Yini Eba Ngokwemshwalense Yempilo Yakho Imali?

Umshuwalense wakho wezempilo uyakunqunywa futhi ama- premium akho ngenyanga akho cishe akhokhe izindleko ezinkulu zokunakekelwa kwezempilo. Ngisho noma i-deductible yakho ibalwa ngesabelo sezingonyama sesabelomali sesabelomali sokunakekelwa kwempilo, ukuqonda okubalulekile ekubhekiseni umshuwalense wakho wezempilo ongenakulula futhi lokho akulula.

Ukuhlelwa kwepulani ngalinye lempilo kunquma ukuthi yini ebalulekile kumshuwalense wezempilo okhishiwe, futhi uhlelo lwezempilo oluklama lungabonakala luyinkimbinkimbi.

Izinhlelo zezempilo ezithengiswa yilezi zinshuwalense zempilo zizohlukahluka kulokho okubaluleka ekubhekaneni ne-deductible. Ngisho uhlelo olufanayo lungashintsha kusukela ngonyaka owodwa kuya olandelayo. Udinga ukufunda ukuphrinta okuhle futhi ube ne-savvy ukuze uqonde ukuthi yini, ngokuqinisekile, kulindeleke ukuthi ukhokhe, futhi lapho, ngokuqinisekile uzokhokha.

Okubheka Ngomshwalense Wempilo Yakho Imali

Imali ithola ukuthi idalwe ngokukhipha imali yakho kuye ngokuthi indlela yokwabelana kwezindleko zempilo yakho ihlelwe kanjani. Kunezindlela eziningi zokwabelana ngezindleko kungalungiswa, kepha iningi liwela ezinkambeni ezimbili eziyinhloko zokuklama.

1. I-"Ukhokha kuqala, umshwalense ukhokha kamuva": Umshwalense wakho wezempilo angeke akhokhe i-dime kunoma yini ngaphandle kokunakekelwa kokuvimbela kuze kube yilapho usuhlangabezane ne-deductible yakho yonyaka. Ukhokha imali engu-100% yezikweletu zakho zezokwelapha ngaphambi kokuthi i-deductible ibe uhlangane. Ngemuva kokudonswa kwezimali, ukhokha kuphela i- copayments kanye ne- coinsurance ; umshuwalense wakho wezempilo uthola lonke ithebhu.
   • Kulezi zinhlelo, ngokuvamile noma yikuphi imali oyisebenzisayo ekunakekelweni okudingekile kwezokwelapha kubandakanya umshwalense wakho wezempilo ozokhishwa uma nje uzuzwa inzuzo yecebo lakho lempilo futhi wathola ukulandela imithetho yezempilo.

1. "I-deductible ixoshwa kwamanye amasevisi" ukuklama: Umshuwalense wakho wezempilo uthatha ingxenye yethebhu kwezinye izinsizakalo ezingenakuvimbela ngisho nangaphambi kokuba uhlangabezane ne-deductible yakho. Kulolu hlobo lwepulani, ngokuvamile izinsizakalo ezikhokhwayo kusukela ekudonsheni yizinsizakalo ezidinga ukukhokha imali. Kungakhathaliseki ukuthi i-deductible ihlangene noma cha, ukhokha kuphela ikhophi. Umshuwalense wakho wezempilo ukhokhela okusele kwezindleko zalowo msebenzi.
   
   Mayelana nezinsizakalo ezidinga uxhaso lwezimali kunokukhokhwa kwemali , ukhokha izindleko ezigcwele zesevisi kuze kube yilapho usuqedile imali yakho. Ngemuva kokuba i-deductible ihlangene, ukhokhela imali yesamba semali; uhlelo lwakho lwezempilo lukhokhela konke okunye.
   • Kulezi zinhlelo, imali oyisebenzisayo ekubhekaneni nezinsizakalo okukhishwe ngazo imali esivunyelwe ngokuvamile ayibonakaliswa ngokukhipha imali yakho. Isibonelo, uma unemali eyi-$ 35 yokukhokha ukuze ubone isazi noma ngabe uhlangabezane ne-deductible, leyo khophi ye-$ 35 mhlawumbe ngeke ibale ngokubhekwa kwakho.
     
     Noma kunjalo, lokhu kuhluka kusuka ohlelweni lwezempilo kuya ohlelweni lwezempilo; ngakho-ke, funda isifinyezo sakho sezinzuzo nokuphepha ngokucophelela, bese ushaya uhlelo lwakho lwezempilo uma ungaqiniseki. Funda kabanzi ku, " Ingabe I-Copays Bala Ku-Inshuwalense Yempilo Yakho Imali? "

Khumbula, ngenxa ye- Care Affordable Act , ezinhlelweni eziningi zempilo, ukunakekelwa kokuvikela kuhlanganiswe 100% ngumshuwalense wezempilo. Akudingeki ukhokhe noma yiliphi i-deductible, i-copay, noma i-coinsurance yezinsizakalo zokunakekelwa kwezempilo ezivikelayo ozithola kumhlinzeki we- in-network .

Futhi uma uhlangana nokuphuma kwakho kwepokhethi enkulu ngonyaka (kufaka phakathi i-deductible yakho, i-coinsurance, kanye ne-copayments), umshwalense wakho ukhokhela amaphesenti angu-100 akho konke okudingekayo okwenziwe ngokwemithi, okuyi-inethiwekhi.

Yini Engayiboni Ngomshwalense Wezempilo Yakho Deductible

Imali oyikhokhayo ye-ephaketheni yezinsizakalo zokunakekelwa kwezempilo engeyona inzuzo ehlanganisiwe yomshwalense wakho wezempilo ngeke ikhishwe ngomshuwalense wakho wezempilo owenziwe. Isibonelo, uma umshwalense wakho wezempilo ungagqugquzeli ukwelapha izimonyo ebusweni bombuso, imali oyikhokhela ephaketheni lakho lalezi zokwelapha ngeke ilandele umshwalense wakho wezempilo owenziwe.

Imali oyikhokhele umhlinzeki ongaphandle kwe-inthanethi ngokuvamile ayikhokhelwe ekudaleni imali ehlelweni lwezempilo olungabheki ukunakekelwa kwe-out-of-network. Kukhona okuhlukile kule mithetho njengokunakekelwa okuphuthumayo noma izimo lapho kungekho mnikezeli wenethiwekhi ongakwazi ukunikeza isevisi edingekayo.

Izinhlelo zezempilo ezivumela ukunakekelwa kwe-out-of-network, ngokuvamile ama- PPO kanye nezinhlelo ze- POS , zingase zihluke ngokuthi zikhokha kanjani imali oyikhokhele ukunakekelwa kwe-out-of-network.

Ungase ube nezinkampani zombili zomshuwalense wezempilo ohlukile, owodwa wokunakekelwa kwe-in-network kanye nolunye olukhudlwana lokunakekelwa kwe-out-of-network. Kulesi simo, imali ekhokhelwa ukunakekelwa kwe-out-of-network ithola isikweletu ekubhekaneni ne-out-of-network deductible kodwa ayibali ngokubhekene ne-in-network deductible. Enye ye-caveat: uma umhlinzeki wakho ongaphandle kwe-inthanethi ekhokhisa imali engaphezu kwendabuko yensizakalo oyitholile, uhlelo lwakho lwezempilo lunganciphisa inani elibalulekayo kulokhu okuvela ngaphandle kwenethiwekhi okukhishwe kwisamba sokwejwayelekile.

Ama-copayments (ama-copays) ngokuvamile awabalanga ku-deductible. Uma uhlelo lwakho lwezempilo lunemakhophi angu-$ 20 ekuvakasheni kwamahhovisi okunakekelwa okuyinhloko, i-$ 20 oyikhokhayo cishe ngeke ibhekane ne-deductible yakho.

Kodwa-ke, kuzobalelwa ekuphumeni kwakho konke okuphakathi kwamapulani (ezinye izinhlelo ezinamakhulu nezikhulu zingaba nemithetho ehlukene mayelana nokuthi umkhawulo wabo wokusebenza ongapheli kahle).

Amaphrimiyamu akho ngenyanga awabalwa ngokubheka kwakho . Eqinisweni, amaphrimiyamu awavunyelwanga nganoma yiluphi uhlobo lokubelana ngezindleko. Izinkokhelo zindleko zokuthenga umshuwalense. Yikho intengo oyikhokhela umshwalense ngokuthatha ingxenye yengozi yezezimali yezindleko zakho zokunakekelwa kwezempilo.

Okudingeka Ukwazi Ngaphambi Kokuthola Ukunakekelwa Kokuxhumana Nenethiwekhi
I-Out-Of-Pocket Isikhulu-Indlela Esebenzayo & Kungani Kufanele Uqaphele
Yini Engayifinyeleli Ngaphandle Kokuphuma Kwakho Kwe-Pocket?