Mfundo Zowonjezera Za Inshuwalansi Zaumoyo

Kodi Akuluakulu a Zamankhwala Amafunika Kudziwa Chiyani?

Kumvetsetsa zofunikira za inshuwalansi zaumoyo zimathandiza ogwira ntchito ku ofesi kuntchito kuti alankhulane bwino ndi odwala za inshuwalansi za umoyo wawo ndi kukambirana nawo nkhani za odwala ndi oimira inshuwalansi.

Kukhala ndi chidziwitso chachikulu cha mtundu uliwonse wa inshuwalansi kungachepetse mavuto okhudza kufotokozera malingaliro ndi kusonkhanitsa malipiro. Pali mitundu iwiri ikuluikulu ya mapulani a inshuwalansi:

1. Insurance Insemnity
2. Ndondomeko Zosamalidwa

Insurance Insemnity

Ndondomeko za inshuwalansi zopanda malipiro zimapereka malipiro ku ofesi ya zachipatala pogwiritsa ntchito ndalama zothandizira. Mulipira-kwa-utumiki, ofesi ya zamalonda imalipidwa ndalama zokhazikitsira mtundu uliwonse kapena gawo la utumiki woperekedwa. Maofesi a maofesi, ma test lab, x-ray, kapena ntchito zina zimaperekedwa mogwirizana ndi ndondomeko ya malipiro. Njira yolipira imeneyi imalola ofesi yachipatala kulandira malipiro apamwamba pa gawo lililonse la chisamaliro.

Odwala omwe ali ndi ndondomeko ya malipiro operekera ntchito kuchokera mumthumba ndikufuna kubwezera ndalama zowonjezera kuchokera kwa omwe amapereka chithandizo cha inshuwalansi. Ofesi ya zachipatala imangophatikizapo ntchito zomwe zimafuna chilolezo .

Kuphatikiza apo, ndondomeko zopereka malipiro:

• Mamembala sali a magulu a madokotala
• Palibe kutumizidwa kwa akatswiri oyendera
• Malipiro amapangidwa malinga ndi chizoloŵezi chozoloŵera, chachizolowezi ndi cholingalira (UCR) pazinthu zoperekedwa.

Ndondomeko Zosamalidwa

Sungani dongosolo la chisamaliro kufunafuna kusamalira ndalama za chithandizo chamankhwala kwa mamembala awo mwa kukonza ndi kukonzekera chisamaliro ndi magulu a madokotala, akatswiri, ndi zipatala. Pali njira zinayi zosamalira zosamalira:

1. Mabungwe Omwe Amasamalira Odwala (HMOs)
2. Mabungwe Opereka Othandizira (PPOs)
3. Makampani Odzipereka Okhaokha (EPOs)
4. Mapulani a Point-of-Service (POS)

Kusiyanitsa kwakukulu pakati pa mitundu iyi ya mapulani ochezera osamaliridwa alembedwa pansipa.

1. Mabungwe Omwe Amagwira Ntchito Zaumoyo (HMOs)

Chikhalidwe chomwe chimakhala chodziwika kwambiri ndi mapulani a HMO ndi njira yake yolipira. Misonkho ya mliri, kapena malipiro, ndi malipiro, pamwezi kulipidwa ndi ofesi ya zachipatala kwa wodwalayo. Ndalamayi imakhalabe yofanana mosasamala kuti ndi angati omwe amachezera wodwalayo ali ndi mtengo wa ndalama zomwe amapeza komanso ngakhale atalandira chisamaliro konse. Zizindikiro zina za HMO ndi:

• Ochepa kwa othandizira pa intaneti pokhapokha pazidzidzidzi
• Zowonjezera zimafunika kuti muwone katswiri
• Udindo wam'mbuyomu ndi wofunika kuntchito zina
• Mamembala alibe mapepala osokonekera komanso ochepa

2. Makampani Opereka Othandizira (PPOs)

PPOs ali ofanana ndi njira zowonjezera m'njira zambiri. Mapologalamu onse awiri ndi ndondomeko zopereka malipiro zimalipidwa ndi njira yothandizira. Mulipira-kwa-utumiki, ofesi ya zamalonda imalipidwa ndalama zokhazikitsira mtundu uliwonse kapena gawo la utumiki woperekedwa. Maofesi a maofesi, ma test lab, x-ray, kapena ntchito zina zimaperekedwa mogwirizana ndi ndondomeko ya malipiro. Njira yolipira imeneyi imalola ofesi yachipatala kulandira malipiro apamwamba pa gawo lililonse la chisamaliro. Zizindikiro zina za PPO ndi:

• Omwe amatha-ndi-otuluka pa intaneti amaloledwa, odwala amalipira zochepa pamene ogwiritsira ntchito pa intaneti amagwiritsidwa ntchito
• Palibe kutumizidwa kuti upeze katswiri
• Udindo wam'mbuyomu ndi wofunika kuntchito zina
• Mamembala angakhale ndi udindo wopereka ndalama, ndalama zothandizira ndalama komanso ndalama zothandizira ndalama

3. Makampani Omwe Amapereka Zokha (EPOs)

Ma EPO ali ofanana koma oletsedwa kuposa PPOs.

• Ochepa kwa othandizira pa intaneti pokhapokha pazidzidzidzi
• Palibe kutumizidwa kuti upeze katswiri
• Udindo wam'mbuyomu ndi wofunika kuntchito zina
• Mamembala angakhale ndi udindo wopereka ndalama, ndalama zothandizira ndalama komanso ndalama zothandizira ndalama

Mapulani a Point-of-Service (POS)

Mapulani a POS ndi mtanda pakati pa mapulani a PPO ndi mapulani a HMO. Mapulani a POS amapereka ma-service-network-komatu, zina mwa izo zingakhale zochepa, zochepetsedwa kapena zosapezeka.

• Omwe amatha-ndi-otuluka pa intaneti amaloledwa, odwala amalipira zochepa pamene ogwiritsira ntchito pa intaneti amagwiritsidwa ntchito
• Zowonjezera zimafunika kuti muwone katswiri
• Udindo wam'mbuyomu ndi wofunika kuntchito zina
• Mamembala angakhale ndi udindo wopereka ndalama, ndalama zothandizira ndalama komanso ndalama zothandizira ndalama