Inani elinyukayo lezinkampani zomshuwalense kanye nezinhlangano zokunakekelwa eziphathekayo zihlanganisa imithi ehambisanayo kanye neyehlukile, evuselelwe ukufunwa kwabathengi kanye nomzimba okhulayo wobufakazi obusayense obonisa izinzuzo kanye nezindleko eziphumelelayo.
Ucwaningo lwamuva lwama-HMO amakhulu angu-18 kanye nabahlinzeki bomshuwalense, kuhlanganise no-Aetna, Medicare, Prudential, noKaiser Permanente, bathola ukuthi abangu-14 kubo bahlanganisa okungenani okungu-11 kwezingu-34 zokwelashwa ezihlukile.
I-chiropractic, ukusikhipha imithi yokwelapha, kanye nokwelashwa yizinto ezintathu zokwelashwa eziphethwe kakhulu kunazo zonke ezilandelwa yimithi yesifo sofuba. Ezinye izindlela zokwelapha eziqhubekayo zikhona izindlela zokwelapha, ukuhlengwa kwemithi, ukuphathwa kwengqondo, nokuzindla.
Kodwa izinga lokusabalalisa namanje lincane kakhulu; abantu ngokuvamile bakhokhela izinsizakalo ngenkokhelo yokukhokhela esekelwe noma bayavunyelwa inani elincane elingenangqondo lezinhlelo.
Umphumela wokuphela wukuthi izikwelapha zihlulelwa ngokungafanele njengokungasebenzi uma inkinga yangempela ukuthi ukuhlinzekwa okulinganiselwe akuzange kuvumele umuntu ukuba aqedele uhlelo lokunakekelwa oluphakanyisiwe.
Nazi izimpendulo zemibuzo engu-12 ejwayelekile kakhulu mayelana nokuhlinzekwa komshuwalense wezokwelapha ezihambisanayo nezinye.
1. Abantu bakhokhela kanjani ukwelashwa okuhambisanayo nokunye okunye?
Iningi labantu likhokha izinsizakalo nemikhiqizo ehambisanayo neminye imikhiqizo ngokwayo.
Inamba ekhulayo yezinhlelo zempilo inikeza ukuhlinzekwa kwemithi ehambisanayo neyehlukile, kodwa-ke, ijwayele ukulinganiselwa futhi ihluka kusuka kuhulumeni kuya kuhulumeni.
2. Ngingayithola kanjani ukuthi kukhona imithetho emibusweni yami mayelana nokuhlinzekwa ngomshuwalense we-thérapie engiyithandayo?
Ungazama ukuxhumana nobudlelwane bezentandokazi kazwelonke salolu hlobo lwezokwelapha, isibonelo, izinhlangano zama-acupuncturists.
Eziningi zalezi zinhlangano ziqapha ukukhokhelwa komshuwalense nokubuyisela okukhethekile.
3. Nginomshwalense wezempilo. Uma nginesithakazelo ekutholeni ukwelashwa kumsebenzi, yimiphi imibuzo yezimali engingayicela?
Okokuqala, udinga ukwaziswa mayelana nohlelo lwakho lomshuwalense wezempilo. Ingabe inikeza noma yikuphi ukutholakala kwemithi yokwelapha ehambisanayo nezinye izindlela? Uma kunjalo, yiziphi izidingo nemingcele? Isibonelo, ingabe uhlelo lukhawulela izimo ezizozihlanganisa, zidinga izinsizakalo zokwelapha ezihambisanayo nezinye izindlela ezinikezwa ngabasebenzi abathile (njengodokotela noma odokotela abanelayisensi enenethiwekhi yenkampani), noma bafaka izinsizakalo kuphela uma lo mgomo unquma ukuba ube nemithi kuyadingeka? Funda uhlelo lwakho ngokucophelela, kufaka phakathi imingcele kanye nezikhawulelo. Kungumqondo omuhle ukuhlola nenkampani yomshuwalense ngaphambi kokuba ufune ukwelashwa.
Nanka eminye imibuzo okumele ikubuze umshwalense:
- Ingabe ukunakekelwa lokhu kudinga ukugunyazwa ngaphambilini noma kuqala?
- Ingabe ngidinga ukudluliselwa kusuka kumhlinzeki wami wokunakekela oyinhloko?
- Iziphi izinsizakalo, ukuvivinywa, noma ezinye izindleko ezizohlanganiswa?
- Zingaki ukuhambela ezimboziwe futhi ngesikhatsi sesikhathi (isibonelo, ukuvakashelwa kuka-6-10 ngonyaka wokukhishwa kwesikhumba)?
- Ingabe kukhona ukukhokhelwa kokubambisana?
- Ingabe ukwelashwa kuyobekwa noma yisiphi isimo noma izimo ezithile kuphela?
- Ingabe kuzodingeka izindleko ezengeziwe, njengezivivinyo ze-lab, izithako zokudla, imishini, noma izinto?
- Ngidinga ukubona udokotela kwinethiwekhi yakho? Uma kunjalo, ingabe unganginika uhlu lwabahlengikazi endaweni yami?
- Uma ngisebenzisa udokotela ongeyona ingxenye yenethiwekhi yakho, ingabe uhlinzeka noma yikuphi ukukhokhelwa? Zikhona yini izindleko ezingaphandle kwe-pocket?
- Zikhona yini imingcele ye-dollar noma ikhalenda yokufinyelela kwami?
Kuzokusiza ukuthi ugcine amarekhodi ahleliwe mayelana nakho konke ukusebenzisana nenkampani yakho yomshuwalense. Gcina amakhophi ezincwadi, izikweletu, kanye nezimangalo.
Yenza amanothi ngamakholi, kufaka phakathi usuku, isikhathi, igama lommeleli wezinkonzo zamakhasimende, nokuthi uthini. Uma unelisekile ngezincazelo zommeleli, cela ukukhuluma nomunye umuntu.
Uma inkampani yomshuwalense idinga ukuba uhanjiswe, qiniseka ukuthi uyayithola futhi uyithathe nawe ochwepheshe. Kungumqondo omuhle ukugcina ikhophi yamarekhodi akho.
4. Yimiphi imibuzo yezimali okufanele ngiyicele udokotela?
Nazi eminye imibuzo yokubuza udokotela noma abasebenzi bakhe behhovisi:
- Uyamukela umshuwalense wami wezempilo?
- Ngiyafaka amafomu okufaka isicelo, noma wena (umhlinzeki) unakekele lokho?
- Iyini izindleko zokuqokwa kokuqala?
- Zingaki zokwelashwa engizodinga?
- Ngingayithola yini ukwelashwa isikhathi sokuhlola ukuze ngibone ukuthi ngabe ukwelashwa kusebenza kimi ngaphambi kokuba ngizinikele esikoleni esigcwele?
- Ingabe kuzoba nezindleko ezengeziwe?
Kungasiza futhi ukubuza ukuthi yimuphi umshwalense ohlela ukuthi udokotela uyakwamukela, uma kwenzeka ube nesithakazelo ekushintsheni amapulani ngesikhathi esithile (isibonelo, ngokushintsha komsebenzi).
Uma ungenayo inkokhelo yomshuwalense yokwelapha futhi ukhokhe imali egcwele isikhathi ngasinye kungaba nzima kuwe, ungase ubuze:
- Ihhovisi lakho lingenza yini uhlelo lokukhokha ukuze izindleko zami zisakaze isikhathi eside?
- Ingabe unikeza imali yokulinganisa? Imali yesilinganiso esilinganiselwe ilungisa izindleko ezisekelwe emalini yengeniso kanye nekhono lokukhokha.
5. Kuthiwani mayelana nokufakwa komshuwalense wezokwelapha ezihambisanayo nezinye izindlela ezinganikezwa ngabaqashi?
Uma ukuhlinzeka ngemithi ehambisanayo nokunye okuhlinzekwayo kuhlinzekwa, ngokuvamile kuvame ukukodwa kwezinhlobo ezilandelayo:
Ama-deductibles aphezulu. I-deductible iyinani lemali elingu-dollar elimele umthengi akhokhele ngaphambi kokuba umshwalense eqala ukukhokha izinkampani zokwelashwa. Ngaphansi kwalolu hlobo lwenqubomgomo, ukuhlinzeka ngemithi ehambisanayo kanye nokunye, kodwa umthengi ukhokha imali ephakeme.
Abagibeli bezinqubomgomo. Umgibeli uyisichibiyelo somgomo womshuwalense ongashintsha ukuhlinzeka ngandlela-thile (njengezinzuzo ezikhulayo noma ezinciphisa). Ungakwazi ukuthenga umgibeli ongezelayo noma owandisa ukuhanjiswa endaweni yezokwelapha ezihambisanayo nokunye.
Inethiwekhi yabahlinzeki abanethiwekhi. Abanye abatshuwalense basebenzisana neqembu labahlinzeki bemithi ehambisanayo nabanye abavuma ukunikeza izinsizakalo kumalungu eqembu ngesilinganiso esingaphansi kunalokho okwenzelwe abangewona amalungu. Ukhokha ngaphandle kwe-pocket ukwelashwa, kodwa ngesilinganiso esinqunyiwe.
Abaqashi baxoxisana nezinkampani zomshuwalense ngezinhlelo zamapulani nezinsiza. Lokhu kwenziwa ngezikhathi ezithile (ngokuvamile ngonyaka). Ungase ufise ukuvumela izinkampani zenzuzo yenkampani yakho zikwazi nganoma yiziphi izintandokazi zokukhangisa onakho. Uma inkampani yakho inikeza uhlelo olungaphezu kweyodwa, hlola ngokucophelela lokho okunikezwa ngamunye, ngakho-ke ungakhetha uhlelo oluhlangabezana nezidingo zakho.
I-Agency for Researchcare and Quality (AHRQ), i-Federal Agency, inezincwadi eziwusizo ngokukhetha nokusebenzisa uhlelo lomshwalense wezempilo.
6. Umshwalense wami ungicelile ubufakazi, kusukela ezincwadini zesayensi nezokudokotela, mayelana nokusetshenziswa kwemithi yokwelapha ehambisanayo. Ngiyitholaphi?
I-National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse ingakusiza ukuthi uthole ulwazi oluvela ezincwadini zesayensi nezokudokotela mayelana nemithi ehlukile. Basebenzisa ulwazi lwamaphephandaba wezokwelapha nezibuyekezo zezokwelapha ezibuyekezwa kontanga, njenge-CAM ku-PubMed.
7. Inkampani yami yomshuwalense inqabe isimangalo sami ngenqubo yokwesekwa / yokunye. Ngabe kukhona engingakwenza?
Akukho okunye okuphazamisayo kunokuthola ukuthi isimangalo sinqatshiwe. Kusenzeke ngisho nakubantu ngemuva kokuqinisekisa ngefoni ngenkampani yomshuwalense mayelana nokwelapha okuthile.
Njengoba kuxoxwe ngaphambili, qinisekisa ukuthi uyazi inqubomgomo yakho kuhlanganise nokuthi iyini, futhi akusiyo, okufanele ihlanganise. Hlola ukuthi kube nephutha ekukhoneni noma ekukhokheni kwensizakalo yakho (ebizwa ngephutha lokubhala), noma ngehhovisi lomsebenzi noma ngenkampani yomshuwalense; qhathanisa amakhodi kumthethosivivinywa womsebenzi ngamakhodi edokhumenti owutholile enkampanini yomshuwalense.
Uma ucabanga ukuthi umshwalense wakho wenze iphutha ekucubunguleni isimangalo sakho, ungacela isibuyekezo kusuka enkampanini.
Futhi, inkampani yomshuwalense kumele ibe nenqubo yokukhalaza futhi inikeze ikhophi yayo ngenqubomgomo yakho. Kungaba usizo ukuxoxa nodokotela wakho noma ngabe angakwenza noma yini egameni lakho, njengokubhala incwadi. Uma uthathe lezi zinyathelo futhi inkinga ayixazululwanga, xhumana nehhovisi lakho likomshwalense wombuso womshuwalense, onomgomo wesikhalazo somthengi.
8. Ingabe kukhona imithetho engisizayo ukuba ngigcine umshuwalense wami wezempilo uma ngilahlekelwa noma ngishintsha imisebenzi? Ingabe le mithetho iyasebenza ekwelapheni okuhambisanayo nokwelapha okunye?
Uma njengamanje unesimiso somshuwalense esibandakanya noma yikuphi ukuhlinzekwa kwemithi ehambisanayo nokunye, lemithetho elandelayo ingase ibe nesithakazelo kuwe.
Umthetho we-Health Insurance Portability and Accountability Act (HIPAA) ka-1996 uhlinzeka ngokuvikeleka okungapheli kwabaningi baseMelika abaqashiwe. I-HIPAA ivikela ukuhlinzekwa komshuwalense wezempilo kwabasebenzi kanye nemindeni yabo uma isisebenzi sishintsha noma siphelelwa umsebenzi. Umthetho:
- Ukunciphisa ikhono lezinkampani zomshuwalense ukwenqaba ukuhlinzekwa ngokusekelwe ezimweni zesikhangiso.
- Ivimbela izinhlelo zezempilo zeqembu kusukela ekuphikeleni noma ukukhokhisa okungaphezulu ukuhlinzekwa ngenxa yempilo engafanele ekhona noma yamanje.
- Ukuqinisekiswa kokuvuselelwa kokuqashwa, kungakhathaliseki ukuthi yiziphi izimo zezempilo zabantu abahlanganiswe ngaphansi kwenqubomgomo.
- Iqinisekisa abanye abaqashi bamabhizinisi amancane, kanye nabantu abathile abalahlekelwa umsebenzi wokuhlobene nomsebenzi, ilungelo lokuthenga umshuwalense wezempilo.
Amasevisi we-Medicare neMediicaid Services angakunika ulwazi olujwayelekile ohlelweni lwe-Federal HIPAA. Qaphela ukuthi izwe ngalinye lingase libe nemithetho ethile ehlobene nezidingo ze-HIPAA; uma udinga ulwazi oluthe xaxa ku-HIPAA esifundazweni sakho, thintana nehhovisi lakho lomshwalense wombuso womshuwalense.
Omunye umthetho we-Federal ongakusiza nguMthetho Wokuhlanganiswa Kwemali Yezokuhlaziywa Kwezimali Ze-Omnibus (COBRA) ka-1985.
Ukuqhutshwa kwe-COBRA okuqhubekayo kukunika ithuba lokuthenga nokulondoloza isikhathi sakho samanje sezempilo impilo yakho isikhathi esibekiwe uma ulahlwe noma usebenze amahora akho emsebenzini ngezansi ezingeni lokuthola izinzuzo.
Ubude bokungena ngokuqhubekayo kuxhomeke esizathu sokulahlekelwa kwekhasi lakho.
I-COBRA ngokuvamile ihlanganisa izinhlelo zezempilo zamabhizinisi ezinabasebenzi abangu-20 noma ngaphezulu, izinhlangano zabasebenzi, nohulumeni basekhaya noma basekhaya.
Kufanele uhlangabezane nezikhathi ezithile zokufaka isicelo kanye nezinye izimo, njengezinhlelo zokukhokha, ukugcina ukufakwa ngaphansi kwe-COBRA. I-COBRA ingakusiza futhi ukuba ugweme igebe ekukhusheni uma uguqula imisebenzi futhi ungahambi ngokushesha ekuthengisweni kwenkampani yakho entsha.
Ukuze uthole olunye ulwazi mayelana ne-COBRA, thintana nehhovisi eliseduzane lePenssion and Welfare Benefits Administration yoMnyango Wezabasebenzi.
Isimo sakho singase sibe nomthetho odinga inshuwalense ukuqhubeka nokuhlinzekwa kohlelo lweqembu kubantu abalahlekelwe ukuhlinzeka ngezokwelapha ngezizathu ezihlukahlukene. Hlola ngehhovisi lakho lomshuwalense wombuso.
9. Yimaphi ama-akhawunti akhokhelwa intela ezindleko zezokwelapha? Bangangisiza kanjani?
Ukuhlelwa kwemali okuguquguqukayo (FSA; ngezinye izikhathi okuthiwa i-akhawunti ye-Flexible Spending Account) yinzuzo enikezwa abanye abaqashi enikeza indlela yokusiza ukukhokha izindleko zezokwelapha ngaphandle, ngenkathi kunciphisa imali engenayo yentela.
With FSAs for izindleko ezihlobene nezempilo, ukhetha inani lama-dollar pre-tax ukubekelwa eceleni kwesikhokhelo sakho isikhathi ngasinye. Le mali iyatholakala ukuze kubuyiselwe izindleko ezithile eziphathelene nempilo ezingakhokhwa nganoma iyiphi enye indlela, njengomshwalense.
Kungase kudingeke unikeze amadokhumenti avela kudokotela noma omunye umhlinzeki wezokunakekelwa kwempilo ukuthi ukwelashwa kuyadingeka ngokwempilo.
Qaphela ukuthi i-IRS ayivumeli izindleko ezifanayo zizokhokhiswa kokubili nge-FSA futhi zithathwa njengokuncishiswa kwentela.
Olunye uhlobo lwenzuzo yokukhokha intela yezindleko ezihlobene nezempilo i-akhawunti yokulondoloza impilo (HAS). Ukumiswa yiCongress ngoDisemba 2003, ama-HSA avumela abantu abathile abambe iqhaza ohlelweni lwezempilo oluphezulu lokudonswa imali yokugcina imali kwi-akhawunti engenayo intela. Uma uvumelekile, ungasebenzisa lezi zindleko ukukhokha izindleko zakho zokwelashwa zesikhathi esizayo noma lezo oshade naye noma abazondayo. I-IRS inezincwadi ngolunye ulwazi mayelana nama-FSA kanye nama-HSA. UMnyango Wezezimali unesixhumanisi esiqondile kolwazi mayelana nama-HSA kuwebhusayithi yayo.
10. Ingabe uHulumeni waseHulumeni unezinsiza ezingangisiza ngemali ngezindleko zami ezihlobene nempilo?
Njengamanje, izinhlelo zokusiza ezempilo zase-Federal azihlelwa ukusiza ngezinye izindleko zemithi.
Zihloselwe ukuhlinzeka ngokusekela ngokuqondile (izinkokhelo ngqo) noma ukusekela okungaqondile (njengezindlu noma izikweletu zokunakekelwa kwengane, ukunakekelwa kwezempilo emitholampilo yomphakathi, noma ezinye izinsizakalo zenhlalakahle) kubantu abaHulumeni abanquma ukuthi banesidingo. Izibonelo zihlanganisa abantu aba:
- Yiba nezinzuzo eziphansi kanye nezinsizakalo ezilinganiselwe
- Awunayo enye inshuwalense yezokwelapha
- Unokukhubazeka
- Ziyingxenye yabantu abanenkinga yokuthola ukunakekelwa kwezokwelapha
- Kungenani okungu-65 ubudala ubudala
- Uke wakhonza empini
Kunama-database e-Federal e-intanethi angakwethula kulezi zinhlelo. I-GovBenefits (www.govbenefits.gov) inikeza ukubuka konke nokuhlola okukusiza ukuthi ubone ukuthi yiziphi izinzuzo ezifanele izidingo zakho. I-FirstGov (www.firstgov.gov) inolwazi ngemisebenzi ehlobene nezempilo efana ne-Medicare ne-Medicaid.
Njengengxenye yocwaningo lwayo, Isikhungo Sikazwelonke Sokuqeda Imithi Ephelele (Alternative Medicine) (NCCAM) senza ukuhlolwa kwemitholampilo kwezinye izindlela zokwelashwa ezihlukile.
11. Ingabe izinsizakalo zokwelapha ezihambisanayo nezinye izindlela ezikhishwayo intela yami engenayo?
Kusukela ngo-2002, i-IRS ivumela inani elilinganiselwe lezinkampani ezidonswayo ukuze zisebenze kanye nemikhiqizo ehambisanayo.
12. Ungasikisela noma yiziphi ezinye izinsiza?
Uma ukwelashwa (kungakhathaliseki ukuthi imithi ehambisanayo noma ejwayelekile) yesifo noma isimo kubangela inkinga yezezimali kuwe nomndeni wakho, ungase ufise ukuzama okulandelayo ngolwazi oluthe xaxa:
- Uma uthola ukunakekelwa esibhedlela noma emtholampilo, leso sakhiwo singase sibe nesisebenzi senhlalakahle noma ummeli wezeguli ongakunikeza.
- Ungase uthole ukuthi kuyasiza ukuxhumana nezinhlangano ezingenzi-nzuzo ezisebenza ngesifo sakho noma isimo sezokwelapha (zama ukucinga nge-inthanethi noma hlola izinkomba kulabhulali yakho yangakini).
Umthombo: Izinkinga zezeMpahla zabathengi eMidlelweni eQinisekisayo neyezinye izindlela, Isikhungo sikaZwelonke seMidiya eQinisekisa kanye neyeMithi (NCCAM). http://nccam.nih.gov/health/financial/
Ukuziphendulela: Ulwazi oluqukethwe kule sayithi luhloswe ngezinhloso zemfundo kuphela futhi aluthathi iseluleko, ukuxilongwa noma ukwelashwa.