Uyini umehluko phakathi kwe-Coinsurance vs. Copays?

-Delile

• Ukuqonda ukuthi ukweleta malini
• Ingabe ukuphuma okuphuma ephaketheni kukuthinta kanjani lokho okukweletayo?
• Usebenza kanjani umshuwalense?
• Abahlinzeki be-in-network nabangaphandle kwenethiwekhi
• Okubalulekile

Imali yomshwalense

Izindleko zomshuwalense wezempilo zivame ukufaka amaprimiyamu nyangazonke kanye neminye imithwalo yemfanelo yezezimali, njengama-copays kanye ne-coinsurance.

Yize le migomo ibonakala ifana, lezi zinhlelo zokwabelana ngezindleko zisebenza ngokuhlukile. Nakhu ukuwohloka:

• Coinsurance. Ukhokha iphesenti elinqunyiwe (njengamaphesenti angama-20) wezindleko zayo yonke insizakalo yezokwelapha oyitholayo. Inkampani yakho yomshuwalense ibhekene nephesenti elisele.
• ICopay. Ukhokha inani elinqunyiwe ngezinsizakalo ezithile. Isibonelo, kungadingeka ukhokhe imali engu- $ 20 njalo lapho ubona udokotela wakho wokunakekela oyinhloko. Ukubona uchwepheshe kungadinga i-copay ephakeme, enqunywe kusengaphambili.

Okunye ukucatshangelwa kokwabelana ngezindleko kwaziwa njenge-deductible. Imali yakho edonselwayo yonyaka inani lemali ozozikhokhela izinsizakalo ngaphambi kokuthi umshwalense wakho wezempilo uqale ukuthatha lezo zindleko.

Ngokuya ngohlelo lwakho lomshuwalense wezempilo, imali yakho ongayikhipha ingaba ngamakhulu ambalwa noma izinkulungwane zamaRandi unyaka ngamunye.

Funda ukuze ufunde kabanzi mayelana ne-coinsurance nama-copay nokuthi alithinta kanjani inani lemali ozoyikweleta lapho uthola izinsizakalo zezokwelapha.

Ukuqonda ukuthi ukweleta malini

Ukuqonda ama-copays, i-coinsurance, nama-deductibles kungakusiza ukuthi uzilungiselele izindleko zokuthola ukwelashwa.

Ezinye izinhlobo zokuvakasha zizodinga kuphela i-copay. Ezinye izinhlobo zokuvakasha zizodinga ukuthi ukhokhe iphesenti lesamba esiphelele (i-coinsurance), engaya ekukhishweni kwakho, kanye ne-copay. Kokunye ukuvakasha, ungakhokhiswa inani eligcwele lokuvakasha kepha ungakhokhi i-copay.

Uma unecebo elihlanganisa amaphesenti ayi-100 wokuvakashelwa kahle (ukuhlolwa konyaka), kuzodingeka ukuthi ukhokhe kuphela i-copay yakho enqunywe kusengaphambili.

Uma uhlelo lwakho lumboza u- $ 100 kuphela ngokuvakasha kahle, uzoba nesibopho se-copay kanye nezindleko ezisele zokuvakasha.

Isibonelo, uma i-copay yakho ingama- $ 25 futhi izindleko eziphelele zokuvakasha zingama- $ 300, uzoba nesibopho se- $ 200 - $ 175 yazo engabalwa kudonsi yakho.

Kodwa-ke, uma usuvele uhlangabezane nemali yakho yonke ekhishwe ngonyaka, khona-ke uzoba nesibopho se-copay engu- $ 25 kuphela.

Uma unohlelo lwe-coinsurance futhi ushaye imali yakho ekhishwe yonke, uzokhokha iphesenti lalokho kuhambela kahle kwe- $ 300. Uma isilinganiso sakho se-coinsurance singamaphesenti angama-20, kanti umshwalense wakho umboza amanye amaphesenti angama-80, kuzodingeka ukhokhe u- $ 60. Inkampani yakho yomshuwalense izokhokhela u- $ 240 osele.

Hlala ubuza inkampani yakho yomshuwalense ukuqinisekisa ukuthi uyazi ukuthi yini ehlanganisiwe nokuthi yiziphi izibopho zakho zezinsizakalo ezahlukahlukene. Ungaphinde ushayele ihhovisi likadokotela ubuze ngezindleko ezilindelekile zokwelashwa kwakho ngaphambi kokuya lapho ubonwe khona.

Ingabe ukuphuma okuphuma ephaketheni kukuthinta kanjani lokho okukweletayo?

Iningi lomshuwalense wezempilo linalokho okubizwa ngokuthi "ukuphuma okuphuma ephaketheni." Yikho kakhulu ozokhokha ngonyaka onikeziwe ngezinsizakalo ezimbozwe uhlelo lwakho.

Uma ususebenzise inani lakho eliphakeme kuma-copay, i-coinsurance, kanye nemali edonswayo, inkampani yakho yomshuwalense kufanele ifake amaphesenti ayi-100 wezinye izindleko ezengeziwe.

Khumbula ukuthi inani eliphuma ephaketheni alibandakanyi imali ekhokhelwe inkampani yakho yomshuwalense kudokotela wakho noma omunye umhlinzeki wezokunakekelwa kwempilo. Lesi sibalo yimali oyikhokhele ukunakekelwa kwezempilo kuphela.

Futhi, uhlelo lomuntu ngamunye luzoba nobukhulu obuphansi kakhulu obuphuma ephaketheni kunecebo elihlanganisa wonke umndeni. Wazi lowo mehluko njengoba uqala ukubhajetha izindleko zakho zokunakekelwa kwezempilo.

Usebenza kanjani umshuwalense?

Umshuwalense wezempilo wenzelwe ukuvikela abantu nemindeni kwizindleko ezikhuphukayo zokunakekelwa kwezempilo. Akuvamisile ukuthi kushibhe kakhulu, kepha kungakongela imali ngokuhamba kwesikhathi.

Abahlinzeki bomshuwalense badinga amaprimiyamu nyangazonke. Lezi yizinkokhelo ozenza enkampanini yomshuwalense njalo ngenyanga ngakho-ke unomshuwalense wokumboza ukukhathazeka okujwayelekile nokuyinhlekelele.

Ukhokha ama-premium noma ngabe uvakashela udokotela kanye ngonyaka noma uchitha izinyanga esibhedlela. Ngokuvamile, uzokhokha amaprimiyamu aphansi nyangazonke wohlelo olunokudonswa okuphezulu. Njengoba ukudonswa kwemali kwehla, izindleko zenyanga nenyanga ziyanda.

Umshuwalense wezempilo uvame ukuhlinzekwa ngabaqashi kubasebenzi besikhathi esigcwele. Izinkampani ezincane ezinabasebenzi abambalwa kuphela kungenzeka zingakhethi ukuhlinzeka ngomshuwalense wezempilo ngenxa yezindleko.

Ungakhetha futhi ukuthola umshuwalense wezempilo uwedwa enkampanini yomshuwalense yangasese, noma ngabe uqashwe ngokugcwele futhi unenketho yomshuwalense wezempilo oxhaswe umqashi.

Lapho uthola umshuwalense wezempilo, kufanele uthole uhlu lwezindleko ezihlanganisiwe. Isibonelo, uhambo oluya egumbini lezimo eziphuthumayo kwi-ambulensi lungabiza u- $ 250.

Ngaphansi kohlelo olufana nalolu, uma ungazange uhlangane nemali yakho ebanjwayo bese uya egumbini lezimo eziphuthumayo kwi-ambulensi, kufanele ukhokhe u- $ 250. Uma uhlangabezane nokugibela kwakho okudonswayo kanye nokuhamba kwama-ambulensi kumbozwe amaphesenti ayi-100, khona-ke ukuhamba kwakho kufanele kube mahhala.

Kwezinye izinhlelo, ukuhlinzwa okukhulu kumbozwa ngamaphesenti ayi-100, ngenkathi ukuhlolwa noma ukuhlolwa kungahlanganiswa kuphela ngamaphesenti angama-80. Lokhu kusho ukuthi unesibopho samaphesenti angama-20 asele.

Kubalulekile ukubuyekeza ama-copays, i-coinsurance, kanye nemali ekhishwayo lapho ukhetha uhlelo. Gcina umlando wakho wezempilo.

Uma ulindele ukuhlinzwa okukhulu noma ukuletha ingane ngonyaka ozayo, ungahle uthande ukukhetha uhlelo lapho umhlinzeki womshuwalense ehlanganisa amaphesenti aphezulu alezi zinhlobo zezinqubo.

Ngoba awusoze wabikezela izingozi noma ukukhathazeka kwezempilo esikhathini esizayo, futhi cabanga ukuthi ungakhokha malini inyanga nenyanga nokuthi ungakhokha malini uma ngabe unesimo sempilo esingalindelekile.

Kungakho kubalulekile ukuthi ubheke futhi ubheke zonke izindleko ezilindelekile, kufaka phakathi:

• ebanjwayo
• okuphezulu ephaketheni
• imali ekhokhwa njalo ngenyanga
• ikopisha
• ukuqinisekiswa kwemali

Ukuqonda lezi zindleko kungakusiza uqonde inani eliphakeme lemali ongayikweleta uma udinga izinsizakalo eziningi zezempilo ngonyaka onikeziwe.

Abahlinzeki be-in-network nabangaphandle kwenethiwekhi

Mayelana nomshuwalense wezempilo, inethiwekhi iqoqo lezibhedlela, odokotela, nabanye abahlinzeki abasayine njengabahlinzeki abathandwayo ohlelweni lwakho lomshuwalense.

Laba abahlinzeki be-in-network. Yibo inkampani yakho yomshuwalense ekhetha ukuyibona.

Abahlinzeki abangaphandle kwenethiwekhi bamane nje yilabo abangasayiniwe kuhlelo lwakho. Ukubona abahlinzeki abaphuma kunethiwekhi kungasho izindleko eziphakeme kakhulu zokuphuma ephaketheni. Lezo zindleko zingahle zingasebenzi ekubanjweni kwakho.

Futhi, kubalulekile ukuthi uqinisekise ukuthi uyazi ukungena nokuphuma kohlelo lwakho lomshuwalense ukuze wazi ukuthi ngubani nokuthi yini okuhlanganiswayo. Udokotela ongaphandle kwenethiwekhi angaba sendaweni yangakini, noma kungaba umuntu ombonayo lapho usohambweni.

Uma ungaqiniseki ukuthi udokotela wakho omthandayo uku-network, ungashayela umhlinzeki womshuwalense noma ihhovisi likadokotela wakho ukuthola.

Kwesinye isikhathi odokotela bayashiya noma bajoyine inethiwekhi entsha, futhi. Ukuqinisekisa isimo senethiwekhi sikadokotela wakho ngaphambi kokuvakasha ngakunye kungakusiza ugweme izindleko ezingalindelekile.

Okubalulekile

Umshuwalense wezempilo ungaba yinkinga eyinkimbinkimbi. Uma unomshuwalense ngomqashi wakho, buza ukuthi ngubani kumqashi wakho othintana naye ngemibuzo. Imvamisa umuntu osebenza emnyangweni wezabasebenzi, kepha hhayi njalo.

Inkampani yakho yomshuwalense kufanele futhi ibe nomnyango wezinsizakalo zamakhasimende ukuphendula imibuzo yakho.

Izinto ezibaluleke kakhulu okufanele uzikhumbule lapho uqala uhlelo lomshuwalense ukwazi:

• zonke izindleko zakho
• lapho uhlelo lwakho luqala ukusebenza (izinhlelo eziningi zomshuwalense ziyashintsha maphakathi nonyaka)
• yiziphi izinsizakalo ezihlanganiswayo nokuthi zingakanani

Ungahle ungahleleli ngokuhlinzwa okukhulu noma ukulimala, kepha umshuwalense ungasiza ukunciphisa umthwalo wezezimali uma uhlangabezana nenkinga enkulu yezokwelapha.