Lub npe ntawm daim ntawv kho mob ua rau ob lub qhov muag glaze dua thiab lub hlwb mus overload. Tiam sis, nws yog ib daim tseem ceeb ntawm lub puzzle txog koj txoj kev noj qab haus huv. Kev kho mob yuav kim heev, tshwj xeeb tshaj yog thaum nyob nrog ib tug los ntshav disorder. Muaj ntawv kho mob tseem ceeb heev rau lessening tias nyiaj txiag tab kaum. Qhov xwm zoo yog tias koj tsis tau muaj ib tug kws muaj txuj. Muaj kev paub yooj yim thiab paub txog qhov twg mus nrog cov lus nug yog yeej tag nrho koj xav tau.
Ib qhov chaw zoo pib yog muaj ib co fundamental insurance terminology. Nws yog ib hom lingo uas muaj ntau acronyms.
– Qhov no hais txog cov chaw muab kev pab thiab tsev kho mob uas muaj ntawv cog lus nrog ib daim ntawv kho mob los muab kev pab them nqi kho mob rau ib qho kev pom zoo kom them nqi kho mob. Tej nuj nqis uas muaj nyob rau daim ntawv cog lus yuav tsum sau tawm thiab tsis them rau koj.
– Kev Tawm Hauv-Network – Ib qho chaw muab kev pab network/chaw ua hauj lwm/chaw nyob tsis muaj ib daim ntawv cog lus nrog koj daim ntawv kho mob. Qhov no txhais tau tias cov chaw muab kev pab no tsis tas sau tej nuj nqis tsub thiab tej zaum koj yuav tau them cov nqi no. Txoj kev zoo tshaj uas yuav tsum paub yog hais tias ib tug neeg zov me nyuam/lub chaw nyob yog nyob rau hauv los yog tawm hauv network yog kom paub meej tias koj daim ntawv kho mob.
– PPO – Najnpawb Provider Organization npaj. Hom kev pab them nqi no tej zaum yuav them rau cov kev pab thaum mus nrhiav kev pab kho mob hauv-network los yog tawm ntawm-network. Koj yuav tsum tsis txhob xa mus nrhiav kev pab sab nraud ntawm koj lub network. Txawm li ntawd los, nws muaj nws ib cov kev pab cuam nyob hauv lub network. Ib tug neeg zov me nyuam hauv koj lub network yuav tau pom zoo raws li cov sij hawm teem tseg thiab koj tsis tau them ntau tshaj qhov network tso cai.
- Piv txwv li: Koj pom ib tug neeg zov me nyuam hauv-network rau ib qho chaw ua hauj lwm mus ntsib thiab tus nqi yog $150. Koj network tsuas pub $75 rau qhov chaw ua hauj lwm mus xyuas. Yog hais tias koj yuav tsum tau them 20% ntawm qhov chaw ua hauj lwm mus ntsib, koj tsuas yuav tau them $15. Tus neeg zov me nyuam hauv-network yuav tau sau tawm qhov txawv ntawm tus nqi them thiab tus nqi ($75). Txawm li ntawd los, yog hais tias tus neeg zov me nyuam ntawd tsis nyob network thiab raug txim $150 koj yuav tshuav nqi 20% ntawm $150 ($30).
– HMO – Health Maintenance Organization plan. Feem ntau, hom kev pab uas koj yuav tsum tau xaiv ib tug kws kho mob (PCP). Koj tus PCP yog thawj zaug uas hu rau kev kho mob. Koj yuav tau xa ib daim ntawv xa mus rau koj tus PCP mus ntsib tus kws paub hauj lwm los sis koj yuav tsis muaj kev pab them nqi kho mob rau cov kev pab. Lub hom phiaj no feem ntau yuav tsuas them rau cov kev pab uas tau los ntawm cov neeg zov me nyuam uas muaj in-network thiab daim ntawv cog lus nrog lub HMO xwb.
– Paub Txog Qhov Kev Pab Cuam. Cov kev pab them nqi no yog ib hom hybrid. Koj feem ntau yuav tau xaiv ib tug PCP uas yuav yog koj kis ntawm tus kws paub hauj lwm tshwj xeeb. Txawm li ntawd los, koj pcP yuav xa koj mus rau ib tug kws paub hauj lwm tawm ntawm-network tus kws paub hauj lwm thiab koj yuav tsum tau cov kev pab them nqi kho mob. Nco ntsoov tias txawm muaj referrals, kev siv nyiaj kho mob yuav yooj yim dua los ntawm ib tug neeg zov me nyuam tawm-network tus neeg zov me nyuam.
– Qhov Yus Them Yus Rau Kev KhoMob (Deductible Health Plan) – Ib txoj kev npaj uas tsim nyog raws li ib txoj kev npaj HDHP thaum nws muaj ib qho yus them yus uas yus them yus yog hais tias IRS. Rau 2021, cov nyiaj no yog $1,400 rau ib tug neeg los yog $2,800 rau ib tsev neeg. IRS kuj teev tseg rau tag nrho-pocket txwv ($7,000 ib tug neeg thiab $14,000 tsev neeg). Yog hais tias koj muaj ib tug HDHP, koj kuj teeb ib tug account Health Savings Account.
- Kev Txuag Nyiaj (HSA) – Qhov no yog ib tug account uas tso cai rau cov neeg txuag tau nyiaj rau ib lub hauv paus ua ntej yuav siv rau cov nqi kho mob. Tus account no feem ntau teeb ntawm lub sij hawm thaum uas tso cai rau lub koom haum saib xyuas.
– Qhib Sau Npe Xaiv Tsev Kawm Ntawv – Qhov no yog lub sij hawm ib xyoos twg uas koj yuav saib tau cov kev pab them nqi kho mob txawv rau koj thiab kev hloov lub hom phiaj yog hais tias koj xaiv.
– Premium – Qhov no yog qhov nyiaj uas koj yuav them rau lub tuam txhab tuav pov hwm kev noj qab haus haus luam tswv yim (insurance) uas muaj kev pab them nqi kho mob. Feem ntau cov nyiaj them txhua hli thiab yuav ua ntej cov nyiaj ua se tau los. Nws tseem ceeb heev uas yuav tau khaws cov nyiaj hli no txhua hli thaum saib koj daim ntawv kho mob tag nrho cov nqi kho mob.
– Qhov yus them yus – Qhov nyiaj uas koj them uas koj yuav tau them txhua xyoo rau cov kev pab kho mob ua ntej koj lub tuam txhab tuav pov hwm them nws.
- Piv txwv – koj muaj $1,000 uas yus them yus ces koj daim ntawv kho mob yuav them 80% thiab koj them 20% ntawm tsub. Koj yuav tau them tus thawj $1,000 ntawm cov nqi kho mob ua ntej koj daim ntawv kho mob them 80% ntawm tej nuj nqis.
– Tawm Hauv-Pocket Maximum – Los Tau Paub Tias Yog Tsis Tau. Qhov no yog qhov ntau tshaj plaws uas koj yuav tau them txhua xyoo tawm hauv koj lub hnab tshos rau koj cov nqi kho mob. Feem ntau yog koj qhov yus them yus, npib, thiab copays.
- Piv txwv – Koj muaj ib tug $1,000 uas yus them yus rau $3,000 Tawm-Pocket max. Koj twb them tus thawj $1,000, tam sim no koj yuav them 20% ntawm tag nrho tsub kom txog thaum koj twb them tawm $2,000 ntxiv.
– Npib – Qhov no yog qhov feem pua uas koj yuav them rau cov nqi kho mob tom qab koj twb tau ntsib koj qhov yus them yus.
- Piv txwv – Koj daim ntawv kho mob them 80% thiab koj them 20% ntawm ib qho chaw ua hauj lwm mus ntsib xwb. Yog hais tias tus nqi ntawd yog $100, koj cov nyiaj npib yog $20.
– Copayment – Qhov no yog ib qho uas koj tshuav nqi koj tshuav ib yam kev kho mob uas koj tau txais ib yam kev kho mob.
- Piv txwv – Koj muaj $25 copayment uas tshuav rau koj qhov chaw ua hauj lwm mus xyuas; tiam sis yog hais tias koj mus ceev ceev, koj copayment yuav yog $100. Feem ntau cov kev pab them nqi rau koj copayments ntawm koj qhov yus them yus thiab tawm ntawm-hnab tshos, tiam sis tsis yog txhua yam.
Tam sim no tias koj muaj cov ntsiab lus yooj yim nyob rau hauv koj siv, koj yuav npaj txav mus saib ntau hom kev pab them nqi rau koj. Ntxiv mus, peb mam tshawb lwm yam thiab pej xeem tuav pov hwm thiab piav ntxiv txog qhov loj deal yog nyob ib ncig ntawm qhib sau npe.
Lo nrog peb! Me ntsis, peb yuav tau txais los ntawm tag nrho cov yooj yim thiab ntev koj yuav muaj koj toolbox npaj lub sij hawm tom ntej no ib tug neeg theem pem lub npe ntawm daim ntawv kho mob.
Ntxiv thiab, ntawm no yog ib tug illustration zoo kawg thiab ntxiv illustration rau tej lub insurance jargon tham txog saum toj no.
