Yintoni eQhelekileyo, yesiNtu kunye neNgqiqo (UCR)?

Inkampani yezeMpilo ichaziwe

Ukuba ukhe wamangaliswa ngumthetho oyilwayo, awuwedwa. Ngamanye amaxesha loo mmangaliso uyenzeka ngenxa yokuba inkampani yakho yeinshurensi ingakhange igubungele ezinye okanye zonke izinto ugqirha wakho azihlawulise ngenkqubo yezonyango kuba khange ihlangabezane ne-UCR yabo, okanye yesiqhelo, ngokwesiko, kunye nenqanaba elifanelekileyo.

Iinkampani zeinshurensi zisebenzisa indlela ye-UCR ukwenza isigqibo sokuba bazakuhlawula malini kwinkonzo yezonyango engaphandle kwenethiwekhi esekwe kuninzi lwabanye oogqirha kwindawo ehlawulwayo. Ukuba ugqirha wakho uhlawula ngaphezulu kwenqanaba lenkampani yeinshurensi i-UCR, banokungavumi ukuyigubungela yonke loo nto, ukuhlawulisa umrhumo we-UCR ukuhlawula yonke intlawulo.

Ukuba usebenzisa umboneleli wenethiwekhi, kwaye une isicwangciso sokhathalelo njenge-HMO, i-PPO, okanye i-POS, awunyanzelekanga ukuba ukhathazeke malunga nemirhumo ye-UCR. Kungenxa yokuba abo baboneleli sele bethethile kunye nenkampani yakho yeinshurensi kwaye bavuma ukwamkela inqanaba le-UCR njengentlawulo yabo epheleleyo. Ngamanye amaxesha, nangona kunjalo, unokufuna ukusebenzisa umboneleli ongaphandle kwenethiwekhi, okanye unokuba unayo Isicwangciso sokhuseleko (enqabileyo). Yiyo loo nto kulungile ukwazi ukuba zisebenza njani iifizi ze-UCR kwaye ungazithintela njani ukuba unako.

I-UCR imele ntoni?

I-UCR imele isiqhelo, isiko, kwaye inengqiqo, kwaye ichaza ukuba iinkampani zeinshurensi zithatha isigqibo sokuba ingaba umboneleli wezonyango uhlawulisa inkqubo elingana okanye engaphantsi kwesixa semali abacinga ukuba kufuneka ihlawuliswe.

Nantsi indlela iinkampani zeinshurensi ezichaza ngayo indlela yesiqhelo, yesiqhelo, kunye nesengqiqweni:

Okuqhelekileyo: Intlawulo ithathwa njengesiqhelo ukuba iyahambelana noko umboneleli wezonyango ngamnye ahlawulise abaguli ngaphambili ngenkqubo efanayo okanye efanayo okanye iinkonzo.

Isiko: Ukuhlawuliswa kulisiko ukuba ngaphakathi kuluhlu lwemirhumo uninzi lwabanikezeli bezonyango kwindawo yommandla ehlawulisa iinkqubo ezifanayo okanye ezifanayo okanye iinkonzo.

Iyaqiqa: Intlawulo ithathwa njengefanelekileyo ukuba iyazifezekisa zombini iikhrayitheriya eziqhelekileyo nezesiko okanye ukuba yimeko ekhethekileyo. Oko kunokubandakanya inkqubo enqabileyo okanye enzima kakhulu.

Ithetha ntoni yesiqhelo, yesiNtu, kunye nengqiqo?

Iinkampani zeinshurensi eziza njani neentlawulo zazo ze-UCR zinokuba yimfihlakalo, kodwa uninzi lubeka iindleko ze-UCR zabo Iipesenti ezingama-80 . Oko kuthetha ukuba i-80% yababoneleli bezonyango kwindawo enikiweyo ihlawuliswe ngokulinganayo okanye ngaphantsi kunenqanaba lenkampani yeinshurensi ye-UCR.

Nantsi indlela esebenza ngayo xa kufikwa kubungakanani bayo. Masithi ukrazula i-meniscus yakho ngelixa ubaleka kwaye unokuhlinzwa ukuze uyilungise. Usebenzisa ugqirha wotyando ongaphandle kwenethiwekhi ohlawula i-6,000 yeedola kwinkqubo. Kodwa inkampani yakho ye-inshurensi i-UCR ihlawulisa loo nkqubo yi- $ 5,000. Ukuba inkampani yakho yeinshurensi ihlawula iipesenti ezingama-80 zeendleko zonyango ngaphambi kokuba udibane neyakho kutsalwa , baya kugubungela iipesenti ezingama-80 zetyala lakho ukuya kuthi ga kwi-5,000 yeedola. Abayi kuyigubungela i-1, 000 yeedola ngaphezulu kwenqanaba labo le-UCR, oko kuthetha ukuba unokufuna ukuhlawula umrhumo weedola ezili-1 000 ze-UCR, ukongeza kwi-20% yakho yemali yokufumana imali kwi-UCR yeedola ezingama-5,000.

Kwiimeko ezininzi, iinkampani ze-inshurensi aziyibali imali oyihlawula ngaphezulu kweqondo le-UCR malunga nokutsalwa kwakho okanye ukuphuma epokothweni ubuninzi . Oku kuthetha ukuba, ukuba uhlala usebenzisa oogqirha abangaphandle kwenethiwekhi, ungaphelisa ukuhlawula isixa semali eninzi kwiimali zonyango.

Iindaba ezimnandi zezokuba uninzi lwezicwangciso zeinshurensi, ezinje nge-HMOs okanye ii-PPOs, ziza nenethiwekhi enkulu yababoneleli, kubandakanya oogqirha, izibhedlele, iilebhu kunye nonyango. Ukuba uhlala kuloo nethwekhi, awuyi kuhlawula umrhumo we-UCR.

I-Medicare inenguqulo yayo yamaxabiso e-UCR awaziwa njenge Amayeza ahlawulwayo avumelekileyo . Nawuphi na umniki-nkonzo ovumayo ukuthatha inxaxheba kwi-Medicare naye uyavuma ukwamkela i-Medicare rate evumelekileyo yokuhlawula njengentlawulo epheleleyo evela kwi-inshurensi. Kodwa abanye oogqirha abangababoneleli abangathathi nxaxheba banokujika bakubhatalele umahluko. Ukukunceda ukuthintela ukuba kungenzeki, buza oogqirha ukuba bayayamkela na isabelo seMedicare, oko kuthetha ukuba abayi kukucela ukuba uhlawule imali eseleyo. Kodwa ke kuya kufuneka uhlawule imali yakho etsalelweyo kwaye Uqinisekiso .

Ezinye iiMedigap, okanye izicwangciso zokuncedisa kwiMedare, zinokunceda ekuhlawuleni iindleko zoogqirha abagqithisileyo.

Yintoni ethathelwa ingqalelo umrhumo we-UCR?

Akukho mithetho mininzi kakhulu emisela ukuba iinkampani zeinshurensi zigqibe njani kumaxabiso abo esiqhelo, ngokwesiko, kunye nangexabiso elifanelekileyo. Uninzi lusebenzisa idatha yalo ukumisela ukuba ngoobani abagcini-mali bokubiza iinkqubo. Ngokomthetho, nangona kunjalo, iinkampani zeinshurensi kufuneka zikuxelele ukuba zize njani ngenqanaba ukuba uyabuza.

Kukho imigaqo esisiseko, nangona kunjalo, ukuba iinkampani zeinshurensi ziyalandela ukuthatha isigqibo sokuba ngaba intlawulo iqhelekile, isiko, kwaye iyavakala. Intlawulo iyahambelana noko umboneleli wezonyango akubizile ngaphambili (ngesiqhelo), ilingana noluhlu oluhlawuliswa ngamanye amagqirha (ngokwesiko), kwaye inokuthi ihlangane nemilinganiselo yesiqhelo neyesiqhelo okanye imeko ekhethekileyo (esengqiqweni) . Ukuba inkampani yeinshurensi icinga ukuba umboneleli wakho wezonyango akayithobeli loo ndlela, baya kuvuma kuphela ukuhlawula ireyithi ye-UCR, kwaye kuya kufuneka ubhatale eseleyo, eyimali ye-UCR.

Ngaba ungakuphepha ukuhlawula iifizi ze-UCR?

Eyona ndlela yokuthintela ukuhlawula iifizi ze-UCR kukusebenzisa ababoneleli benethiwekhi. Ngamanye amaxesha, nangona kunjalo, oko akunakuphepheka. Ukuba uyazi kwangaphambili ukuba uza kube usebenzisa i umboneleli ongaphandle kwenethiwekhi , buza ugqirha ukuba bazakubhatala malini ngenkqubo okanye inkonzo. Emva koko buza inkampani yakho yeinshurensi ukuba yeyiphi intlawulo yabo ye-UCR yenkqubo leyo. Unokwazi ukufumana ugqirha wakho ukuba avume ukwamkela intlawulo ye-inshurensi ye-UCR njengentlawulo epheleleyo.

Kananjalo unakho ukufumana inkampani yakho yeinshurensi ukuba ihlawule ngaphezulu kwereyithi ye-UCR ukuba ugqirha ubhala ileta echaza ukuba kutheni kufuneka behlawulise ngaphezulu inkqubo ethile. Kuyenzeka ukuba inkampani yakho yeinshurensi ivumelane ngokulungisa inkqubo yakho yetyala emva kokuba unokubonisa ukuba abanye oogqirha abaninzi kuloo ndawo bahlawulisa isixa esifanayo kwinto ehlawulwe ngugqirha wakho.

Ngaba iifizi ze-UCR zisebenza kumachiza amiselweyo?

Ngethamsanqa, xa kufikwa kumayeza amiselweyo, akuqhelekanga ukuba ube nexhala malunga nemirhumo ye-UCR. Kungenxa yokuba intlawulo ye-UCR yamayeza amiselweyo sisixa umntu angenayo i-inshurensi angahlawula iyeza. Oku kukwabizwa njengexabiso lemali.

Iindaba ezimnandi zezokuba i-SingleCare inokukunceda ugcine kwimigqaliselo yakho-nokuba imeko yakho ye-inshurensi. Siyakholelwa ukuba wonke umntu kufuneka abe nakho ukuhlawulela amayeza akhe. Qalisa ukukhangela iziyobisi zakho singlecare.com . Ungonga ukuya kuthi ga kwiipesenti ezingama-80.