Yintoni iPPO?

Inkampani yezeMpilo ichaziwe

Xa kuziwa kwi-inshurensi yezempilo, akukho kunqongophala kwee-acronyms kunye namagama angaqhelekanga afunekayo ukuze aqonde indlela esebenza ngayo impilo Ngaba unayo okanye ucinga ngokutyikitya i-PPO? Funda ukuba yintoni, nokuba yeyona ndlela ilungileyo kuwe, kwaye wazi njani ukuba sele unayo.

Yintoni iPPO?

I-PPO luhlobo lwesicwangciso seinshurensi yezempilo. Imele umbutho womboneleli okhethiweyo. Ngee-PPOs, uhlawula kancinci xa ubona umboneleli okwinethiwekhi yenkampani yakho yeinshurensi- yeyona ndawo uyithandayo. I-PPO yakho sele ixoxisene ngenqanaba elithile leenkonzo zononophelo lwempilo ezibonelelwa ngababoneleli benethiwekhi.

Uyakwazi ukubona ababoneleli abaninzi ngaphandle kwenethiwekhi ye-PPO yokhathalelo lonyango. Nangona kunjalo, uya kuthi ngokubanzi uhlawule ngaphezulu kunikezelo lwangaphandle kwenethiwekhi kunye neenkonzo zonyango. Kungenxa yokuba akukho sivumelwano kuvunyelwene ngokusesikweni phakathi kwe umboneleli ongaphandle kwenethiwekhi kunye nesicwangciso sakho.

Kutheni le nto umntu enokukhetha i-PPO ngaphezulu kwe-HMO?

Ii-PPO lolunye lweentlobo ezithandwayo zezicwangciso zeinshurensi yezempilo ngenxa yokuguquguquka kwazo. Nge-PPO, ungandwendwela nawuphi na umboneleli wezempilo ongathanda, kubandakanya iingcali, ngaphandle kokufumana ukuthunyelwa kugqirha wokuqala (PCP) kuqala. Oko kunokuba luncedo ukuba awukufuphi kugqirha okwinethiwekhi yakho yomboneleli, njengaxa uhamba, okanye ukuba sele uneqela labaqeqeshi bezempilo ukhululekile kunye nalo, nokuba baphume kwinethiwekhi.

Izibonelelo ze-PPO zibandakanya ithuba lokukwazi ukukhetha ugqirha kunye neengcali ozifunayo ngaphandle kokuya kugqirha wokuqala, kuchaza IYuna Rapoport , MD, MPH, ugqirha wamehlo eManhattan Eye kwisiXeko saseNew York. Oku kubeka isiguli esihlalweni somqhubi.

PPO vs. HMO

Ii-PPOs ayisiyiyo kuphela inketho, ewe. Olunye uhlobo oluqhelekileyo lwesicwangciso seinshurensi yezempilo yi-HMO, okanye umbutho wolondolozo lwempilo. Izicwangciso ze-HMO zinomahluko ophambili kwii-PPO ezinokuchaphazela ukhetho lwakho lwenkampani yeinshurensi yezempilo.

Nge-HMO, kuya kufuneka uhambe ngePCP yakho ukuze ugqithiselwe ukuze ubone ingcali yenethiwekhi. I-HMO yakho nayo ayizukugubungela utyelelo lwangaphandle kwenethiwekhi Ngaphandle kokuba yingxakeko yezonyango yokwenyani, kwaye nalapho, unokuba yinxalenye yetyala.

Nangona kunjalo, uGqirha Rapoport uthi kunokubakho ixabiso kwizicwangciso ze-HMO zezigulana. Izibonelelo ze-HMOs zivela kwindlela esekwe kwiinkqubo, utshilo. Ngokugcina ubudlelwane obusondeleyo nogqirha wokuqala, kukho ukutyelela okumbalwa ngokungeyomfuneko kwiingcali, ukucinga kancinci, kunye novavanyo lokuqonda isifo. Iziphumo ziyafana okanye zibhetele kune-PPO, kwaye abaguli banabo bonke oogqirha babo abanconyelwe yinkqubo.

Ngelixa ukufumana ukuthunyelwa ngaphambi kokuba ubone ingcali kunokuba yintlungu, kukwathetha ukuba i-PCP yakho iyabandakanyeka kwimpilo yakho ngendlela ngamanye amaxesha oogqirha abakwi-PPO abakho, ekuncedeni ukuba ulungelelanise ukhathalelo ngokufanelekileyo.

Ukuthelekiswa kweendleko

Kwaye kunjalo, awungekhe uthethe nge-inshurensi yezempilo kwaye ungakhankanyi ngeendleko zokuphuma epokothweni. Iinethiwekhi ze-PPO zihlala ziphezulu iipremiyamu , iikopayi , kunye Unciphiso lonyaka kunee-HMOs njengembuyekezo yokuguquguquka ngakumbi. Ukuba ubona umboneleli ongaphandle kwenethiwekhi, kuya kufuneka uhlawule iindleko kwangaphambili kwaye ufake ifayile yebango lembuyiselo. Ukuba uxabisa ubhetyebhetye kwaye ungakhathali ukuyihlawula ngakumbi, iPPO inokuba lolona khetho lulungileyo lwezempilo kuwe.

Iindleko zokhathalelo lwempilo kunye neenethiwekhi ze-HMO zihlala zingabizi kakhulu. Uya kuba neeprimiyamu ezisezantsi zenyanga kunye neepopay ngokutshintshiselana ngokusebenzisa i-PCP yokulungelelanisa ukhathalelo lwempilo yakho. Nangona kunjalo, uhlala ungakwazi ukubona ababoneleli abangaphandle kwenethiwekhi abane-HMO. Ukuba uyakwenza oko, uya kuba noxanduva lweendleko zizonke.

Ezinxulumene: HMO vs. PPO

Ukongeza, unokujonga isicwangciso esiphakamileyo sezempilo (HDHP), umbutho wababoneleli ababodwa (EPO), okanye inqaku lesicwangciso seenkonzo (POS).

Ndazi njani ukuba ndinayo iPPO?

Ukucinga ukuba loluphi uhlobo lwesicwangciso seinshurensi yezempilo onayo? Ihlala isitsho njalo ngasemva kwikhadi lakho leinshurensi. Ikhadi lakho linokude libonise ukuba uza kuhlawula malini kwii-copays zokundwendwela ugqirha. Ukutsala umnxeba ngokukhawuleza kumboneleli wakho okanye ukungena kwiakhawunti yakho ye-Intanethi kunokubonelela ngokucacileyo.

Ukuba awunayo i-PPO kwaye ufuna ukutshintshela kwenye, kuya kufuneka uyenze ngexesha ukubhalisa okuvulekileyo -Ngokuqhelekileyo, kodwa hayi rhoqo, ngo-Novemba okanye ngo-Disemba-ngaphandle kokuba une-a isiganeko sobomi esifanelekileyo . Imicimbi efanelekileyo ibandakanyaukuya kwikhowudi entsha ye-zip okanye kwisithili, ukutshata, okanye ukuba nosana.

Izicwangciso ze-PPO zinokufumaneka kumqeshi wakho, kwindawo yentengiso zikarhulumente wakho (ukuba kukho enye), okanye indawo yentengiso yomdibaniso. Eyona ndawo onokuqala kuyo olu khetho kukhathalelo lwempilo.gov.

I-Medicare ikwabonelela nge- Inketho ye-PPO (phakathi kwe-HMO kunye nezinye iindlela) phantsi kwe-Medicare Advantage (Icandelo C) ukuba uneminyaka engama-65 ubudala okanye ngaphezulu kwaye ufanelekile. Into ekufuneka igcinwe engqondweni xa ujonga isicwangciso se-PPO yile iiakhawunti zokonga impilo (HSAs) kunye neeakhawunti zokonga eziguquguqukayo (FSAs) , kunye nezinto ezifana nekhadi lakho le-SingleCare, nazo zinokukunceda ukunciphisa iindleko zonyango lwakho kunye nemigqaliselo.