Umshuwalense wezempilo awukhokheli zonke izindleko zokunakekelwa kwezempilo. Esikhundleni salokho, kulindeleke ukuthi ungeke ulandelele umthethosivivinywa ngenxenye yezindleko zokunakekelwa kwakho ngokusebenzisa izidingo zakho zokwabelana ngezindleko zempilo ezifana ne- deductible yakho, i- copayments , ne- coinsurance .
Njengoba ama-deductibles kanye nama-copayments ayinani elilinganiselwe, alithathi eziningi zezibalo ukuthola ukuthi kufanele akhokhe malini.
Ukukhokhwa kwama-$ 30 okugcwalisa umshwalense kuzokubiza u-$ 30 kungakhathaliseki ukuthi ibhilikhithi eliphelele le-odokotela lalingakanani. Umshuwalense wakho wezempilo uthatha lonke ithebhu.
Noma kunjalo, ukubala imali yakho yokukhokhwa kwemali yomshuwalense wezempilo kuyinkimbinkimbi. Njengoba ukuqinisekiswa kwezimali kungumaphesenti wezindleko eziphelele zesevisi, uzothola imali ehlukile yokuqinisekiswa kwenkonzo ngayinye oyitholayo. Uma insizakalo yokunakekelwa kwezempilo oyitholile ishibhile, ukuqinisekiswa kwakho kwezimali ngeke kube okuningi. Kodwa-ke, uma insizakalo yokunakekelwa kwempilo yayibizayo, imali yakho yokukhokhela imali ingakhuphuka ibe amakhulu noma ngisho nezinkulungwane zamaRandi.
Udinga ukuqonda ukuthi ungabala kanjani inkokhelo yakho yokukhokhela imali yomshuwalense wezempilo ukuze wazi ukuthi uzothola malini imali yokukhokhela imali futhi ungabhajethi.
Okokuqala, Thola i-Coinsurance yakho Rate
Okokuqala, kuzodingeka uthole isilinganiso sakho sezinkokhelo zohlobo lokunakekelwa okutholayo. Kumele ukwazi ukuthola lokhu ku-Summary of Benefits kanye nokuphepha owawutholile uma ubhalisile ohlelweni lwakho lwezempilo.
Ngezinye izikhathi ungayithola ngisho nakumakhadi wakho yomshuwalense wezempilo.
Qaphela; kwezinye izinhlelo zezempilo, ukuqinisekiswa kwezimali kungaba amaphesenti afanayo kungakhathaliseki ukuthi uthola uhlobo luni. Isibonelo, imali engu-30% yokuqinisekiswa kwezibhedlela kanye no-30% ukuqinisekiswa kwemigomo ekhethekile yezidakamizwa. Kwezinye izinhlelo zezempilo, ungase ube nesilinganiso esiphansi sezinkokhelo zezinsizakalo ezithile kanye nesilinganiso esiphezulu sezinye izinhlobo zesevisi.
Isibonelo, ungathola ukuqinisekiswa kwama-35% esibhedlela, kodwa u-20% kuphela wokuqinisekiswa kokuhlinzekwa esikhungweni sokuhlinzeka ngeziguli.
Okulandelayo, Thola Izindleko Zokunakekela Kwakho
Uma usuwazi isilinganiso sakho sokubambisana, kufanele udinga izindleko eziphelele zenkonzo yokunakekelwa kwezempilo oyitholile. Uma usebenzisa umhlinzeki we- in-network , uhlelo lwakho lwezempilo seluxoxisane kakade izaphulelo ezivela kulowo mhlinzeki. Bala inkokhelo yakho yemali yomshwalense wempilo yomshuwalense ngokususelwa kwisilinganiso esinqunyiwe, hhayi izinga elilinganiselwe elibhekiswe kubantu abangewona uhlelo lwakho lwezempilo. Thola lemali esetshenziselwe inethiwekhi kwi- Explanation of Benefits echazwe ngokuthi "inani elivumelekile."
Uma ungayitholanga inkonzo yokunakekelwa kwezempilo okwamanje, ngeke ube ne-EOB ukuze uhlole. Uzodinga ukubuza umnikezeli wakho ukuthi izinga lani-inethiwekhi lensiza ethile. Ngenye indlela, iwebhusayithi yakho yomshuwalense wezempilo ingaba nomlinganisi wezindleko ezokusiza ukuthi unqume izindleko zesevisi kuye ngokuthi iyiphi umhlinzeki oyisebenzisayo. Uma kungekho okunye okukhethwa kukho okukusebenzelayo, bheka izinketho eziningi ku-" Thola ukuthi Kunakekelwa Kanjani Ukunakekelwa Kwezokwelapha ."
Okokugcina, Bala Ukubambisana Kwakho
Ukubala ukuqinisekiswa kwemali okhokhayo, kufanele uqale ukuguqula inani lakho lepesenti kumuntu wesimali ngokuhambisa idijithi yedesimali izikhala ezimbili ngakwesokunxele njengalokhu:
Amaphesenti: | Umfanekiso olinganiselwe ohlose: |
15% | 0.15 |
20% | 0.20 |
25% | 0.25 |
30% | 0.30 |
35% | 0.35 |
40% | 0.40 |
45% | 0.45 |
50% | 0.50 |
Manje, wandise lesi sibalo sesimadayimali ngezindleko eziphelele zenkonzo yokunakekelwa kwezempilo:
Isilinganiso semali ye-Coinsurance (njengombalo wesimanga) X izindleko eziphelele = ukuqinisekiswa okumele ukhokhwe.
Izibonelo
Uhlelo lwezempilo luka-Antoine ludinga u-20% ukwabelana ngezindleko ukugcwalisa umuthi. Izindleko zakhe zesekhwalithi ephelele ziyi $ 150.
0.20 X $ 150.00 = $ 30.00
Izinga le-Coinsurance X izindleko eziphelele = ukuqinisekisana kuka-Antoine.
U-Antoine ufanele imali engu-$ 30 yalesi sigwebo.
Uhlelo lwezempilo lukaKensey ludinga ukwabiwa kwezindleko ezingama-35% ezokubhedlela. Izindleko eziphelele zokuhlala kwakhe esibhedlela i $ 12,850.00
0.35 X $ 12,850 = $ 4,497.50
Izinga le-Coinsurance X izindleko eziphelele = uxhumano lweKinsey okhokhelwayo.
UKensey uzokweleta u-$ 4,497.50 amacala okukhokhela imali esibhedlela.
Izingosi ezithinta imali yakho yezinkokhelo
Ungakhohlwa ukuthi kumele ukhokhe imali yakho. Kuzinhlelo eziningi zempilo, kuzodingeka ukhokhe konke okudonswe ngaphambi kokuba uhlelo lwakho lwezempilo luqale ukukhokha ingxenye yezindleko zokunakekela kwakho. Ngemuva kokuba usukhokhele imali yakho egcwele imali, uzokwabelana ngezindleko zokunakekelwa kwakho ngecebo lakho lempilo ngokukhokha imali yokukhokhela imali. Funda kabanzi ku, " Deductible-Kuyini nokuthi Kusebenza Kanjani ."
Uma unesikhwama sokunakekelwa kwempilo enkulu kakhulu, isikhulu sakho sokuphuma esikhwameni singakhansela futhi sikuvikele kwezinye izindleko. Uma ama-deductibles, ama-copayments, nokuqinisekisana okukhokhelwe kwakho kulo nyaka kufaka kuze kube sekuphumeni kwe-pocket, izidingo zakho zokwabelana ngezindleko ziphelile unyaka. Uhlelo lwakho lwezempilo luhola amaphesenti angu-100 wezindleko zokunakekelwa kwe-in-network yakho yonke inyaka. Awudingi ukukhokha u-coinsurance, ama-copays, noma ama-deductibles futhi kuze kube ngonyaka ozayo ... ngokuvamile. Funda kabanzi ku, " Ukuphuma kwePokhethi Okukhulu-Indlela Okusebenzayo Nokuthi Kufanele Uyiqaphele ."
Ngenxa yoMthetho Wokunakekelwa Onganakekelwayo, ukunakekelwa okuningi kokuvikela kumele kuhlanganiswe umshwalense wakho wezempilo ngaphandle kokudinga ukukhokhelwa kwemali, ukukhokha imali, noma ukukhishwa imali. Lokhu kusho ukuthi ngeke kudingeke ukhokhe imali yezinkokhelo ezintweni ezinjengokuhlola kwakho ngokomzimba ngonyaka, ukugoma kwaminyaka yonke kanye nokugoma njalo. Nakuba kungase kubonakale sengathi ukunakekelwa kokuvimbela kuyinto mahhala, akunjalo. Esikhundleni salokho, izindleko zalokhu ukunakekelwa kokuvikela zifakwe kwi- premium yomshuwalense wezempilo wanyanga zonke noma ngabe empeleni uyayisebenzisa yini.