i-inshorensi yakho yezempilo ayifuni imithi yokwenza izimonkwane ebusweni bombuso, imali oyihlawulayo ephaketheni lakho kulezi zonyango ayiyi kubalwa kwi-inshorensi yakho yezempilo.

Imali oyihlawulele kumboneleli -ngaphandle wenethiwekhi ayidla ngokubaluleka kwi-plan yezempilo engabonakaliyo ngononophelo lwentlalo. Kukho ukungafani kulo mgaqo njengononophelo lwengxamiseko okanye imeko apho kungekho mnikezeli wenethiwekhi onokukwazi ukubonelela ngenkonzo efunekayo.

Izicwangciso zezempilo ezivumela ukunyamekelwa kwenethiwekhi, ngokuqhelekileyo i- PPOs kunye nezicwangciso ze- POS , zingahluka malunga nendlela ababole ngayo imali oyihlawule ngayo ukunakekelwa kwe-out-of-network.

Unokuba neenkonkcola zee-inshurensi zempilo ezimbini ezahlukileyo, enye yokunakekelwa kwenethiwekhi kunye nenye inkulu yokunakekelwa kwe-offline-network. Kule meko, imali ehlawulwayo yokunakekelwa kwe-out-of-network ithola ingqalelo kwi-out-of-network deductible kodwa ayinakubalwa kwi-network-deductible. Omnye umcebisi: ukuba umnikezeli wakho ongekho ngaphandle kwenkokhelo yesiko enikeziweyo , isicwangciso sakho sempilo sinokuthi sinciphise inani elithengiswayo kwi-out-of-network yakho echithwe kwixabiso lemveli.

Ii-Copayments (i-copays) ngokuqhelekileyo azibalanga kwi-deductible. Ukuba isicwangciso sakho sezempilo sinemali engama-20 e-ofisi yokunyamekela i-ofisi yokunyamekela, i-$ 20 oya kuhlawula iya kuba yinto engabonakali kwi-deductible yakho.

Nangona kunjalo, kuya kubala kwi- out-of-pocket yakho ephezulu phantse zonke izicwangciso (ezinye izicwangciso ezinkulu kunye nezicwangciso ezinokuzala zingaba nemithetho eyahlukileyo ngokubhekiselele ekusebenzeni kwawo kwemida ephezulu).

Iiprayimari zenyanga aziyi kubalwa kwi-deductible yakho . Enyanisweni, ii-premiums azixeliwe naluphi na uhlobo lolwabiwo-mali. Iintlawulo zeeNyanga ziyindleko yokuthenga i-inshurensi. Yilona xabiso olihlawula umshwalense ngokuthatha inxalenye yengozi yemali yeendleko zakho zonyango lwempilo.

Oko Kufuneka Ukwazi Ngaphambi Kokunakekelwa Ngogxininiso lweNethiwekhi
Ukuphuma Kwangaphandle Kwipokhethi-Indlela Esebenzayo Nokuba Kutheni Ufanele Uqikelele
Yintoni ongayibala kwi-Out-Of-Pocket?