Main >> Inkampani >> Kuyini ukuqinisekiswa kwemali?

Kuyini ukuqinisekiswa kwemali?

Kuyini ukuqinisekiswa kwemali?Ukuchazwa Kwezempilo Kenkampani

Kwesinye isikhathi amagama wokunakekelwa kwezempilo angabonakala njengolimi oluhluke ngokuphelele. Ngamazwi afana nalawa ikopay , ebanjwayo , futhi okuphezulu ephaketheni uphonswa ngapha nangapha, kufanele wazi kanjani ukuthi yini lokho? Yilapho uchungechunge lwethu lwe-Healthcare Defined lungena khona. Siphula amagama ukuze uqonde-futhi ngokuqonda kuza ukonga okungcono.





Lapha, sizobhekana nokuqinisekiswa kwemali. I-Coinsurance iphesenti lezindleko zezinsizakalo zokunakekelwa kwezempilo ezihlanganisiwe okufanele uzikhokhe ephaketheni ngemuva kokuthi usufinyelele emalini yakho ekhishwayo yonyaka. Lesi sibalo sinqunywa ngamaphesenti asetshenziswe kuzindleko eziphelele zesevisi ngayinye yezokwelapha. Inkampani yakho yomshuwalense ikhokha amaphesenti aphezulu, futhi kulindeleke ukuthi ukhokhe encane. Isibonelo, umshwalense wakho ukhokha ama-80% futhi uzokhokha ama-20%. Lo mqondo, ovame ukubizwa ngokuthi ukubamba iqhaza kwamaphesenti kunciphisa ubungozi benkampani yomshuwalense ngokufuna lowo muntu ukuthi abelane ngengxenye yezindleko ezikhokhelwa emuva.



Coinsurance vs. copay

Ukuqonda i-coinsurance kudinga ukuqonda indima yayo ngaphakathi kohlelo lokwabelana ngezindleko jikelele. Ezinye izindlela zokwabelana ngezindleko zifaka phakathi okudonswayo nama-copay , futhi womathathu la magama avame — futhi ngokungalungile — asetshenziswa ngokungafani. Amakhophi kuyimali ekhokhwayo umuntu okudingeka ayikhokhe ngesikhathi sokuvakasha kwehhovisi likadokotela noma kadokotela. Ukukhokhwa kwemali eqinisekisiwe, ngokuhlukile, kuyiphesenti lemali ekhokhwayo yodokotela noma yekhemisi, okusho ukuthi izindleko ezingaphandle kwephakethe zingahluka.

Abanye abathengi basebenza ngaphansi komcabango wokuthi uma sebefeze unyaka wabo kuphume ephaketheni deductible, inkampani yabo yomshuwalense wezempilo izongenelela futhi ikhokhele noma yiziphi izindleko ezengeziwe unyaka wonke. Ngeshwa, uhlelo aluhlali lulula njalo.

Imali ekhishwayo iyinani elinqunyiwe okufanele umuntu alikhokhe ephaketheni ngaphambi kokuba inkampani yomshuwalense ingenele ukukhokha izindleko eziningi zokunakekelwa kwezempilo. I-coinsurance iqala ukusebenza ngemuva kokuthi kudonswe imali.



Umqondo obanzi we-coinsurance ulula impela. Ngemuva kokuthi kudonswe imali yakho, inkampani yakho yomshuwalense izokhokha iphesenti elithile lezindleko zokuvakasha ngakunye, likushiye unesibopho sokusele. Isibonelo, ake sithi unenqubo ye- $ 1,000 futhi umshwalense wakho uhlanganisa ama-90% wezindleko zizonke. I-coinsurance yakho ingu-10%, kulokhu okungaba ngama- $ 100.

Ingabe ukuqinisekiswa kwemali kuhle noma kubi?

I-coinsurance ayisihle neze noma imbi, kepha iyiqiniso ezinhlelweni eziningi zomshuwalense. Izindaba ezimnandi kukhona ukuthi kunomkhawulo kaningi ezindlekweni zakho ezingaba khona eziphuma ephaketheni. Inkampani yakho yomshuwalense ekugcineni izowukhokha wonke umthethosivivinywa wensizakalo emboziwe uma usufinyelele inani eliphakeme kakhulu lokuphuma ephaketheni, okubandakanya imali yakho ekhokhwayo yonyaka kanye nemali yokuqinisekisa imali. Izindaba ezimbi ukuthi iningi labantu alikaze lihlangabezane nezindleko zalo eziphezulu zokuphuma ephaketheni unyaka nonyaka.

Yini umkhawulo ophuma ephaketheni?

Isamba esiphume ephaketheni yimali eningi umuntu azoyikhokhela izinsizakalo zezokwelapha ezimbozwe umshwalense ngonyaka. Ngemuva kokuhlangana nokudonswa kwemali, kusamele ukhokhe iphesenti ngokusebenzisa i-coinsurance. Kodwa-ke, uma inani eliphakeme lokuphuma ephaketheni selihlangatshezwe lapho ukhokha inani elithile lemali ekhishwayo, ama-copayments, kanye ne-coinsurance, inkampani yomshuwalense izokhokha izinsizakalo eziyi-100% ezihlanganiswe nohlelo lwakho lomshuwalense wezempilo.



Ngakho-ke esibonelweni esifanayo esivela ngenhla, ake sithi uhlelo lwakho lunezinga eliphakeme elingaphandle kwamaphakethe lama- $ 5,000. Uma ususebenzise leyo mali ngama-deductibles, ama-copay, kanye ne-coinsurance, umshuwalense uzokhokha ngo-100% kuze kube yilapho uhlelo lwakho luhlelwa kabusha (imvamisa ekupheleni konyaka wekhalenda).

Kusho ukuthini ukuqinisekiswa kwemali kuwe?

Amaphesenti akho we-coinsurance azohluka ngokuya ngenqubomgomo yomshuwalense wezempilo noma Uhlelo lwe-Medicare uyakhetha. Ngemuva kokushaya imali yakho ekhishwayo, amaphesenti avame kakhulu womshuwalense wakho uma kuqhathaniswa nalokho okumbozayo imvamisa kungama-80/20, 90/10, noma ama-70/30.

Ngakho-ke ushaya nje imali yakho ebanjwayo — ake siyibize ngo- $ 2,000 - okusho ukuthi usebenzise imali engaka kwizindleko ezahlukahlukene zezempilo ezihlanganisiwe ngonyaka. Manje, i-coinsurance yakho iyangena. Uma i-coinsurance yakho ingama-20%, ukhokha ama-20% wenani ngalinye lesikweletu, futhi umshwalense wakho uhlanganisa ama-80% asele.



Isibonelo, uvakashela udokotela ngomphimbo obuhlungu, bese kuthi imali ekhokhwayo ibe ngu- $ 100. Uma i-coinsurance yakho ingama-20%, uzokhokhiswa u- $ 20 walokho kuvakashelwa futhi umshuwalense wakho uzokhokha u- $ 80.

Kepha izinto zingaba nzima kakhulu ukusuka lapho. Izinkampani zomshuwalense zivame ukusetha amanani aphakeme we-coinsurance wezinsizakalo eziwela ngaphandle kwenethiwekhi yazo-okungukuthi, izinsizakalo ezenziwa ngabasebenzi bezokwelapha abangenayo inkontileka nenkampani yakho yomshuwalense.



Izinga le-in-network coinsurance rate le-10% livame ukweqa liye ku-30% noma ku-40% kudokotela ongaphandle kwenethiwekhi noma incwadi kadokotela. Ezinye izinhlelo kungenzeka zinganikeli nganoma yikuphi ukufakwa okungaphandle kwenethiwekhi.

Ngaphezu kwalokho, uma inkokhelo yensizakalo enikeziwe ibingaphezulu kwalokhu umhlinzeki oku-in-network angakukhokhisa, lowo muntu kuzodingeka ukuthi enze umehluko ezindlekweni.



Ungalukhetha kanjani uhlelo olulungile

Uma uthola ukuthi unezindleko eziphakeme zezokwelapha unyaka ngamunye, ungahle uthande ukubheka uhlelo olunezinga eliphakeme imali ekhokhwa njalo ngenyanga , ngoba lokho kuzoba nemali ekhishwayo ephansi kanye ne-coinsurance, futhi umshwalense wakho uzokhokha izindleko zakho zezokwelapha ngokushesha.



Uma ungavamisile ukuvakashela udokotela, ungahle uthande ukucubungula uhlelo oluneprimiyamu ephansi yanyanga zonke yize ingahle idonswe ngemali ephezulu futhi ikhokhelwe. Futhi khumbula, ukudonswa kwemali kusethwa kabusha lapho unyaka wakho wohlelo uphela.

Ukucatshangelwa kwe-coinsurance namanani akhokhelwayo kuphakathi kwezinto eziningi okufanele ucabange ngazo lapho ukhetha uhlelo. Kufanele futhi ucabangele ukuthi odokotela bakho bayabamba iqhaza kwinethiwekhi yohlelo nokuthi izinsizakalo ezithile zezokwelapha ozidingayo ziyahlanganiswa yini.

Akunandaba ukuthi uhlelo lwakho lomshuwalense, Okufanayo kungasiza ngemithi kadokotela engahle ingabizi ngisho nomshwalense. Vele ufune umuthi wakho bese uthola inani elingcono kakhulu — azikho izimali ezifihliwe zokujoyina noma zokusebenzisa.