Ukuqonda izicwangciso zeinshurensi yezempilo

Uninzi lweenkampani zeinshurensi zibonelela ngeendlela ezahlukeneyo zezicwangciso zempilo. Kwaye xa uthelekisa izicwangciso, ngamanye amaxesha kunokubonakala ngathi isuphu yoonobumba. Nguwuphi umahluko phakathi kwe-HMO, i-PPO, i-POS, kunye ne-EPO? Ngaba banikela ingxelo efanayo?

Esi sikhokelo kwizicwangciso zezempilo sinokukunceda uqonde uhlobo ngalunye lwesicwangciso. Emva koko unokukhetha ngokulula isicwangciso esifanelekileyo wena kunye nosapho lwakho.

Kuxhomekeka kwindlela oyifumana ngayo i-inshurensi yezempilo, unokukhetha iintlobo ezahlukeneyo zezicwangciso.

Imibutho yoLondolozo lwezeMpilo (HMOs). Ezi zicwangciso zibonelela ngenethiwekhi yababoneleli ngezempilo kunye neepremiyamu eziphantsi zenyanga. Ababoneleli banesivumelwano kunye nesicwangciso sezempilo. Oku kuthetha ukuba babiza ixabiso elisetiweyo leenkonzo. Uya kukhetha umboneleli wokuqala. Lo mntu uya kulawula ukhathalelo lwakho kwaye akuthumele kwiingcali. Ukuba usebenzisa ababoneleli, izibhedlele, kunye nabanye ababoneleli abavela kwinethiwekhi yesicwangciso, uhlawula kancinci epokothweni. Ukuba usebenzisa ababoneleli ngaphandle kwenethiwekhi, kuya kufuneka uhlawule ngaphezulu.

Imibutho yababoneleli ababodwa (EPOs). Ezi zizicwangciso ezibonelela ngothungelwano lwababoneleli kunye neepremiyamu eziphantsi zenyanga. Kuya kufuneka usebenzise ababoneleli kunye nezibhedlele kuluhlu lwenethiwekhi ukugcina iindleko zakho zokuphuma epokothweni ziphantsi. Ukuba ubona ababoneleli ngaphandle kwenethiwekhi, iindleko zakho ziya kuba phezulu kakhulu. Ngee-EPOs, awudingi umboneleli wokuqala wokulawula ukhathalelo lwakho kwaye akunike ukuhanjiswa.

Imibutho yababoneleli abakhethiweyo (ii-PPOs). Ii-PPO zibonelela ngenethiwekhi yababoneleli kunye nokukhetha ukubona ababoneleli ngaphandle kwenethiwekhi ukuze ufumane imali ethe kratya. Awudingi umboneleli wokuqala wokukhathalela ukhathalelo lwakho. Uya kuhlawula ngaphezulu kwiipremiyamu kwesi sicwangciso ngokuthelekiswa ne-HMO, kodwa unayo inkululeko ethe kratya yokubona ababoneleli ngaphakathi nangaphandle kwenethiwekhi ngaphandle kwesidingo sokudluliselwa.

Izicwangciso zePoint-of-Service (POS). Izicwangciso ze-POS zifana ne-PPO. Banikezela ngenethiwekhi kunye nangaphandle kwenethiwekhi. Ungabona nabaphi na abanikezeli benethiwekhi ngaphandle kokuthunyelwa. Kodwa ufuna ukuthunyelwa ukuze ubone ababoneleli abangaphandle kwenethiwekhi. Ungonga imali kwiipremiyamu zenyanga ngolu hlobo lwesicwangciso xa kuthelekiswa ne-PPO.

IziCwangciso zeMpilo eziPhezulu eziPhezulu (HDHPs). Olu hlobo lwesicwangciso lubonelela ngeeprimiyamu eziphantsi zanyanga zonke kunye nokutsalwa okuphezulu konyaka. I-HDHP inokuba yenye yeentlobo zesicwangciso esingentla ngentsalela ephezulu. Ukuxhuzulwa yimali emiselweyo ekufuneka uyihlawule ngaphambi kokuba i-inshurensi yakho iqale ukuhlawula. Ngo-2020, ii-HDHP zinokutsalwa kwe- $ 1,400 ngomntu ngamnye kunye ne- $ 2,800 kusapho ngalunye ngonyaka okanye nangaphezulu. Abantu abanezicwangciso bahlala befumana iakhawunti yokonga okanye yokubuyisela imali. Oku kukunceda ukuba ugcine imali yokutsalwa kunye nezinye iindleko eziphuma epokothweni. Inokukunceda ugcine imali kwirhafu.

Intlawulo yenkonzo (FFS) izicwangciso azixhaphakanga namhlanje. Ezi zicwangciso zibonelela ngenkululeko yokubona nawuphina umboneleli okanye isibhedlele osithandayo. Isicwangciso sihlawula isixa esimiselweyo ngenkonzo nganye, kwaye uhlawula eseleyo. Awudingi ukuhanjiswa. Ngamanye amaxesha, uhlawulela inkonzo ngaphambili, fayilisha ibango, kwaye icebo liyakubuyisela. Esi sisicwangciso seinshurensi ebiza imali eninzi xa singafaki inethiwekhi okanye ukhetho lwePPO.

Izicwangciso zentlekele bonelela ngezibonelelo zeenkonzo ezisisiseko kunye nokugula okanye ukonzakala okukhulu. Ziyakukhusela kwiindleko zengozi enkulu okanye ukugula. Ezi zicwangciso azinakho ukugubungela kakuhle abantu abaneengxaki zempilo abafuna ukhathalelo rhoqo okanye iimvavanyo. Ungathenga kuphela isicwangciso esiyintlekele ukuba ungaphantsi kweminyaka engama-30 okanye ungangqina ukuba awunakho ukubhatala impilo. Iipremiyamu zanyanga zonke ziphantsi, kodwa iimali ezitsaliwe zezi zicwangciso ziphezulu kakhulu. Njengomntu ngamnye, ukuncitshiswa kwakho kunokuba malunga ne-6,000 yeedola. Uya kudinga ukuhlawula imali ephezulu ngaphambi kokuba i-inshurensi iqale ukuhlawula.

Xa ukhetha isicwangciso, cinga ngeemfuno zakho zonyango kunye nezinto ozikhethayo. Ukongeza kuhlobo lwesicwangciso, qiniseka ukuba uthelekisa izibonelelo, iindleko zokuphuma epokothweni, kunye nenethiwekhi yomnikezeli ukuze ulunge.

Isiseko se-AHIP. Isikhokelo sabathengi sokuqonda uthungelwano lwesicwangciso sezempilo. www.ahip.org/wp-content/uploads/2018/08/ConsumerGuide_PRINT.20.pdf. Kufunyenwe ngoDisemba 18, 2020.

Indawo yezempilo.gov iwebhusayithi. Ungasikhetha njani isicwangciso seinshurensi yezempilo. Isicwangciso seinshurensi yezempilo kunye neentlobo zenethiwekhi: ii-HMOs, ii-PPOs, kunye nokunye. Lwezempilo Health.gov/choose-a-plan/plan-types. Kufunyenwe ngoDisemba 18, 2020.

Inkathalo yezempilo.gov.website. Isicwangciso esiphakamileyo sezempilo (HDHP). www.healthcare.gov/glossary/high-deductible-health-plan/. Kufumaneka ngoFebruwari 22, 2021.

Indawo yezempilo.gov iwebhusayithi. Ungasikhetha njani isicwangciso seinshurensi yezempilo: Izinto ezi-3 zokwazi ngaphambi kokuba ukhethe isicwangciso seinshurensi yezempilo. Lwezempilo Health.gov/choose-a-plan. Kufunyenwe ngoDisemba 18, 2020.

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