Nguwuphi umahluko phakathi koQinisekiso neCopays?

Umxholo

• Ukuqonda ukuba unetyala elingakanani
• Ngaba ukuphuma epokothweni okuphezulu kukuchaphazela njani oko ukutyalayo?
• Isebenza njani i-inshurensi?
• Abanikezeli benethiwekhi kunye nabangaphandle kwenethiwekhi
• Umgca wezantsi

Imirhumo yeinshurensi

Iindleko zeinshurensi yezempilo zihlala zibandakanya iipremiyamu zenyanga kunye nolunye uxanduva lwezezimali, ezinje ngee-copays kunye ne-coinsurance.

Nangona la magama abonakala efanayo, la malungiselelo okwabelana ngeendleko asebenza ngokwahlukileyo. Nalu ulwaphulo:

• UQinisekiso. Uhlawula ipesenti emiselweyo (enje ngeepesenti ezingama-20) yeendleko zayo yonke inkonzo yezonyango oyifumanayo. Inkampani yakho yeinshurensi inoxanduva lwepesenti eseleyo.
• ICopay. Uhlawula isixa esimiselweyo seenkonzo ezithile. Umzekelo, kuya kufuneka uhlawule ikopi eyi- $ 20 ngalo lonke ixesha ubona ugqirha wakho wokhathalelo oluphambili. Ukubona ingcali kunokufuna ikopi ephezulu, emiselweyo kwangaphambili.

Enye into ekwabelwana ngayo ngeendleko yaziwa njengokuncitshiswa. Unciphiso lwakho lonyaka sisixa semali oza kuhlawula ngaso iinkonzo ngaphambi kokuba i-inshurensi yakho yempilo iqale ukuthatha ezo ndleko.

Kuxhomekeke kwisicwangciso sakho seinshurensi yezempilo, ukutsalwa kwakho kunokuba ngamakhulu ambalwa okanye amawaka amawaka eedola ngonyaka.

Funda ukuze ufunde ngakumbi malunga ne-coinsurance kunye neepopay kunye nendlela ezichaphazela ngayo imali oza kuyityala xa ufumana iinkonzo zonyango.

Ukuqonda ukuba unetyala elingakanani

Ukuqonda ukukopishwa, ukuqinisekiswa kwemali, kunye nokuncitshiswa kunokunceda ekulungiseleleni iindleko zokufumana unyango.

Ezinye iintlobo zokundwendwela ziya kufuna kuphela ikopi. Ezinye iintlobo zokundwendwela ziya kufuna ukuba ubhatale ipesenti yetyala elipheleleyo (i-coinsurance), eya kuthi ihlawulelwe, kunye nepopay. Olunye utyelelo, unokuhlawulwa ngexabiso elipheleleyo lotyelelo kodwa ungahlawuli.

Ukuba unesicwangciso esigubungela iipesenti ezili-100 zokundwendwela kakuhle (ukuhlolwa konyaka), kuya kufuneka uhlawule kuphela ikopi yakho esele umiselwe.

Ukuba isicwangciso sakho sigubungela kuphela i-100 yeedola ukuya kutyelelo oluhle, uya kuba noxanduva lwe-copay kunye neendleko ezisele zotyelelo.

Umzekelo, ukuba i-copay yakho iyi- $ 25 kwaye iindleko zizonke zokundwendwela zingama-300 eedola, ubuya kuba noxanduva lwe- $ 200- $ 175 yazo enokujonga kwi-deductible yakho.

Nangona kunjalo, ukuba sele udibene ne-deductible yakho epheleleyo yonyaka, uya kuba noxanduva kuphela kwi-25 ye-copay.

Ukuba unesicwangciso se-coinsurance kwaye ubethe yonke imali yakho, uya kuhlawula ipesenti ye-300-ukutyelela kakuhle. Ukuba inqanaba lakho leinshorensi liipesenti ezingama-20, kunye ne-inshurensi yakho egubungela enye ipesenti ezingama-80, kuya kufuneka uhlawule i-60 yeedola. Inkampani yakho yeinshurensi iya kugubungela i-240 yeedola eseleyo.

Ngalo lonke ixesha jonga kwinkampani yeinshurensi yakho ukuze uqiniseke ukuba uyazi ukuba zeziphi izinto ezigutyungelweyo kwaye luxanduva lwakho ngeenkonzo ezahlukeneyo. Ungatsalela umnxeba kwi-ofisi kagqirha kwaye ubuze malunga neendleko ezilindelekileyo zonyango lwakho ngaphambi kokuba uye kummiselo wakho.

Ngaba ukuphuma epokothweni okuphezulu kukuchaphazela njani oko ukutyalayo?

Uninzi lwezicwangciso zeinshurensi yezempilo zinento ebizwa ngokuba yi "out-of-pocket maximum". Yeyona nto uza kuyibhatala ngonyaka onikiweyo weenkonzo ezigqunywe sisicwangciso sakho.

Nje ukuba uchithe ubuninzi bakho kwii-copays, i-coinsurance, kunye ne-deductibles, inkampani yakho ye-inshurensi kufuneka igubungele iipesenti ezili-100 zazo naziphi na iindleko ezongezelelweyo.

Gcina ukhumbula ukuba iitotali ezingaphandle kweepokotho azibandakanyi imali ehlawulwe yinkampani yakho yeinshurensi kugqirha wakho okanye komnye umboneleli wezempilo. Amanani ngokungqongqo yimali oyihlawuleyo yokhathalelo lwempilo.

Isicwangciso esizimeleyo siya kuba nesezantsi kakhulu ngaphandle kweepokotho kunesicwangciso esigubungela usapho luphela. Wazi lo mahluko njengoko uqala uhlahlo-lwabiwo mali lwempilo yakho.

Isebenza njani i-inshurensi?

I-inshurensi yezempilo yenzelwe ukukhusela abantu kunye neentsapho kwiindleko ezikhulayo zononophelo lwempilo. Ayidla ngexabiso eliphantsi kakhulu, kodwa inokukugcinela imali kwixesha elide.

Iinshurensi zifuna iipremiyamu zenyanga. Ezi ziintlawulo ozenzayo kwinkampani yeinshurensi inyanga nenyanga ukuze ube neinshurensi yokugubungela inkxalabo yesiqhelo neyintlekele.

Uhlawula iipremiyamu nokuba utyelele ugqirha kube kanye ngonyaka okanye uchitha iinyanga esibhedlele. Ngokwesiqhelo, uya kuhlawula iipremiyamu ezisezantsi zenyanga zesicwangciso esinokutsalwa okuphezulu. Njengoko kunciphisiwe kuncipha, iindleko zenyanga ziyanda.

I-inshurensi yezempilo ihlala ibonelelwa ngabaqeshi kubasebenzi abasisigxina. Iinkampani ezincinci ezinabasebenzi abambalwa kuphela abanokukhetha ukubonelela nge-inshurensi yezempilo ngenxa yeendleko.

Unokukhetha ukufumana i-inshurensi yezempilo ngokwakho kwinkampani yeinshurensi yabucala, nokuba uqeshwe ngokusisigxina kwaye unokukhetha i-inshurensi yezempilo exhaswa ngumqeshi.

Xa ufumana i-inshurensi yezempilo, kuya kufuneka ufumane uluhlu lweendleko ezigutyungelweyo. Umzekelo, uhambo oluya kwigumbi likaxakeka kwi-ambulensi lunokubiza i-250 yeedola.

Ngaphantsi kwesicwangciso esinjengalesi, ukuba awukadibani nokutsalwa kwakho kwaye uye kwigumbi likaxakeka kwi-ambulensi, kuya kufuneka uhlawule i $ 250. Ukuba udibene nokuncitshiswa kwakho kunye nokuhamba kweenqwelo yezigulana kugutyungelwe iipesenti ezili-100, emva koko uhambo lwakho kufuneka lube simahla.

Kwezinye izicwangciso, utyando olukhulu lugutyungelwa kwiipesenti ezili-100, ngelixa ukuvavanywa okanye ukuvavanywa kunokugutyungelwa kuphela kwiipesenti ezingama-80. Oku kuthetha ukuba unoxanduva lweepesenti ezingama-20 ezisele.

Kubalulekile ukuphonononga iikopi, ukuqinisekiswa kweemali, kunye nokuncitshiswa xa ukhetha isicwangciso. Gcina ukhumbula imbali yakho yezempilo.

Ukuba ulindele ukuba utyando olukhulu okanye ukuhambisa umntwana kunyaka ozayo, unokufuna ukukhetha isicwangciso apho umboneleli weinshurensi egubungela ipesenti ephezulu yezi ntlobo zeenkqubo.

Kuba ngekhe uqikelele iingozi okanye inkxalabo yezempilo yexesha elizayo, cinga nokuba unganakho ukuhlawula malini inyanga nenyanga kwaye unganakho kangakanani ukubangaba unempilo ongayilindelanga.

Kungenxa yoko le nto kubalulekile ukuba ujonge kwaye uqwalasele zonke iindleko ezilindelweyo, kubandakanya:

• kutsalwa
• ukuphuma epokothweni ubuninzi
• Intlawulo yanyanga le
• ikopi
• Uqinisekiso

Ukuqonda ezi nkcitho kunokukunceda uqonde elona xabiso liphezulu lemali onokuthi uboleke ukuba ufuna iinkonzo ezininzi zempilo kunyaka othile.

Abanikezeli benethiwekhi kunye nabangaphandle kwenethiwekhi

Ngokubhekiselele kwi-inshurensi yezempilo, inethiwekhi yingqokelela yezibhedlele, oogqirha, kunye nabanye ababoneleli abasayinelwe ukuba babe ngabanikezeli abakhethiweyo kwisicwangciso sakho seinshurensi.

Aba banikezeli benethiwekhi. Ngabo inkampani yakho yeinshurensi ikhetha ukuba uyibone.

Ababoneleli abangaphandle kwenethiwekhi ngabo kuphela abangatyikitywanga kwisicwangciso sakho. Ukubona ngaphandle kwabanikezeli benethiwekhi kunokuthetha iindleko eziphezulu zokuphuma epokothweni. Ezi ndleko zinokungasebenzi ekutsalweni kwakho.

Kwakhona, kubalulekile ukuba uqiniseke ukuba uyazi ii-ins kunye nokuphuma kwesicwangciso sakho se-inshurensi ukuze wazi ukuba ngubani kunye nezinto ezigutyungelweyo. Ugqirha ongaphandle kwenethiwekhi angabakho kwidolophu yakho, okanye angangomntu ombonayo xa useluhambeni.

Ukuba awuqinisekanga ukuba ugqirha omthandayo ukwi-network, ungatsalela umnikezeli weinshurensi okanye iofisi kagqirha wakho ukuze ufumane.

Ngamanye amaxesha oogqirha bayaphuma okanye bajoyine inethiwekhi entsha, nabo. Ukuqinisekisa ubume benethiwekhi kagqirha wakho phambi kotyelelo ngalunye kunokukunceda uphephe iindleko ezingalindelekanga.

Umgca wezantsi

I-inshurensi yezempilo inokuba ngumcimbi onzima. Ukuba unayo i-inshurensi ngomqeshi wakho, buza ukuba ngubani kumqeshi wakho umntu ekunokuqhagamshelwana naye ngemibuzo. Ihlala ingumntu kwisebe lezabasebenzi, kodwa hayi rhoqo.

Inkampani yakho yeinshurensi kufuneka nayo ibe nesebe lenkonzo yabathengi ukuphendula imibuzo yakho.

Izinto ezibaluleke kakhulu ukugcina engqondweni xa uqala isicwangciso seinshurensi kukwazi:

• Zonke iindleko zakho
• xa isicwangciso sakho siqala ukusebenza (izicwangciso ezininzi zeinshurensi ziyatshintsha phakathi enyakeni)
• zeziphi iinkonzo ezibandakanyiweyo kwaye zingakanani

Usenokungacwangcisi ukusebenza kakhulu okanye ukwenzakala, kodwa i-inshurensi inokukunceda ukunciphisa umthwalo wemali ukuba ufumana ingxaki enkulu kwezonyango.