Kunzwisisa Kunongedzerwa Utano Hwekuita Zvirongwa
Une tsamba dzakawanda kuti uchengetedze, hazvishamisi kuti unogona kuvhiringidzika pamusoro pekuti kusiyana kwakadini pakati pezvirongwa zvehutano hweHMO, PPO, POS uye EPO.
Nzira chaiyo nyore kunzwisisa ndeyokuti mutsauko mukuru mune izvi zvose ndeyekuti zvinogadzirisa sei kana kushandura mitambo yavanoshandisa ndeye. Nekuchinja mune zvekurapa nehutano hwehutano, chirongwa chevatsigiri chinotarisa kuwana nzira dzekudzikisa mari kune ivo pachavo uye kuronga nhengo, inowedzera mambure evatapi, mari inowedzera yakajeka chirongwa.
Ichi ndicho chikonzero kune zvakasiyana siyana, sarudzo yako yehutano inshuwarheni yepurogiramu yemutambo ichaita mutsauko mukudhura uye kuziva nezvezvasarudzo zvingakubatsira iwe kuwana hutano hwehutano hwehutano .
Tichadzokorora zvinhu zvose pamusoro pekutarisirwa kwekuchengetedzwa iwe pano uye kurondedzera hukuru hunokosha humwe humwe hwehutano hwehutano hwehutano hweHMO, PPO, POS uye EPO kuitira kuti iwe unzwisise kusiyana uye kuti zvirongwa zvakasiyana zvekutarisira zvinoshanda sei.
Chii Chinonzi Chirongwa Chekuchengetedza Utano?
Kutungamirirwa Nehutano Hwezvirongwa zviratidzo zvehutano hwehutano hwakabuda mumagumo ekupedzisira ezana remakore rechi20. Kugadziriswa kwehutano hwehutano hunotipa inshuwarisi yehutano kumunhu mumwe nomumwe weboka kana mushandirwi. Iboka racho kana mushandirwi ndiro chirongwa chinotsigira chirongwa chekuchengeta kuchengetedza. Urongwa hwehutano hwehutano hunobatsira huchabatsira vabatsiri (nhengo dzeurongwa) kuburikidza nekuita kuti vawedzere mitero inofadza kana kuregererwa kwehutano yveshuwarisi mabasa kubva muurongwa hwehutano hwehutano hwavo.
Kugadziriswa kwehutano hwehutano hunoita urongwa hwevatsigiri kutaurirana maitiro akaderedzwa evanhu vane mazano vane zvipatara, vatapi vezvokurapa uye vanachiremba, nekubatanidza ivo mumutambo.
Izvo zvinoshandiswa zvinoshandiswa zvinoshandiswa kumadzitateguru ekubhadhara-ku-kushanda kana kubhadharwa kwehutano inshuwarani zvirongwa nokuti vanogovana zvinodhaka zvinodhaka zvinetso zvemari pakati pevamwe vanhu, uye mapurogiramu avo ehushuwarisi uye nhengo dzemutungamiri wekutarisira.
Sezvo mutemo weHMO wakapfuura muna 1973, zvirongwa zvekuchengetedza zvakagadziriswa zvakawanikwa kune vazhinji veAmerica nevekupedzisira kwema80 uye kubva zvino zvakatorwa sehuwandu hwehutano hwehutano hwehutano muUnited States.
Zvirongwa zvehutano hwehutano zvakasiyana zvakasiyana nezvirongwa zvekare zvekuti nhengo dzinowanzofanira kusarudza "chiremba wekuisa rubatsiro" kubva mumatare echiremba anopiwa nechirongwa chinotsigira. Kuva chikamu chekubatanidza kuchapa vashandi zvirongwa kubatsirwa kwekuwana mavhisi kubva kune vanobatana nehutano hwehutano hwepahutano pamitengo yakagadzirirwa inoderedza mari yeurongwa.
Makomborero Evanhu Vanotarisira Utano Zvirongwa: HMO, PPO kana POS
Urongwa hwehutano hwehutano hwehutano hunopa zvipo kune vose vari kuronga zvirongwa nevatsigiri.
- Kutungamirirwa kwehutano hwehutano hwemagariro huri kubatsirwa kubva muhutengo hwakaderedzwa nekuwanika kwakakwana kwehutano hwehutano
- Nhengo dzehutano hwehutano dzinobatsirwa nekuve nekushambadzira kwevatengi
- Ronga Nhengo dzine nguva yakaoma nokuti kana vakashanda nevatengi mumutambo, vanodzivisa kuisa mapepa kubva kumaketani nevatapi vepahutano vane maitiro ekubhadhara. HMO urongwa hunoita kuti izvi zvive nyore.
Mhando dzakasiyana dzeMakachengetwa Utano Hwehupenyu: HMO, PPO, POS, EPO Yakatsanangurwa
Kugadziriswa zvirongwa zvehutano kune imwe nzira yezvirongwa zvehutano hwehutano hwakagara huri hukuru hwemabhadharo ehurumende.
Mumakumi mashoma emakore apfuura, zvirongwa zvehutano hwakagadzirirwa zvakagadziriswa zvakanyanya kufarirwa neshuwarhu yehutano sarudzo sezvo hurongwa hwehutano hwakawedzera. Mhando yeurongwa hwehutungamiri hwaunenge uine huchakutaurira kuti unowana sei rubatsiro rwako rwemishonga saka zvakakosha kudzidza pamusoro pavo uye kuti vanoita sei.
- Health Maintenance Organization (HMO)
- Mutengi Anoda Kuda (PPO)
- Purogiramu Yebasa Rekushandisa (POS)
- Exclusive Provider Organization (EPO)
Utano Hutsva: Kunzwisisa Kusiyanisa Mukutungamirirwa Kwarongwa Purogiramu Ongasarudza
Kune marudzi akasiyana-siyana ehutano inshuwarisi kana Medical Insurance Plans. Zvinosuruvarisa, vanhu vakawanda havatarisiri mune zvekusarudzwa kwehutano hunowanikwa kwavari nokuti dzimwe nguva kusiyana kunoratidzika kwakaoma uye kunogona kukurira. Vanhu vazhinji vanofunga nezvezvinhu zvinokosha zvakadai seducuctible, coinsurance kana kuedza kunzwisisa mazwi ehutano inshuwarisi .
Zvakakosha kunzwisisa kuti chirongwa chako chehutano hwehutano hwehutano chinoshanda sei kuitira kuti uzive kuti kuchinja kwehutano hupi mune zvezvehutano urongwa hwako huchakupa muitiko iwe unoda kuwana chiremba. HMO uye PPO vane zvigaro zvavo asi saka vanoita zvimwe zvirongwa zvakadai seIndemnity Health Insurance Plans , izvo zvisingatarisirwi zvirongwa zveinishuwarenzi yekutarisira. Kunzwisisa kusiyanisa kunogona kubatsira kana iwe uri kuedza kusarudza kana iwe uzvizozvipa iwe pachako pabasa rekambani yebatsiro hurongwa, kana mudzimai wako kana chirongwa chemishonga inshuwarano yehutano . Iwe unogona kudzidza zvakawanda pamusoro pechisarudzo ichi nekuverenga nezvehutano inshuwarisi yaivers kana funga zvakanakira apo iwe uine hutano hwehutano hwehutano hwehuviri hwehutano hwehutano inshuwarhu .
Tsanangudzo yeHMO
A Health Maintenance Organisation, kana HMO, inopa vashandi kana mapoka nzira yekuchengetedza vashandi vavo vose kana kuti nhengo dzehutano hwehutano hwakaderera nekutapudza mari kuburikidza nekutaurirana nevamwe vanachiremba, zvipatara, uye makiriniki. Izvi zvinopa vashandi vanofanira kushandiswa nevashandi nekuda kwemari yakaderedzwa inofanira kupiwa kune yavo yehutano inshuwarano. Mune chirongwa cheHMO, iwe unogona kushanduka zvishoma asi huchave uine zviitiko zvinoreruka zvinoshandiswa kubva pamusangano unotarisira kuisa muzvirevo zvako.
Tsanangudzo yePPO
Mutengi Anofanirwa Sangano, kana PPO, anopa kuderedzwa mari kune nhengo dzinotengeswa kune hurongwa hwehutano hwehutano. Kufanana neHMO, asi vashandi kana nhengo dzinogona kusarudza chiremba chavanoda kuwona panzvimbo pekungochengetwa chete nevatapi veHMO. Nhengo inogona kusarudza pakati pemuteereri kana musingabatsiri.
Tsanangudzo yePOS
Ne chirongwa chePoint of Service, kana POS, nhengo dzinogona kusarudza chiremba chavo chave chibvumirana kupa zvivhisi pamutengo usingabhadharwi. MuPOS nhengo yacho inofanira kushandisa chiremba akasarudzwa sepagedhi rokutanga asati atamira kune imwe nyanzvi. Mune mamwe mazwi, pose apo mushandi aine chirwere chekurapa chiremba wePOS anofanira kutanga atanga kuonana nekutanga kuti awane zvakanyanya kubatsirwe nehutano hwehutano hwehutano.
Tsanangudzo ye EPO
NeChirongwa Chekugoverana Chekushandisa, kana EPO, mushandi kana nhengo yeurongwa anogona kusarudza kubva kune avo vanotakura mukati memusangano uye haafaniri kushanda nechiremba wekuchengeta vana. Zvisinei, chero basa chero ripi zvaro rakatorwa kunze kwekambani haringatongorwikwi zvachose.
Kuenzanisa Kwekusiyana kweHMO, PPO, POS, EPO Health Care Plans
Zvirongwa zvine hutano hukuru hunogona kunge huchidhura zvakanyanya nekuda kwekushayikwa kwekutanga kutaurirana nhengo dzesangano zvibvumirano. Kunyange zvazvo zvirongwa zvichipindirana asi nhamba yemapoka, kambani ye inshuwarisi nemamwe mamiriro ezvinhu chaiwo, HMO inowanzova yakanyanya kudhura yezvakachengetedzwa zvinotarisirwa, pamwe nePPO iri pakati pemugwagwa, uye POS inogona kunge inodhura kupfuura HMO , sezvo inopa kuchinja kukuru. Yeuka kuti pane chero mamiriro ezvinhu, kunyanya ne EPO kana ukawana maitiro kunze kwenhare kana nhengo dzezvipatara, iwe unogona kubhadhara mari zvachose kunze kwehomwe. Iwe unofanirwa kushevedza hurongwa hwako usati waona munhu asiri mutezo wemutevedzeri wehutano hwehutano kuti ave nechokwadi chokuti hausi kuzokwira pasi rose bhiri iwe pachako.
Ndeipi Inotungamirirwa Nehutano Hwokugadzirisa Ndiyo Izvo? HMO, PPO, POS kana EPO
Zvose zvirongwa zvekuchengetedza zvakasiyana-siyana zvinowirirana zvikuru muzvikwereti uye pasina mari yekubhadhara mari , saka zvakakosha kudzokorora utano hwehutano hwehutano uye sarudzo yehutano yveshuwarisi nekuchenjera uye edza kuwana mhando yepamutemo yekufananidza mamiriro ako. Kana uchida kuva nechiremba mukuru anotarisira kutarisira kwako HMO zvirongwa zvingave zvauri kutsvaga. Kana iwe ukaona nyanzvi dzakawanda, asi usingadi kugara uchienda kuchiremba wekunyanya kutarisira ipapo PPO urongwa kana POS inogona kushanda zviri nani kwauri. Ramba uchiyeuka kuti nekuda kwekunyanya kushandiswa kwePPO kana zvirongwa zvePOS zvingave zvakasimudza mari yepamusoro uye chero paunenge uchienda kune vezviongorori kana kugamuchira kurapwa kunze kwekambani, iwe uri kubhadhara zvakawanda.
Medicaid uye Kutungamirirwa Nehutano Hwekugadzirira
Sezvo mararamiro ezvehutano uye zvirongwa zvehutano zvakagadziriswa, vamwe vanoti zvino inopa Medicaid Managed Care plans. Iwe unogona kudzidza zvakawanda nezvehurongwa hwako hweMedicaid yehurumende uye iwe unopa sarudzo yekutarisira yakachengetedzwa kuburikidza nekukurukura nehupfumi huri hufisi yehofisi .