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Iziseko zokhathalelo lwempilo

Fumana i-Inshorensi ye-SD

Iziseko zokhathalelo lwempilo

I-inshurensi yezempilo inceda ekuhlawuleni iindleko xa ufuna ukhathalelo

Akukho mntu uceba ukugula okanye ukulimala, kodwa impilo yakho inokutshintsha ngokuqhwanyaza kweliso. Uninzi lwabantu lufuna unyango ngaxa lithile. I-inshurensi yezempilo inceda ekuhlawuleleni ezi ndleko kwaye ikukhusele kwiindleko eziphezulu kakhulu.

YINTONI I-INSHORENSI YEZEMPILO

I-inshurensi yezempilo sisivumelwano phakathi kwakho nenkampani yeinshurensi. Uthenga isicwangciso, kwaye inkampani iyavuma ukuhlawula inxalenye yeendleko zakho zonyango xa ugula okanye wenzakala.
Zonke izicwangciso ezibonelelwayo kwiMarike zibandakanya ezi zibonelelo zili-10 zezempilo zibalulekileyo:

  • Iinkonzo zezigulana ezinyangayo (ukhathalelwa ngaphandle ulaliswa esibhedlele)
  • iinkonzo Emergency
  • Ukulaliswa esibhedlele (njengokuhlinzwa kunye nokuhlala ubusuku bonke)
  • Ukukhulelwa, ukubeleka kunye nokunyamekela okusanda kuzalwa (phambi nasemva kokuzalwa)
  • Iinkonzo zempilo yengqondo kunye nokusetyenziswa kweziyobisi, kubandakanywa unyango lwempilo yokuziphatha (oku kubandakanya iingcebiso kunye nonyango lwengqondo)
  • Amayeza kagqirha
  • Iinkonzo zokubuyisela kwimeko yesiqhelo kunye nokuhlala kunye nezixhobo (iinkonzo kunye nezixhobo zokunceda abantu abonzakeleyo, abakhubazekileyo, okanye iimeko ezingapheliyo bafumane okanye bafumane izakhono zengqondo nezomzimba)
  • Iinkonzo zaselebhu
  • Iinkonzo zothintelo nezempilo kunye nolawulo lwezifo ezingapheliyo
  • Iinkonzo zabantwana, kubandakanywa nokhathalelo lomlomo kunye nombono (kodwa ukhathalelo lwamazinyo lwabantu abadala kunye nombono ayizizo iinzuzo zempilo ezibalulekileyo)

I-inshurensi yezempilo sisivumelwano phakathi kwakho nenkampani yeinshurensi. Xa uthenga isicwangciso, inkampani iyavuma ukuhlawula inxalenye yeendleko zakho zonyango xa ugula okanye wenzakala.

UKUKHUSELA KWAMAHHALA

Uninzi lwezicwangciso zempilo kufuneka zihlawule iseti yeenkonzo zothintelo, njengokudubula kunye novavanyo lovavanyo, ngaphandle kweendleko kuwe. Oku kuyinyaniso nokuba awuzange udibane ne-deductible yakho yonyaka. Iinkonzo zothintelo zithintela okanye zibhaqe isigulo kwangethuba xa unyango lunokusebenza ngcono. Ezi nkonzo zisimahla kuphela xa uzifumana kugqirha okanye komnye umboneleli kuthungelwano lwesicwangciso sakho.

Nazi ezinye iinkonzo eziqhelekileyo kubo bonke abantu abadala:

  • Ukuhlolwa koxinzelelo lwegazi
  • Ukuhlolwa kweCholesterol: iminyaka ethile + abo basemngciphekweni omkhulu
  • Ukuhlolwa kokudakumba
  • Ukugonywa
  • Ukuhlolwa kokutyeba kunye neengcebiso

utyelelo Healthcare.gov/coverage/preventive-care-benefits/ kuluhlu olupheleleyo lweenkonzo zothintelo kubo bonke abantu abadala, abasetyhini kunye nabantwana.

INCEDA UHLAWULE INKONZO

Ngaba uyazi ukuba iindleko eziqhelekileyo zokuhlala esibhedlele iintsuku ezintathu yi-$ 30,000? Okanye ukulungisa umlenze owaphukileyo kunokubiza ukuya kuthi ga kwi-7,500 yeedola? Ukuba ne-inshurensi yezempilo inokukunceda ekukhuseleni kwiindleko eziphezulu, ezingalindelekanga ezifana nezi.
Ipolisi yakho ye-inshorensi okanye isishwankathelo sezibonelelo kunye ne-inshorensi iya kukubonisa ukuba zeziphi iintlobo zokhathalelo, unyango, kunye neenkonzo ezikhuselweyo kwisicwangciso sakho, kuquka ukuba inkampani ye-inshurensi iya kuhlawulela kangakanani unyango oluhlukeneyo kwiimeko ezahlukeneyo.

  • Iipolisi ze-inshurensi yezempilo ezahlukeneyo zinokubonelela ngeenzuzo ezahlukeneyo.
  • Unokufuneka uhlawule i-deductible ngonyaka ngamnye ngaphambi kokuba inkampani yakho ye-inshurensi iqale ukuhlawula ukhathalelo lwakho.
  • Kusenokufuneka uhlawule i-coinsurance okanye i-copayment xa ufumana unyango.
  • Isivumelwano se-inshorensi yezempilo kunye nothungelwano lwezibhedlele, oogqirha, iikhemesti, kunye nababoneleli bezempilo.

INTO OYIHLAWULAYO 

Ngokuqhelekileyo uya kuhlawula i-premium nyanga zonke kwi-inshorensi yezempilo, kwaye unokufuneka udibane ne-deductible ngonyaka. I-deductible yimali onetyala layo kwiinkonzo zokhathalelo lwempilo ngaphambi kokuba i-inshurensi yakho yezempilo okanye isicwangciso siqale ukuhlawula. Imali etsalwayo ayinakusebenza kuzo zonke iinkonzo.

Ingakanani imali oyihlawulayo kwi-premium yakho kunye ne-deductible isekelwe kuhlobo lwe-inshorensi onayo. Ipolisi enexabiso eliphantsi ayinakuquka iinkonzo ezininzi kunye nonyango.
Okubaluleke kanye njengexabiso leprimiyamu kunye nokutsalwa kwemali kufuneka uhlawule xa ufumana iinkonzo.

Imizekelo ibandakanya:

  • Oko uhlawula ngaphandle kwepokotho yeenkonzo emva kokuba uhlawule i-deductible (i-coinsurance okanye i-copayments)
  • Yimalini xa iyonke okufuneka uyihlawule ukuba uyagula (ubuninzi obuphuma epokothweni)

LUNGELE UKUBHALISA

IZINTO EZINHLANU ENINOKUZENZA UKUZE ULUNGELE UKUBHALISA

  1. Dibana nomqhubi wenqanawa wasekhaya Okanye u tyelele ImpiloYabantu.gov. Funda kabanzi malunga neMarike ye-Inshurensi yezeMpilo, kunye nezinye iinkqubo ezifana neMedicaid, kunye neNkqubo ye-Inshurensi yezeMpilo yaBantwana (CHIP).
  2. Buza umqeshi wakho ukuba ibonelela nge-inshurensi yezempilo. Ukuba umqeshi wakho akaboneleli nge-inshurensi yezempilo, unokufumana i-inshorensi ngeMarike okanye eminye imithombo.
  3. Yenza uluhlu lwemibuzo phambi kokuba kufike ixesha lokukhetha isicwangciso sakho sempilo. Umzekelo, "Ngaba ndingahlala nogqirha wam wangoku?" okanye “Ngaba esi sicwangciso siza kuhlawulela iindleko zempilo yam xa ndihamba?”
  4. Qokelela ulwazi olusisiseko malunga nomvuzo wekhaya lakho. Uya kufuna ulwazi lwengeniso kwi-W-2 yakho, i-stubs yokuhlawula, okanye ukubuyiswa kwerhafu.
  5. Misela ibhajethi yakho. Kukho iintlobo ezahlukeneyo zezicwangciso zempilo ukuhlangabezana neemfuno ezahlukeneyo kunye nohlahlo lwabiwo-mali. Kuya kufuneka ufumanise ukuba yimalini na okwaziyo ukuyichitha kwiipremiyamu nyanga nganye, kwaye yimalini ofuna ukuyihlawula ngaphandle kwepokotho yemimiselo okanye iinkonzo zonyango.

1. YIBE PHAMBILI IMPILO YAKHO

  • Ukuhlala usempilweni kubalulekile kuwe nakwintsapho yakho.
  • Gcina impilo enempilo ekhaya, emsebenzini, kunye nasekuhlaleni.
    Fumana uhlolo olucetyiswayo lwezempilo kwaye ulawule iimeko ezingapheliyo.
  • Gcina zonke iinkcukacha zakho zempilo kwindawo enye.

2. UKUQONDA INKONZO YAKHO YEMPILO

  • Jonga isicwangciso sakho se-inshurensi okanye ilizwe
  • Inkqubo ye-Medicaid okanye ye-CHIP ukubona ukuba zeziphi iinkonzo ezigqunyiweyo.
  • Ziqhelanise neendleko zakho (iipremiyamu, iintlawulo, iimali ezitsalwayo, i-inshorensi ehlangeneyo).
  • Wazi umahluko phakathi kwe-intanethi kunye ne-out-of-network.

3. YAZI INDAWO OMAKUYONA UKUNAKEKELA

  • Sebenzisa isebe likaxakeka kwimeko esongela ubomi.
  • Ukhathalelo olusisiseko luyakhethwa xa ingeyongxamiseko.
  • Wazi umahluko phakathi kokhathalelo lokuqala kunye nokhathalelo olungxamisekileyo.

2. UKUQONDA INKONZO YAKHO YEMPILO

  • Jonga isicwangciso sakho se-inshurensi okanye ilizwe
  • Inkqubo ye-Medicaid okanye ye-CHIP ukubona ukuba zeziphi iinkonzo ezigqunyiweyo.
  • Ziqhelanise neendleko zakho (iipremiyamu, iintlawulo, iimali ezitsalwayo, i-inshorensi ehlangeneyo).
  • Wazi umahluko phakathi kwe-intanethi kunye ne-out-of-network.

3. YAZI INDAWO OMAKUYONA UKUNAKEKELA

  • Sebenzisa isebe likaxakeka kwimeko esongela ubomi.
  • Ukhathalelo olusisiseko luyakhethwa xa ingeyongxamiseko.
  • Wazi umahluko phakathi kokhathalelo lokuqala kunye nokhathalelo olungxamisekileyo.

4. FUMANA UMNIKI

  • Buza abantu obathembileyo kunye/okanye wenze uphando kwi-intanethi.
  • Jonga uluhlu lwesicwangciso sakho sababoneleli.
  • Ukuba unikwe umnikezeli, qhagamshelana nesicwangciso sakho ukuba ufuna ukutshintsha
  • Ukuba ubhalisile kwi-Medicaid okanye i-CHIP, qhagamshelana ne-Medicaid yelizwe lakho okanye inkqubo ye-CHIP yoncedo.

5. YENZA IQESHA

  • Chaza ukuba usisigulana esitsha okanye ubulapho ngaphambili.
  • Nika igama lesicwangciso sakho se-inshurensi kwaye ubuze ukuba bayayithatha na i-inshurensi yakho.
  • Baxelele igama lomboneleli ofuna ukumbona kwaye kutheni ufuna idinga.
  • Cela iintsuku okanye amaxesha asebenzayo kuwe.

4. FUMANA UMNIKI

  • Buza abantu obathembileyo kunye/okanye wenze uphando kwi-intanethi.
  • Jonga uluhlu lwesicwangciso sakho sababoneleli.
  • Ukuba unikwe umnikezeli, qhagamshelana nesicwangciso sakho ukuba ufuna ukutshintsha
  • Ukuba ubhalisile kwi-Medicaid okanye i-CHIP, qhagamshelana ne-Medicaid yelizwe lakho okanye inkqubo ye-CHIP yoncedo.

5. YENZA IQESHA

  • Chaza ukuba usisigulana esitsha okanye ubulapho ngaphambili.
  • Nika igama lesicwangciso sakho se-inshurensi kwaye ubuze ukuba bayayithatha na i-inshurensi yakho.
  • Baxelele igama lomboneleli ofuna ukumbona kwaye kutheni ufuna idinga.
  • Cela iintsuku okanye amaxesha asebenzayo kuwe.

6. LULUNGISELELA Utyelelo LWAKHO

  • Yiba nekhadi lakho le-inshurensi kunye nawe.
  • Yazi imbali yempilo yosapho lwakho kwaye wenze uludwe lwawo nawaphi na amayeza owathathayo.
  • Yiza noludwe lwemibuzo nezinto eninokuxoxa ngazo, kwaye nibhale amanqaku ebudeni botyelelo lwakho.
  • Yiza nomntu oza kukunceda ukuba uyayifuna.

7. QAPHELA UKUBA UMniki-nkonzo UKULUNGILE NA

  • Ngaba uye waziva ukhululekile ngomboneleli ombonileyo?
  • Ngaba uye wakwazi ukunxibelelana kunye nokuqonda umnikezeli wakho?
  • Ngaba uye waziva ngathi wena nomboneleli wakho ningenza izigqibo ezifanelekileyo kunye?
  • Khumbula: kulungile ukutshintshela kumboneleli owahlukileyo!

8. AMANYATHELO OKULANDELAYO EMVA KOKWENYWA KWAKHO

  • Landela imiyalelo yomboneleli wakho.
  • Gcwalisa nayiphi na imigqaliselo oyinikiweyo, kwaye uyithathe njengoko uyalelwe.
  • Cwangcisa utyelelo olulandelayo ukuba uyalufuna.
    Hlaziya ingcaciso yakho yeenzuzo kwaye uhlawule amatyala akho onyango.
  • Qhagamshelana nomboneleli wakho, isicwangciso sezempilo, okanye urhulumente Medicaid okanye CHIP arhente nayo nayiphi na imibuzo.

Umthombo: Indlela yakho eya kwiMpilo. Amaziko eMedicaid kunye neeNkonzo zeMedicare. NgoSeptemba 2016.

Ngolwazi oluthe kratya

Eli phepha lixhaswa ngamaZiko eMedicare kunye neeNkonzo zeMedicaid (CMS) yeSebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu (HHS) njengenxalenye yebhaso loncedo lwemali lilonke. $1,200,000 nge-100 yeepesenti exhaswa ngemali yiCMS/HHS. Imixholo yeyombhali (ababhali) kwaye ayimelanga izimvo ezisemthethweni, okanye uqinisekiso, yiCMS/HHS, okanye uRhulumente waseUS.