Imiqondo engu-7 ibalulekile ekusebenziseni impilo yakho ngokuhlakanipha
Uma usemusha kumshuwalense wezempilo kunemibono eyisikhombisa eyisisekelo okufanele uyiqonde ukugwema izinkumanga ezibi zezimali. Uma ungayiqondi le migomo esemqoka, ngeke ukwazi ukukhetha uhlelo lwezempilo ngokuhlakanipha noma ukusebenzisa umshwalense wakho wezempilo ngempumelelo.
Ukwabelana ngezindleko
Ikhamphani yakho yomshuwalense wezempilo ngeke ikhokhe zonke izindleko zokunakekelwa kwempilo zakho. Unomthwalo wemfanelo yokukhokha ezinye zezikweletu zakho zokunakekelwa kwempilo ngisho noma unomshwalense wezempilo.
Lokhu kwaziwa ngokuthi ukwabelana ngezindleko ngoba wabelana nezindleko zokunakekela impilo yakho nenkampani yakho yomshuwalense wezempilo.
Lezi zindlela ezintathu ezivame ukwenzelana nezindleko ziyi- deductibles , i- copayments , ne- coinsurance . Ezinye izinhlelo zezempilo zisebenzisa zonke izindlela ezintathu, kanti ezinye zingasebenzisa eyodwa noma ezimbili kuphela. Uma ungaqondi izimfuneko zakho zokwabelana ngezindleko zezempilo, awukwazi ukwazi ukuthi uzodingeka ukhokhele kunoma iyiphi insizakalo yokunakekelwa kwezempilo.
I- deductible yiyo okufanele ukhokhe unyaka ngamunye ngaphambi kokuba umshwalense wakho wezempilo ukhawule ngokugcwele futhi uqala ukukhokha isabelo saso. Isibonelo, uma unemali eyi-$ 1,000 ekhishwe, kufanele ukhokhele imali yokuqala yezinkulungwane zemali zakho zokunakekelwa kwezempilo ngaphambi kwe-$ 1,000 ngaphambi kokuba inkampani yakho yomshuwalense wezempilo iqale ukukhokha. Uma usukhokhele imali engu-R1 000 emindenini yakho yokunakekelwa kwezempilo, "uhlangabezane ne-deductible" ngalolo nyaka futhi ngeke kudingeke ukhokhe noma yikuphi okudonswayo kuze kube ngonyaka ozayo.
Ngenxa yoMthetho Wokunakekelwa Onganakekelwayo, inkampani yakho yomshuwalense wezempilo manje kufanele ukhokhele ukunakekelwa kwezempilo okuvimbela ngaphandle kokufuna ukuthi ukhokhe okokuqala.
Lokhu kusho ukuthi kuzokhokha izinto ezifana nokuhlola kwakho ngokomzimba ngonyaka kanye nokuhlola i-mammogram ngisho noma ungahlangabezane ne-deductible yakho okwamanje. Kodwa-ke, hlela isikhumba sakho noma uthole umkhuhlane futhi kuzomele uhlangabezane ne-deductible yakho ngaphambi kokuba umshwalense wakho akhokhe.
Funda kabanzi mayelana nokudonswa kwemali ku-" Deductible-Okuyiyo nokuthi Kusebenza Kanjani ."
I-Copayments yinani elincane, elilinganiselwe okhokha njalo lapho uthola uhlobo oluthile lwenkonzo yokunakekelwa kwezempilo. Isibonelo, ungase ube nokukhokhwa kwama-$ 40 ukuze ubone udokotela. Lokhu kusho isikhathi ngasinye lapho ubona udokotela, ukhokha u-R40 uma ngabe ibhilidi kadokotela lingama- $ 60 noma $ 600. Inkampani yakho yomshuwalense ikhokha konke.
I-Coinsurance yiphesenti yomthethosivivinywa okhokha ngaso sonke isikhathi lapho uthola uhlobo oluthile lwenkonzo yokunakekelwa kwezempilo. Isibonelo, uma unama-30% we-coinsurance esibhedlela esibhedlela futhi isikweletu sakho esibhedlela singu-$ 10,000, uzokhokha u-$ 3,000; inkampani yakho yomshuwalense izokhokha u- $ 7,000.
Funda kabanzi mayelana ne-copayments nokuqinisekiswa kwezimali, izinzuzo nezindleko zomuntu ngamunye, nezinkathazo ezimbi ukubuka ukuthi " Uyini umehluko phakathi kweCopay no-Coinsurance? "
Ngaphandle kwe-Pocket Maximum
I-out-of-pocket esiphezulu yiyona phuzu lapho ungayima khona ukukhipha imali ephaketheni lakho ukuze ukhokhele amadokhumenti, ama-copayments, kanye ne-coinsurance. Uma usukhokhele okwethenjelwe ekunqophiseni ama-deductibles, ama-copay kanye nokuqinisekiswa kwezimali ukuze ulingane nesiphakamiso sakho sempilo esiphezulu, umshuwalense wakho wezempilo uyoqala ukukhokha izindleko zokunakekelwa kwempilo zakho ezigcwele 100%. Njenge-deductible, imali oyikhokhelwe ekuphumeni kwe-pocket ukuvuselela okuphezulu ekuqaleni konyaka ngamunye.
Funda kabanzi mayelana nokuphuma kwe-pocket esiphezulu ku-" Out-of-Pocket Maximum-Indlela Esebenzayo Nesizathu Sokuqapha ."
Inethiwekhi Yomhlinzeki
Izinhlelo eziningi zempilo zinabanikezeli bezinsizakalo zokunakekelwa kwezempilo abaye benza isivumelwano nehlelo lempilo ukuhlinzeka ngezinsizakalo ezilinganisweni zamazinga. Ngokubambisana, labahlinzeki bezinsizakalo zezempilo bayaziwa njengenethiwekhi yomhlinzeki wezempilo . Inethiwekhi yomhlinzeki ayihlanganisi nje odokotela, kodwa futhi izibhedlela, ama-laboratories, izikhungo zokwelapha ngokomzimba, izinkampani ze-X kanye nama-imaging, izinkampani zezempilo zasemakhaya, izikhungo zokuhlinzeka ngemithi, izikhungo zokuhlinzeka iziguli, izikhungo zokunakekelwa okuphuthumayo, ama-pharmacy kanye nezinye eziningi izinhlobo zabahlinzeki bezinsizakalo zezempilo.
Abahlinzeki bokunakekelwa kwezempilo babizwa ngokuthi "in-network" uma beyingxenye yenethiwekhi yakho yomhlinzeki wezempilo, futhi "ngaphandle kwe-inethiwekhi" uma beyingxenye yenethiwekhi yomhlinzeki wezinhlelo zakho.
Uhlelo lwakho lwezempilo lufuna ukuthi usebenzise abahlinzeki be-inthanethi futhi inikeza izikhuthazo zokwenza kanjalo. Amanye amahlelo ezempilo, ngokuvamile ama- HMO nama- EPO , ngeke akhokhe lutho ngokunakekelwa oluthola kubahlinzeki bezempilo abangaphandle kwe-network. Ukhokha konke okukhokhwayo uma uphuma ngaphandle kwenethiwekhi.
Amanye amapulani ezempilo, ngokuvamile ama- PPO kanye nama-POS, akhokhe ingxenye yezindleko zokunakekelwa okuvela kubanikezeli be-out-of-network, kodwa ngaphansi kokukhokha uma usebenzisa umhlinzeki we-in-network. Isibonelo, i-PPO yami idinga i-copay ye-$ 45 ukuze ibone udokotela okhethekile we-network, kodwa 50% ukuqinisekiswa kobuqiniso uma ngibona ingcweti engaphandle kwenethiwekhi esikhundleni. Esikhundleni sokukhokha i-$ 45 ukuze ubone i-cardiologist in-network, ngingaqeda ukukhokha imali engu- $ 200- $ 300 ukuze ngibone i-cardiologist engaphandle kwenethiwekhi, kuye ngesamba semali.
Ukugunyazwa kwangaphambi
Izinhlelo eziningi zempilo ngeke zikuvumele ukuba uthole noma yiziphi izinsizakalo zokunakekelwa kwezempilo ozifisayo, noma nini nanoma ikuphi lapho ufisa khona. Njengoba uhlelo lwakho lwezempilo lufakazela okungenani ingxenye yalowo mthethosivivinywa, uzofuna ukuqinisekisa ukuthi empeleni udinga ukunakekelwa kwezempilo oyitholayo, nokuthi uyayithola ngendlela engokomnotho.
Enye yezinqubo ze-insurerrs zezempilo zisebenzisa ukufeza lokhu kuyimfuneko yokugunyazwa kwangaphambili . Uma uhlelo lwakho lwezempilo lunye, kusho ukuthi kufanele uthole imvume yezempilo ngaphambi kokuba uthole uhlobo oluthile lwenkonzo yokunakekelwa kwezempilo. Uma ungatholi imvume kuqala, uhlelo lwezempilo luzokwehla ukukhokha futhi uzobe unamathela kulowo mthethosivivinywa.
Nakuba abahlinzeki bezempilo behlala njalo bezothola izinsizakalo zangaphambi kokugunyazwa ngokuzenzakalelayo, ekugcineni umthwalo wakho wokuqinisekisa ukuthi noma yini edingekayo ukuba igunyazwe ngaphambilini iye yagunyazwa ngaphambilini. Emva kwakho konke, nguwe ophetha ukukhokha uma lesi sinyathelo sithengiswa, ngakho-ke le buck impela ngokuyisisekelo imise nawe.
Isidingo Sokugunyazwa Ngaphambi Kokuqala-Kungani Kufanele Uqaphele .
Izimangalo
Inkampani yakho yomshuwalense wezempilo ayikwazi ukukhokha izikweletu engazi. Impendulo yomshuwalense wezempilo yindlela indlela eziningi zezempilo ezikwaziswa ngayo mayelana ne-bill yokunakekelwa kwezempilo. Ezenzweni eziningi zezempilo, uma usebenzisa umhlinzeki we-in-network, lowo mhlinzeki uzothumela ngokuzenzakalelayo isimangalo kumshwalense wakho wempilo. Noma kunjalo, uma usebenzisa umhlinzeki wangaphandle, kungenzeka ukuthi nguye ophethe ukufaka isimangalo.
Ngisho noma ungacabangi ukuthi uhlelo lwakho lwezempilo luzokhokhela noma yikuphi isimangalo, kufanele uyifake noma kunjalo. Isibonelo, uma ungacabangi ukuthi uhlelo lwakho lwezempilo luzokhokhela ngoba awuzange uhlangabezane ne-deductible yakho okwamanje, kufanele ufake i-claim yakho ngakho imali oyikhokhayo idalwe ngokubheka imali yakho. Uma uhlelo lwakho lwezempilo lungasazi ukuthi usebenzise imali engu-300 emayelana nokwelashwa kwe-ankle ehlutshiwe, ayikwazi ukukhokha ukuthi u-R300 wamahhashi akhokhelwa.
Ukwengeza, uma unayo i- akhawunti yokusebenzisa imali evumelana nezimo ezikukhokhela izindleko zokunakekelwa kwezempilo ezingakhokhwa ngumshwalense wakho wezempilo, i-FSA ngeke ikubuyisele kuze kube yilapho ungabonisa ukuthi umshuwalense wakho wezempilo akazange akhokhe. Indlela kuphela ongayibonisa ngayo lokhu ukufaka isimangalo ne-insurer yakho.
Izinkokhelo
Imali oyikhokhela ukuthenga umshuwalense wezempilo ubizwa ngokuthi i- premium yomshuwalense wezempilo. Ngokuvamile, kufanele ukhokhe imali yomshuwalense wezempilo nsuku zonke. Uma ungakhokhi leyo nyanga, kungenzeka ukuthi ukukhansela kwezempilo yakho kukhanseliwe.
Ngezinye izikhathi awukhokhi yonke i-premium yenyanga. Lokhu kuvamile uma uthola umshuwalense wakho wezempilo ngomsebenzi wakho. Ingxenye ye-premium yanyanga zonke iphuma kumakhokhelo akho, kepha umqashi wakho ukhokha ingxenye ye-premium yenyanga. Lokhu kuyasiza ngoba awunamthwalo wonke umthwalo wakho, kodwa kwenza kube nzima ukuqonda izindleko zangempela kanye nenani lomshwalense wakho wezempilo.
Uma uthenga umshuwalense wakho wezempilo kuHlelo lokuNakekela okuNgenakghoneka kukaHulumeni wakho, ungafaka isicelo somxhaso kahulumeni ukuze usize ukhokhe izinkokhelo zakho zenyanga. Ukuxhaswa kuncike kwimali yakho engenayo futhi ukhokhelwe ngqo kwinkampani yakho yomshuwalense wezempilo ukuze wenze isabelo sakho se-premium yanyanga zonke engabizi kakhulu. Funda kabanzi mayelana Nokunakekelwa Okunakekelwayo Kwempahla yomshuwalense wempilo yomshuwalense ku-" Ngingayithola Usizo Lokukhokhela Umshwalense Wezempilo? "
Ukubhalisa Okuvulekile Nokubhaliswa Okukhethekile
Awukwazi ukubhalisela umshuwalense wezempilo noma nini lapho ufuna; uvumelekile ukuthi ubhalisele umshuwalense wezempilo ngezikhathi ezithile. Lokhu ukuvimbela abantu ukuthi bangalingi ukuzama ukulondoloza imali ngokulinda baze bagule ukuthenga umshuwalense wezempilo .
Ungabhalisela umshwalense wezempilo ngesikhathi sokubhalisa okuvulekile . Abaqashi abaningi banesikhathi sokubhalisa esivulekile kanye ngonyaka, ngokuvamile ekwindla. I-Medicare inekhathi lokubhalisa evulekile njalo ekwindla. Ukunakekelwa okunganakekelwa kwempahla yomshuwalense wempilo yomshuwalense futhi unesikhashana sokubhalisa okuvulekile kanye ngonyaka. Uma ungabhalisele umshwalense wezempilo ngesikhathi sokubhalisa okuvulekile, uzodingeka ulinde kuze kube yisikhathi sokubhalisa esilandelayo, ngokuvamile ngonyaka, ukuze uthole ithuba elilandelayo.
Okungafani nalo mthetho, okubangelwa imicimbi ethile, yisikhathi esikhethekile sokubhalisa. Isikhathi sokubhalisa esikhethekile yisikhathi esifushane uma uvumelekile ukubhalisela umshuwalense wezempilo ngisho noma kungabhalisi okuvulekile. Izikhathi zokubhalisa ezikhethekile zivame ukuqala uma ulahlekelwa umshuwalense wakho wezempilo noma uguqukile usayizi womndeni. Isibonelo, uma ulahlekelwa umsebenzi wakho ngakho-ke umshuwalense wempilo yakho esekelwe emsebenzini, lokho kungabangela isikhathi sokubhalisa esikhethekile ekushintsheni komshuwalense wezempilo wombuso okukunikeza izinsuku ezingu-30-60 ukubhalisela uhlelo lwezempilo olusekelwe ekushintsheni, nakuba kungenjalo ukubhalisa okuvulekile.
Funda kabanzi mayelana nezinkathi zokubhalisa ezikhethekile, ukuthi zisebenza kanjani, nokuthi yini ebangela ukuba zibe " Kuyisikhathi Esibalulekile Sokubhalisa? "