Imibuzo emithathu ebalulekileyo ye-inshurensi ekufuneka uyibuze ngexesha lokukhulelwa

Inkampani

Masijongane nayo. Ukuba nomntwana kuza nexabiso elinexabiso eliphezulu. Oku kuthetha ukuba, ukulungiselela ukukhulelwa kufuna ngaphezulu kohambo nje lokuya kugqirha. Ukwandisa izibonelelo zakho zempilo kunye nokunciphisa inkcitho yakho, kuyakufuneka ujonge eyakho i-inshorensi yempilo , ngokukodwa ukukhuselwa kwe-inshurensi yokukhulelwa.

Ukuba kunokwenzeka, ceba kwangaphambili. Oku kukuvumela ixesha lokuphanda ukhetho lwakho lokukhetha kwaye ukhethe isicwangciso esifanelana neemfuno zakho. Oko kwathiwa, ngamanye amaxesha ukukhulelwa akwenzeki ngexesha elifanelekileyo. Iindaba ezimnandi kukuba unokhetho lokhathalelo lwaphambi kokubeleka, nokuba awuqinisekiswanga.

Nokuba ithini na imeko yakho, uya kuba nemibuzo emininzi malunga neinshurensi yokubeleka kunye nokhathalelo lwempilo, ngokubanzi. Ukukunceda ukuba uqalise, nantsi imibuzo emithathu ukubuza umboneleli weinshurensi xa ulindele.

Igquma ngantoni i-inshurensi yokukhulelwa?

I-inshurensi yokukhulelwa igubungela zonke izibonelelo ezifanelekileyo zempilo ezinxulumene nokunakekelwa kokubeleka. Oku kunokubandakanya utyelelo lokubeleka Ikwaquka ukhathalelo olusandul 'ukuzalwa. Xa uvavanya iinketho zeinshurensi ngexesha lobhaliso oluvulekileyo okanye uphonononge isicwangciso sakho sempilo, jonga iindleko eziphuma epokothweni, iikopi, ukuncitshiswa, kunye nokuqinisekiswa kwemali okuhambelana nokukhulelwa komama.

Kuba ukhathalelo lokubeleka luhlelwa njengenye ye-Affordable Care Act (ACA) IziBonelelo eziBalulekileyo zezeMpilo , Ngethuba nje uthenga isicwangciso esifanelekileyo phantsi kwe-ACA, uya kuba nokukhulelwa. Oku kubandakanya iMarike ye-Inshurensi yezeMpilo kunye Izicwangciso zeMedicaid , egubungela ukhathalelo nokuba ukukhulelwa kwakho kuqala ngaphambi kokuqala kokugubungela.

Oko kwathiwa, ULouise Norris , iarhente yeinshurensi yezempilo enelayisensi ephuma eWellington, eColo., ichaza ukuba iinkcukacha ngqo zezinto ezigutyungelweyo kwilizwe ngalinye zinokwahluka ngokuxhomekeke kubaluleko lomgangatho. Ke, kubalulekile ukuqonda iinkcukacha zendlela esisebenza ngayo isicwangciso sakho. Ukongeza, ukhuselo olunikezwe ngumqeshi, nokuba kungunina okanye iqabane, lubonelela ngokukhulelwa; Nangona kunjalo, unokuba nexesha lokulinda de i-inshurensi yakho iqale.

Iindidi ezithile zeinshurensi azinakho ukubonelela ngezibonelelo zokubeleka. Ukuba ungaphantsi kweminyaka engama-26 ubudala kwaye une-inshurensi yokuxhomekeka kwisicwangciso somnye umntu, esifana nesomzali, okanye unesicwangciso sempilo yomfundi, isenokungabandakanyi ukukhulelwa. Imithetho iyahluka ngokwamazwe-qiniseka ukuba ujonga kwisicwangciso sakho. Ukuba ukhuselo alufakwanga, cinga ukufaka isicelo sesicwangciso sakho ngexesha lokukhulelwa ngokusebenzisa kwezempilo.gov kwindawo yentengiso, okanye yokugubungela iMedicaid (ethi ngamanye amaxesha inike ingxelo ebhetele).

Iinkampani zeinshurensi kufuneka zikwazi ukukunika indleko zokubeleka ezilindelweyo, ezakukunika umbono olungileyo wento abaza kuyigubungela kunye noko unokulindela ukuyihlawula, uyacacisaUMelanie Musson, ingcali yeinshurensi yezempilo Iiarhente zeinshurensi zaseMelika . Umgaqo-nkqubo we-inshurensi one-deductible ephantsi kunye neyona nto iphantsi yokuphuma epokothweni ilungele ukukhulelwa kuba ukuba nomntwana kuyabiza, kwaye uya kuthi ufike kwi-deductible yakho, utshilo.

Ukongeza kwi-inshurensi yezempilo yokukhulelwa kunye nokhathalelo olusandul 'ukuzalwa, kuya kufuneka uziqhelanise ne Umthetho weKhefu loNyango loSapho okanye i-FMLA. Ngaphantsi kwe-FMLA, abaqeshi kufuneka babonelele abasebenzi abafanelekileyo abakhuselwe yimisebenzi kunye nekhefu elingahlawulelwayo ngenxa yezizathu ezithile zonyango kunye nosapho, njengokukhulelwa nokukhathalela usana olusanda kuzalwa, kunye nokugcina izibonelelo zempilo yeqela ngexesha lekhefu. Oku kuvumela abazali abatsha ithuba lokulinganisa umsebenzi kunye noxanduva losapho. Ukuba kufanelekile, unokuthatha ukuya kuthi ga kwiiveki ezili-12 zekhefu elingahlawulelwayo minyaka le lokuzalwa kunye nokhathalelo lomntwana osandul 'ukuzalwa, phakathi kwezinye usapho kunye nezizathu zonyango.

Ngaba ungayifumana i-inshurensi yezempilo ukuba ukhulelwe?

Ewe ukulungele ukufaka isicelo seinshurensi yezempilo ukuba ukhulelwe. Kwixesha elidlulileyo, izicwangciso zeinshurensi ezichaza ukukhulelwa njengemeko esele ikho. Oku kushiye uninzi lwabasetyhini abakhulelweyo bengenayo i-inshurensi yezempilo.

Kodwa ukudlula kwe-ACA kutshintshe yonke loo nto. Ukuba unesicwangciso seMarike okanye i-Medicaid, unelungelo lokufumana ukukhulelwa kunye nokunyamekelwa komama nangona usebenzisa xa ukhulelwe. Oku kubandakanya ukhuseleko lweinshurensi ngomqeshi wakho okanye umqeshi weqabane lakho kunye nesicwangciso sempilo osithenga ngokwakho.

Kuya kufuneka ubhalise kwisicwangciso sezempilo ngexesha lobhaliso oluvulekileyo okanye ngexesha lobhaliso olukhethekileyo ukuba ufanelekile. Ngoku ka kwezempilo.gov , ixesha elithile lobhaliso lixesha elingaphandle konyaka ixesha lokubhalisa elivulekileyo ukuba ufanelekile ukuba ukhe wehlelwa ziziganeko ezithile zobomi ezinjengokuhamba, ukutshata, ukuphulukana ne-inshorensi yempilo, ukwamkela usana, okanye ukuba nosana.

Ngethuba nje ufaka isicelo sesicwangciso sempilo esivumelana ne-ACA, uNorris uthi awuyi kunqatshelwa ukukhutshwa kwezempilo ngononophelo lwangaphambi kokubeleka. Nangona kunjalo, uyacacisa ukuba ukuba ufaka isicelo sento efana nesicwangciso sexesha elifutshane okanye isicwangciso sokuhlawula esisigxina, inkampani yeinshurensi ingasikhaba isicelo ngenxa yokukhulelwa. Izicwangciso zezempilo zexesha elifutshane azihlangani nezikhokelo ze-ACA, kwaye uninzi luthatha kuphela ukutyelela ugqirha kunye nokhathalelo olungxamisekileyo. Izicwangciso zezempilo zexesha elifutshane azibandakanyi iimeko esele zikho.

Ukuba ufumana umvuzo omninzi ukuze ulungele ukugubungela iMedicaid, amanye amazwe aya kugubungela ukukhulelwa phantsi kwe- Inkqubo ye-Inshurensi yezeMpilo yaBantwana (CHIP). Le nkqubo yaziwa ngcono ngokubonelela ngezibonelelo zeinshurensi kubantwana abangenayo i-inshurensi.

Unokunciphisa njani iindleko zokukhulelwa?

Nje ukuba uqonde indlela yokufanelekela i-inshurensi okanye utshintshe izicwangciso ngexesha lokubhalisa elivulekileyo, lixesha lokuba ujonge iindlela zokunciphisa iindleko zokukhulelwa usebenzisa i-inshurensi yakho ngokupheleleyo.

Thelekisa izicwangciso zeinshurensi yezempilo ngexesha lokubhalisa okuvulekileyo

Indawo elungileyo onokuthi uqale ngayo xa ukhetha isicwangciso kukuthelekisa iindleko ezilindelekileyo phantsi kwesicwangciso ngasinye esifumanekayo ngexesha lobhaliso oluvulekileyo, kubandakanya iipremiyamu zenyanga kunye neendleko zokuphuma epokothweni okulindele ukuba uzikhulelwe.

Ngamanye amaxesha isicwangciso esineendleko eziphezulu zokuphuma epokothweni siphelela ekubeni lixabiso elingcono ngenxa yeepremiyamu ezisezantsi, utsho uNorris, kodwa ngamanye amaxesha uyakuphuma phambili ngokuhlawula iipremiyamu eziphezulu ukuze ufumane isicwangciso esineendleko eziphantsi zokuphuma epokothweni.

Enye indlela yokujonga oku kukukhetha isicwangciso esinokutsalwa okuncinci kwaye Uqinisekiso . Ipremiyamu iyakuhlawula oku, ke kubalulekile ukuba wenze izibalo uthathe isigqibo sokuba uza kuba uhlawula malini ukuphela konyaka kwiipremiyamu xa kuthelekiswa nemali ethatyathiweyo kunye ne-coinsurance.

Qonda ipolisi yakho yeinshurensi

Isicwangciso sakho sokuqala sokugcina imali kukubiza inkampani yakho yeinshurensi. Banokukuxelela ukuba isicwangciso sakho sempilo sigubungela kangakanani ukukhathalelwa kwabasetyhini abakhulelweyo, kubandakanya utyelelo logqirha, iindleko zokuhambisa, ukhuseleko kwicandelo, ukhathalelo olusandul 'ukuzalwa, kunye nezinye iinkqubo. Qiniseka ukuba ubuza malunga nokuxhuzulwa kwemali, kwinethiwekhi kuthelekiswa neendleko zangaphandle kwenethiwekhi, iindleko zokuhlala esibhedlele, ukuqinisekiswa kwemali, kunye nokuphuma epokothweni max. Kwaye ukuba ukufutshane nexesha lokubhalisa elivulekileyo kunye nomnikezeli wakho weinshurensi, buza malunga nokutshintsha kwezicwangciso ukunceda ukuthoba iindleko ngokubanzi.

Khetha kwi-network xa kunokwenzeka

Ukufumana ugqirha wokubelekisa, qala ngokujonga umboneleli kunye nesibhedlele esikwi-network. Unokufumana umboneleli we-in-network ngokufikelela kwiwebhusayithi ye-inshurensi yakho. Sebenzisa ababoneleli beenkonzo zononophelo lwempilo kwinethiwekhi banokukugcinela imali eninzi kwiindleko ezingaphandle kwepokotho. Nika ingqalelo kwiimfuno zenethiwekhi kunye neemfuno zokugunyazwa kwangaphambili. Nokuba ugqirha wakho obelekisayo ukwinethiwekhi, i-radiologist, i-anesthesiologist, iinkonzo zelebhu, okanye ezinye iinkonzo zisenokuba ngaphandle kwenethiwekhi. Awufuni kubambeka kwityala elothusayo kuba uye kwisibhedlele esingaphandle kwenethiwekhi okanye une-anesthesiologist engaphandle kwenethiwekhi, utshilo uNorris.

Bhalisela i-FSA okanye i-HSA

UKUYA iakhawunti yenkcitho eguqukayo (FSA) kunye iakhawunti yokonga impilo (HSA) zizixhobo ezizodwa zokonga obeka kuzo imali ukuhlawulela iindleko ezithile ezingaphandle kwepokotho zonyango. Kuba awuhlawuli rhafu kule mali, unganciphisa iindleko zokukhulelwa ngokubhalisa kwenye yezi izicwangciso .

Ukulungela i FSA Umqeshi wakho kufuneka anike isicwangciso. Ukuze usebenzise i-HSA, kufuneka ube nesicwangciso sezempilo esifanelekileyo kunye ne-deductible ephezulu, kwaye awukwazi ukuba kwi-Medicare okanye kwi-Medicaid. Ukuba ukhetha isicwangciso esifanelekileyo se-HSA, unokubeka imali yangaphambi kwerhafu kwi-HSA kwaye usebenzise loo mali ukuhlawula iindleko zakho kunye nezinye iindleko ezingaphandle kweepokotho ezinxulumene nokukhulelwa (okanye naziphi na ezinye iimfuno zononophelo lwempilo) , Utshilo uNorris.

Sebenza nesebe lokuhlawula amatyala esibhedlele

Rhoqo, amasebe okuhlawula amatyala esibhedlele anokunikela ngesaphulelo se-10% ukuya kwi-20% yamatyala ahlawulwe ngokukhawuleza,UMussonuyacacisa. Ke, ukuba ungahlawula kwangoko, tsalela umnxeba isebe lokuhlawula kwaye ujonge ukuba uyasilungela na isaphulelo.

Gcina isibhedlele sakho sihlale sifutshane kwaye silula

Nje ukuba ugqirha wakho akunike ukukhanya okuluhlaza ukuba ugoduke, kwaye uzive ukulungele, phuma esibhedlele ngokukhawuleza. Kananjalo, unokukwazi ukuhambisa ezinye iinkonzo kutyelelo lwezigulana ezingalaliswayo, ezinokubiza iindleko ngakumbi njengokundwendwela iingcali ngokungxamisekileyo okanye uvavanyo olungxamisekileyo (okt i-X-ray, ii-ultrasound, okanye ezinye iilebhu). Oku, kunjalo, kuxhomekeke ekuphulukaneni kwakho kunye nakwimpilo yosana. Ukuba ungagcina ukuhlala kwakho ubuncinci, unokugcina imali eninzi.