HMO, PPO, Kana POS? Nzira yekuziva kuti Ndeipi Urongwa Hwakanaka Kwauri.
Uri kutarisana here nekuita sarudzo pamusoro pehupi hurongwa hwehutano hweboka hunosarudza kubva kune waunoshandira? Iwe unogona kunge uine sarudzo yekusarudza imwe yezvirongwa zvitatu zvinotarisirwa kutarisirwa- HMO, PPO, kana POS. Kunyange zvazvo zvose zvezvirongwa izvi zvinopa huwandu hwehutano hwekuchengetedza, mumwe nomumwe aripo anosiyanisa zvinhu mune imwe neimwe yezvirongwa zvakare. Usati waita sarudzo paurongwa hwehutano hwako, unoda kuziva zvipo zveumwe neumwe.
Sarudzo yaunosarudza inofanira kubva pane zvaunoda iwe pachako, mapurogiramu ezvehutano nemafungiro emari.
Health Maintenance Organizations (HMOs)
A Health Management Organisation (HMO) inzira inopa rubatsiro rwakakwana rwezvokurapa pamubhadharo wekubhadharwa kubhadharira vanyori mune imwe nzvimbo yakatarwa. HMO inotsigira kuchengetedzwa kwekudzivirira uye mararamiro ehutano.
Kusarudzwa Kwevadzidzisi veZvivhisi
IHMO inopa kugoverwa kuburikidza navanachiremba vanorapwa nevashandi uye / kana kuti vane kambani navanachiremba, zvipatara nevamwe vezvehutano. Nhengo (varwere) dzinodiwa kuti dziwane rubatsiro kubva kuvarapi vanobatana neHMO. HMO dzakawanda dzinoshanda munzvimbo shoma shoma, dzakadai seguta guru. Iwe unofanirwa kudiwa kurapwa kunze kweHMO nzvimbo yakananga nzvimbo, yaizogoverwa pane imwe nguva chete.
Kunze kwe-Pocket Zvinodhura
HMO inopa kutarisira kwepamusoro pamwedzi wepamusoro kazhinji pasina kubhadhara kana kubhadhara.
Mune dzimwe mhando dzemagadziro, mwero wemwedzi wega wega unobhadharwa, asi vese vanopa mari vanobhadharwa sezvo mabasa anopiwa. IHMO inobhadhara vateresi zvakananga uye, mune dzimwe nguva, vatapi vanogona kutora chikwereti chiduku chekushanyira office.
Kudzora Kwemari
IHMO inotsigira kuchengetedzwa kwekudzivirira uye vanachiremba havana chikonzero chekupa "miedzo" yakawandisa kana kurapwa.
Mune zvimwe zviitiko, vanachiremba nevamwe vashandi vezvechiremba vangagamuchira mabhonasi kana HMO inoshandisa zvinoshandiswa zvine mari. Pakavewo nekusimbisa kuderedza mari kuburikidza nekuita mamwe maitiro pamusoro pekunze kwepakati nekubvuma murwere kuchipatara.
Vatariri vemikova
Nhoroondo, HMO dzakagovera nhengo imwe neimwe "muchengeti wemagedhi," uyo anowanzoita chiremba wekutanga uye zvichida mushandi. Munguva pfupi yapfuura, mamwe maHMO anobvumira nhengo kuti dzitaurirane nevadzidzisi vematareji zvakananga. Uyu muchengeti wemagedhi anogadzira kutarisira kwe inshuwarisi uye anosarudza nguva uye kana munhu akachengetedzwa achifanira kushanyira nyanzvi, anogamuchirwa kuchipatara, nezvimwewo.
PPACA inoda kuti munyori anobvumirwa kusarudza varindi vesuwo.
Kudzivirira Kuchengetedza
HMO inokurudzira kuchengetedza kwekudzivirira iyo inowanzobatanidza kugovera kwakakwana kwekuzvidzivirira uye chimiro chemakemikari.
Mhosva dzeZvirevo
Vose varonga zvirongwa vanobata zvakananga neHMO kuti vabhadharwe pavanenge vabvumirana nemitambo. Mune mamiriro ezvinhu akawanda, HMO inoshandisa mupiro kuitira kuti hapana nzira yekudaidza inokosha. HMO inobhadhara vanotengesa kunze kwevashandi munzira dzakasiyana-siyana dzekutaurirana.
Zvipo Zvokupa Zvokuda (PPOs)
Masangano anopa mupiro anofananidzwa akafanana nehutano hwechirongwa hukuru kunze kwekuti zvibvumirano zvePPO zvine hutano hwakasiyana-siyana hwehutano "vanopihwa zvakanaka" kuwana mari shoma.
Vavengi vacho vanowanzobhadharwa pamari-ye-kushanda. Hurumende imwe neimwe inotungamirira PPOs uye makambani einishuwarenzi ane maPPO akawanda.
Kusarudzwa Kwevadzidzisi veZvivhisi
Sangano rePPO rinobatsira zvakanyanya kufanana nechirongwa chikuru chechiremba. Kune rusununguko rwevanyori vanodikanwa vechiremba, zvipatara, nezvimwewo, asi insureds ine sarudzo yekuenda panze kwenetaneti kuti iwane rubatsiro. Zvisinei, kana bhizinesi iri kunze kwemasitereti, munhu akachengetedzwa anofanirwa kutarisira kukwira kunze kwemari.
Precertification Zvinoda
A PPO inowanzoda kubvumidzwa kubva kuPPO pamberi pekurapwa kwepachipatara, kurapwa kwepanyama, nezvimwewo.
Kunze kwe-Pocket Zvinodhura
Iyo inshurensi ichadzorerazve mari yakatarwa pamwedzi wega wega wega wePPO. Mukuwedzera, zvikwereti, coinsurance, uye zvigadziriswa ndizvo zvinowanzoitika.
Kana bhizinesi ichienda kumubatsiri kunze kwekambani, mari yekutengeserana uye pamwe inobhadharwa uye inobhadharwa ichave yakakwirira kudarika kurapwa mukati mezita rakagamuchirwa revashandi vehutano.
Kudzivirira Kuchengetedza
Mumakore achangobva kupfuura, PPOs iri kuwedzera hutano hwekudzivirira, asi hahuna huwandu hwakajeka sezvo HMO inoronga.
Mhosva dzeZvirevo
Kana vateereji vese vanopa zvipo, vapeji vachapa zvikwereti nePPO. Kana vakapa
ari kunze-kwe-network, iyo inshutiro inogona kunge yakakonzerwa nekutumira chirevo chacho, kunyange zvazvo mupiro angagamuchira mvumo kubva kune inshurenzi kuti akwanise kutora zvakananga.
Point of Service Plans (POS)
A Point-of-Service Plan (POS) yakasanganiswa yeHMO uye PPO. Rudzi rwePOS runonyanya kufanana "HMO yakasununguka," iyo inobvumira nhengo dzeHMO kuti dziende kunze kwehutano hweHMO uye dzizviise pasi pekusimudzira mari yakawanda. Iyo POS isingawaniki ndeye "gatekeeper PPO," iyo inoshanda sePPO, kusanganisira kushandiswa kwevasiri veterevhiri nevamiriri, asi chiremba wekutarisira mukuru anoshanda semuchengeti wegedhi.
Kusarudzwa Kwevadzidzisi veZvivhisi
Chero chero urongwa hwePOS chirongwa, insureds ine sarudzo yekuenda panze network kuti iwane rubatsiro. Zvisinei, kana bhizinesi iri kunze kwemasitereti, munhu akachengetedzwa anofanirwa kutarisira kukwira kunze kwemari. Muchengeti wemagedhi anogona kurega kusvika kune vanyori kunze kwechirongwa.
Precertification Zvinoda
Puro chirongwa chePOS chinowanzoda kubvumidzwa kubva kuPPO pamberi pekurapwa kwepachipatara, kurapwa kwepanyama, nezvimwewo.
Mutengo weVatsigiri
Sekubatanidzwa kweHMOs uye PPOs, vatengi vePOS vanobhadhara mari yemwedzi wepamwedzi kumalungu avo, uyewo zvinyorwa zvishoma pavanoshanyira vanachiremba. Deductibles inogona kushanda, zvichienderana nechirongwa chaicho. Coinsurance inogona kushanda kune ve-network-providers.
Kudzivirira Kuchengetedza
Zvichida kuti POS inosanganisira mamwe mabasa ekuchengetedza, asi ichasiyana nerudzi rwePOS chirongwa.
Mhosva dzeZvirevo
Kana vateereji vese vanopa zvipo, vapeji vachapa zvikwereti nePPO. Kana vatsigiri vari kunze kwe-network, bhizinesi inogona kunge ine mhosva yekuisa chirevo chacho, kunyange zvazvo mupiro angagamuchira mvumo kubva kune inshuwarisi kuti akwanise kutora zvakananga.
COBRA
Kunyange zvazvo COBRA isingakodzeri zvirongwa zvehutano hwakarongeka, kune avo vanoona "chiitiko chakakodzera," COBRA, Consolidated Omnibus Budget Reconciliation Act ya1985 , ichabvumira vashandi nevanozvidzivirira kuti vasarudze nzira yekuenderera mberi boka rimwe chete rezvemari inshuwarisi, pasina uchapupu hwekusagadzikana, kwemwedzi inenge 36.
Zvichienderana nezvinodiwa, chiitiko chinogona kupfuurira kubva pamwedzi 18-36. Zviitiko zvakadaro zvakakodzera ndezvi:
- Kuguma kwebasa, kunze kwekunyadzisa kwakaipa (mwedzi 18).
- Kuderedza mumaawa ekushanda kwevashandi kusvika pakudaro zvokuti haasisiri kukodzera kubhadhara.
- Kurasikirwa kwekugoverwa nomunhu anovimbiswa nekuda kwehutano hwevashandi, kurambana, kuparadzaniswa kwepamutemo, kana kukodzera kwaMedare.
- Kurasikirwa kwekuchengetedzwa kwehutano nevana vanoshandisa (somuenzaniso, kuwana chiyero chakareba)
Kana chiitiko chakakodzera chikaitika, vanhu vanotevera vanofanirwa kubatsirwa vakakodzera kupfuurira kwekugoverana kweboka:
- Mumwe mushandi akavharidzirwa
- Mushandi wevashandi akavharidzirwa
- Vashandi vakavharidzirwa vanovimba nevana
- Kutevera vashandi havakwanisi kupa rutsigiro rwekuenderera mberi kwevashandi vavo:
- Vashandi vane vashandi vashoma makumi maviri
- Machechi
- Hurumende vashandi
Munhu anoshamiswa mushandi angasarudza kupfuurira mberi kwekuvhara pasi pasi peCOBRA munguva yemakumi matanhatu emasikati pakarepo mushure mekupedzisira kwemazuva maviri:
- Zuva iro kugoverwa kwemunhu kunopera, kana
- Zuva iro chirongwa chemugadziri akaudza munhu anokwanisa kubatsirwa wekodzero yemupiriri wekuramba achiendesa mberi
Iyo chirongwa chirongwa chinodikanwa kuzivisa vose vanofanirwa kubhadhara mukati memazuva gumi nemana kubva ruzivo rwechiitiko chakakodzera. Mubhidha ane mazuva makumi matatu ekuzivisa mutongi kana chiitiko chinodiwa chichiitika. Nguva yekusarudzwa kweCOBRA inotanga pamazuva ezvinofanira kuita uye inofanira kupedza mazuva makumi matanhatu kubva panguva iyo muwani anogamuchira ruzivo mutongi.
Uri kufungisisa kuti ndeupi rudzi rweboka rezvehutano hwekurapa kusarudza? Iva nechokwadi chekuita chikoro chako chekuchikoro uye unonzwisisa izvo zvinowanikwa mune rimwe hurongwa.
Kuzivisa: Iyi ruzivo rwakapiwa kwamuri senyanzvi yekutsvaga zvinyorwa chete. Inenge ichitaurirwa pasina kufunga nezvezvinangwa zvekutsvaga, kushivirira kwekuisa mungozi kana mamiriro emari yemumwe muzvinabhizimisi chaiyo uye ingave isina kukodzera kune varairi vese. Basa rekare harisi kuratidza migumisiro yemangwana. Kuisa mari kunosanganisira njodzi dzinosanganisira kurasikirwa kwatinoitwa mukuru. Iyi ruzivo haruna kuitirwa, uye haufaniri kuita, inoumba chikonzero chikuru chekusarudza kwekutsvaga kwekutsvaga iwe waungaita. Nguva dzose bvunzurudza iwe pachako wepamutemo, mutero kana wekurima wekutsvaga wekutsvaga wekutsvaga kwekutsvaga iwe usati waita chero upi zvake wekutsvaga / mutero / nzvimbo / fungiro yekugadzira mari kana zvisarudzo